BONE MARROW TRANSPLANT PROGRAMME
What are bone marrow transplant and peripheral blood stem cell transplant?
Bone Marrow Transplant and Haematopoietic Stem cell Transplant are non-surgical modes of treatment to cure advanced stages of malignancies as well as non-malignant haematological diseases and multiple other disorders.
As the name suggests, bone marrow transplant and peripheral blood stem cell transplant mean replacing or restoring dysfunctional cells with healthy cells.The diseased cells in your body are first destroyed completely through conditioning therapy, which is inducing high doses of chemotherapy or irradiation.You’ll be then infused with healthy cells that will start multiplying on their own in about 2 to 3 weeks.
What are the different types of Bone Marrow Transplants?
There are three types of Bone Marrow Transplants based on from who the donor cells are harvested
Autologous transplant is when you are receive your own stem cells.
Allogeneic transplants in when you receive cells donated by your sibling or parent. However, an unrelated donor or a person who is not related to you can also give you stem cells for transplant.
Syngeneic transplant is when you are infused with stem cells donated by your identical twin.
What are bone marrow and hematopoietic cells?
Bone marrow is the soft, sponge-like material found inside your bones and contains immature cells known as hematopoietic or blood-forming cells. The Hematopoietic cells keep dividing into more blood-forming cells; and mature into one of three types of blood cells: infection-fighting white blood cells, oxygen-carrying red blood cells and clot-forming platelets.
Though most hematopoietic stem cells are found in the bone marrow, some cells called peripheral blood stem cells are found in your bloodstream. Blood in the umbilical cord also contains hematopoietic cells. Cells from any of these sources can also be used in transplant.
What is conditioning/ Chemotherapy and radiation therapy before bone Marrow Transplant and Peripheral Blood Stem Cell Transplant?
The first step to BMT and PBSCT is destroying the diseased cells from your body through high doses of chemotherapy or radiation called conditioning. At Aster Medcity, we have the most advanced technology for these procedures, including Kerala’s first True Beam Linear Accelerator and dedicated radiotherapy rooms to ensure maximum patient safety. All radiotherapy treatments we provide are based on NCCN (USA) and ESMO (Europe) guidelines.
As cancerous cells divide faster than healthier cells, we can, through conditioning destroy the existing bone marrow cells so that we can infuse healthy, transplanted cells into your body effectively.
What is Donor- Recipient Matching?
Your body is unique and has a set of proteins called human leukocyte-associated (HLA) antigens, on the surface of your body cells. We identify this set of proteins from samples drawn from your blood or buccal swab smears.
We have the expertise and facilities to evaluate bone marrow morphology and immunohistochemistry at our state-of-the-art lab. The other relevant specialised tests include flowcytometry, cytogenetics and molecular genetics.
In most cases, the success of allogeneic transplantation depends on how well the HLA antigens of the donor and recipient’s stem cells. Higher the number of matching HLA antigens, greater are chances of your body accepting the donor’s stem cells.
You are less likely to develop graft-versus-host disease graft-versus-tumour effect post allogeneic transplant: when white blood cells from the donor attack the cells in the patient’s body after the chemotherapy and/or radiation therapy, if the stem cells are closely matched. It is estimated that only 25 to 35 percent of patients have a HLA-matching sibling. The chances of obtaining matching stem cells from an unrelated donor too vary, so finding the right donor is the key to a successful BMT or PBSCT.
How is bone marrow obtained for transplant?
With advance in technology, obtaining cells from a donor or harvesting has become relatively simple. Bone marrow is harvested using needle from the hip or at times breastbone area, after inducing general or local anaesthesia.
The harvested bone marrow is processed to remove blood and bone fragments, combined with a preservative and frozen at sub-zero temperatures to keep the stem cells alive but dormant until required. This technique is known as cryopreservation. We have a cryopreservation unit where we can cryopreserve stem cells for many years.
In order to harvest PBSCs, the donor is given medications to produce and release excess stem cells into the blood stream.
Called apheresis, blood is drawn from the donor and subject to a process that removes only the stem cells. The blood is then returned to the donor and the collected cells, stored in the cryopreservation unit. This usually takes 4 to 6 hours.
We also obtain stem cells from umbilical cord on consent, to treat children and adults. We can cryopreserve these cells or even the entire cord for years.
Donating Cells: What’s the risk?
If you are the bone marrow donor, you might feel tired and lethargic after donating the cells. However you will return to normalcy in a few days or sometimes, in a few weeks. As it is a procedure done under anaesthesia, you might need to do all relevant health checks before donating.
Aphersis, however is easier, except for occasional giddiness, headache and some discomfort caused mainly due to the medicines given for increasing stem cells.
How are healthy, transplanted cells infused?
You will be infused with healthy, transplanted cells in the BMT unit through an IV line – just like you’d be on drips. As there will be no disease -fighting white blood cells and blood-clotting platelets after the conditioning, your susceptibility to infections will be extremely high. You’ll need to be extremely careful so that you don’t contract any infection and follow the doctor’s advise meticulously to avoid any complications.
Since the stem cells used for autologous transplantation should relatively be free of cancer cells, the harvested cells can sometimes be treated before transplantation in a process known as “purging”. This process removes maximum cancer cells from the harvested cells and minimise the chance of reoccurrence.
What happens after the transplant?
The post-conditioning period and 3-4 weeks post infusion are the most crucial for BMT and PBSCT patients as the chances of infection are at an all time high.
Our entire medical team is trained to observe international standards when it comes to hygiene and infection control, so that you are ensured a safe, sterile environment to recuperate.
The stem cells, after entering your bloodstream, travel to the bone marrow and begin to produce new white blood cells, red blood cells, and platelets in a process known as “engraftment.” This usually occurs within about 2 to 4 weeks after the transplantation. Complete recovery of your immune function will take longer - up to several months for autologous transplant and 1 - 2 years for allogeneic or syngeneic transplants. We will evaluate your blood health through various tests including bone marrow aspiration to confirm whether new blood cells are being produced and there’s no relapse.
What are the possible post-transplant complications?
Apart from susceptibility to infection and bleeding, you may experience short-term side effects such as nausea, vomiting, fatigue, loss of appetite, mouth sores, hair loss, and skin reactions.
There are also potential long-term issues that your doctor will explain in detail to you before beginning the treatment.
What is Mini Transplant?
Called a non-myeloablative or reduced-intensity transplant, a mini uses lower, less toxic doses of chemotherapy and/or radiation to prepare you for an allogeneic transplant.
Called a non-myeloablative or reduced-intensity transplant, a mini uses lower, less toxic doses of chemotherapy and/or radiation to prepare you for an allogeneic transplant.
Observership in Paediatric Hemato Oncology & Transplant | Fellowship in Hemato-Oncology & Stem Cell Transplant | DM | DNB | MD | MBBS
Consultant Hematologist, Medical Trust Hospital, Kochi
Hematologist in KCCC, Kuwait’s only tertiary cancer centre
Assistant Professor, Paediatric Hematology, SRMC Chennai
Published Research Articles
Blast crisis CML as initial presentation
Unusual cutaneous fungal infection in acute lymphoblastic leukemia
Secondary AML after osteosarcoma treatment
Proficient in English, Malayalam, Tamil, Hindi
Certification in Anatomic & Clinical (American Board of Pathology)| M.D. in Microbiology (B.J. Medical College, Pune)| Diploma in Clinical Pathology
(Armed Forces Medical College, Pune)| MBBS (Armed Forces Medical College, Pune)
Fellowship in Transfusion Medicine, New York Blood Center, New York
Fellowship in Hematology & Blood Banking, Albert Einstein College of Medicine,New York
Resident, Anatomic & Clinical Pathology, Albert Einstein College of Medicine, New York
Postgraduate Student in Microbiology, B.J. Medical College, Pune
Director, Pathology and Laboratory Medicine, Max Healthcare, New Delhi
Head of Department, Pathology and Laboratory Medicine, Amrita Institute of Medical Science, Kochi
Lecturer, Pathology and Microbiology, Bharati Vidyapeeth Medical College, Pune
Blood Bank Office, Lokmanya Hospital, Pune
Assistant Pathologist, Sancheti Institute of Orthopedics
Demonstrator, Pathology and Microbiology, Armed forces Medical College, Pune
Set up blood banks for Max Hospitals in Saket and Patparganj, New Delhi
Was responsible for setting up the state-of-the-art laboratories and Blood Bank/ Transfusion Medicine Department at AIMS, Kochi, in its starting phase.
Frequently invited by hospitals and medical societies in Kerala to make presentations on Transfusion Medicine
Published Research articles in International Medical Journals
He is also an expert at managing recurrent ascites and pleural effusions with indwelling catheter.
PG Diploma Medicine - Palliative Care (Edith Cowan University, Perth, Australia) | MD in Anaesthesia (Govt. Medical College, Baroda) | MBBS (Govt. Medical College, Thrissur)
Expertise in interventions like:
Trigeminal Nerve Block
Occipital Nerve Block
Stellate Ganglion Block
Thoracic Splanchnic Block (Coeliac Plexus Block)
Chemical Lumbar Sympathectomy
Hypogastric Plexus Block
Ganglion Impar Block
Cervical & Lumbar Epidural Steroid Injection
Transforaminal Epidural Steroid Injection
Facet Joint Block
RFA of Facet / Median branch of Dorsal Nerve
Pulsed RF for Shoulder Pain and Knee pain
Dry Needling or IMS for the Myofascial Trigger points
Clinical Professor in Anaesthesia & Head of the Division of Pain & Palliative Medicine
Pain and palliative care department, Kasturba Medical College Manipal
In charge of Pain and Palliative care clinic, Amala Cancer Hospital
In charge of Pain & Palliative Care Clinic, West Fort Hi Tech Hospital Thrissur
Part of the Comprehensive Cancer Care Team, which aims at bettering the quality of life of cancer patients
Published research articles
Proficient in Malayalam, English, Hindi, Gujarati, Kannada
FIACTA (HON) | FTEE (HON)| MS (Baroda Medical College)| MBBS (Govt. Medical College, Thiruvananthapuram)
Associate Professor, Sree Chithira Thirunal Institute of Medical Sciences, Thiruvananthapuram
Professor and Head of Department, Anaesthesia and Critical Care, AIMS, Kochi
22 years of teaching experience
Examiner for MD anesthesia
Examiner for DNB anesthesia
Examiner for fellowship in cardiac anesthesia
Teacher in Transoesophageal Echocardiography
Published 46 Research articles in International and Indian Journals
Proficient in English, Malayalam, Hindi, Gujarati and Tamil
Dr. Anup R Warrier is Consultant, Department of Infectious Diseases & Hospital Infection Control. A Physician with over 9 years of experience and specialised training in management of infectious diseases and infections in hospitals, his special interests are Tropical Infections, Fever of Unknown Etiology evaluation, infections in the ICU & HIV Medicine, Antimicrobial Stewardship and cost – effective, evidence based infection Control.
DNB in General Medicine | Fellowship in Infectious Diseases (P D Hinduja Hospital,Mumbai) | Board Certified in Infection Control, Certification in Travel Health, European Diploma in Surgical Infections (SIS-Europe)| MBBS (Govt. Medical College, Thiruvananthapuram)
Infectious Diseases Specialist, KIMS Hospital, Trivandrum
In-Charge of Infection Control Program at KIMS Hospital, Trivandrum
Specialized training in Infectious Diseases from premier Institutes in India & USA
Close association with the Intensivists helped gain experience in managing infections in the critically ill
Developed the Infection Control Program at KIMS to the effect that international benchmarking could be done in line with INICC
One of the few Physicians in Kerala formally trained and practicing HIV Medicine
Experienced in evaluation & management of prolonged & undiagnosed fevers and also complicated Tropical Infections.
Management of adult immunizations, fever & infections in travelers
Published Research articles
Proficient in English, Malayalam, Hindi and Telugu
Fellowship - Paediatric (Kings College Hospital, London) |Fellowship- Retrieval& Aeromedical Transfer (Children’s Acute Transfer Services, London) | Fellowship - Paediatric & Cardiac Intensive care (Great Ormond Street hospital, London, United Kingdom) | MD in Pediatrics (JJM Medical College, Davangaree| MBBS (Government Medical College, Alappuzha, University of Kerala) |
Previuos faculty in Neonatal and Paediatric Intensive Care at Christian Medical College, Vellore
Trained in triaging, stabilisation and retrieval of critically ill children at CATS, one of the largest specialist Paediatric retrieval services in Europe
Trained in Aeromedical transfer of critically ill children
Trained in highly complex Paediatric medical and surgical emergencies at Great Ormond street hospital for childre, London, one of World’s best Children’s Hospitals
Trained in managing post op cardiac patients and ECMO patients at the Cardiac intensive care unit at Great Ormond street hospital for childre- one of the busiest center of Children’s cardiac surgery in the World and among the biggest ECMO center for children in Europe.
Trained in Post-operative management of Pediatric Liver Transplant patients at King’s College Hospital, London- the biggest center for pediatric liver transplant in the World
Clinical Fellow, Paediatric Liver transplant & Intensive care unit, Kings College Hospital, Denmark hill. London
Senior Clinical Fellow, Paediatric & Cardiac Intensive Care Unit, Great Ormond Street hospital. London
Retrieval Fellow, Children’s Acute Transport Service (CATS), Great Ormond Street Hospital, London
Clinical Fellow, Paediatric Intensive care unit, St Mary’s hospital, Imperial Healthcare trust. London
Assistant professor, Paediatric intensive care unit, Christian Medical college, Vellore
Assistant Professor, Neonatal intensive care unit, Christian Medical College, Vellore
Associate Professor, Neonatal intensive care unit, Pushpagiri Medical College, Thiruvalla
Proficient in English, Malayalam Hindi, Tamil & Kannada
Trained in advanced therapeutic and stereotactic body radiation, she also excels in in Intensity Modulated Radiotherapy (including Volumetric Modulated Arc Therapy), Brachytherapy, Total Skin Electron Therapy (TSET), 3D Conformal Radiotherapy and Conventional Radiotherapy. Well versed in highly advanced Helical Tomotherapy and CyberKnife procedures, Dr. Durgapoorna’s areas of special interest include management of breast and gynaecological malignancies.
Fellowship in Stereotactic Body Radiation Therapy (MD Anderson Cancer Centre, Texas, USA) | MD in Radiotherapy (Kasturba Medical College, Manipal, Karnataka) | MBBS (Govt. Medical College, Calicut)
Worked in the Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi.
Associate Professor, Department Of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi.
Associated with the Fellowship courses in Surgical Oncology, Neuro Oncology, and Head & Neck Oncology at Amrita Institute of Medical Sciences, Kochi.
Travel Grant Recipient - The State of the Art in Radiation Oncology, Biology, Physics by the American Society of Therapeutic Radiation Oncology, San Antonio, Texas, USA.
Faculty- MD / DMRT (Diplomate Medical Radiation Therapy) & DNB (Diplomate National Board) in Radiation Oncology.
Faculty - Radiotherapy for Bachelor of Science (BSc), MRT students, radiotherapy technologists, nurses and technicians.
Well-versed in pain & palliative care.
Published research articles.
Proficient in Malayalam, English, Hindi, Sanskrit, Kannada.
DM in Clinical Hematology (JIPMER, Pondicherry) | MD in Internal Medicine (Govt. Medical College, Calicut) | MBBS (Govt. Medical College, Thrissur)
Trained Undergraduates in JIPMER and Government Medical Colleges (Thrissur & Calicut)
Training in Hematology from CMC Vellore and AIIMS, New Delhi
Attended the ASH Highlight meeting held at Bangkok, Thailand
Proficient in Malayalam, English, Hindi, Tamil
MD in IH & BTM | MBBS
Experience in setting up blood banks in hospitals with strict compliance to international protocols and accreditations including AABB, JCI, NABH and NABL
Knowledge in all technological aspects related to blood banking - blood collection, processing, screening, storage and issue of blood products.
Experience in component therapy, stem cell therapy, apheresis and blood irradiator procedures
Worked in the Oncology & Hematology department at Tricell- Bone Marrow Transplant Centre, Chennai
Proficient in English & Malayalam
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