Mr. P.S. a 50 year old man was diagnosed as case of Acute Myeloid Leukaemia (AML), 2 months back. Patient received induction chemotherapy at reputed hospital in Mumbai. Patient required haematopoietic stem cell transplant as part of ideal treatment. Fortunately, he has HLA matched sister. However, due to his high age and concomitant respiratory problems patient was not fit for conventional bone marrow transplant with high dose chemotherapy (Myeloablative). This issue can now be tackled by choosing reduced dosed of chemotherapy to prevent complication of high dose chemotherapy. The anticancer effect comes from immunologic mechanism called Graft Versus Leukaemia (GVL) effect which controls leukaemia.
At Kokilaben Dhirubhai Ambani Hospital, we not only have excellent infrastructure with HEPA filtered transplant unit but also experienced experts required to handle this new form of technically challenging type of transplant.
Patient came to us in July 2011, for getting this newer type of haematopoietic stem cell transplant called Reduced Intensity Conditioning (RIC) PBSCT. Patient received fludarabine and melphelan based carefully titrated reduced dose conditioning regimen. It was made sure that he is successfully engrafted with new stem cells with out getting excessive side effects of heavy chemotherapy. Donor in this case was sister, who received 4 days of simple and safe G-CSF injections and stem cells were filtered out by aphaeresis procedure. Later these stem cells were infused into the patient on the same day.
Patient engrafted, i.e., got his counts back on day +12 day and platelets on day +15 day.
Patient is discharged after 21 days of stay in HEPA filtered transplant unit. He is now day +55 and doing well. Post transplant on day +30 evaluation shows no cancer and 97% of sister chimerism. Patient will require monitoring of disease, chimerism on completion of 3, 6 and 12 months post transplant. According to reports his immunosuppressant medicine are expertly adjusted keeping balance between toxicity (GVHD) and efficacy (GVL).
At Kokilaben Hospital we have the advanced laboratory facilities to monitor this kind of patients. We also have full support system in form of excellent blood bank and radiation unit essential for successful transplant.
Reduced intensity transplants are very important new forms of transplant needed in many senior patients or patients with some comorbid cardiac or respiratory conditions, who are also suffering from cancers like AML, ALL, CLL, Lymphoma, Myeloma, etc.