Dr. Santanu Sen: Tumour in 1 week old baby

    Naveen(name changed for privacy of patient) was only 1 week old when his doctors told his devastated parents that he has a large tumour in his tummy.

    A lot of detailed tests including ultrasonography and CT scan of his abdomen confirmed the suspicion that he has a neuroblastoma, a tumour that originates from the supra-renal gland on top of the kidneys.

    Further tests and a biopsy of the tumour showed that though the tumour was limited only to the original site with no distal spread (metastasis), it was positive for ‘Myc-N’, a genetic marker which signifies that it was a very aggressive tumour that needs intensive treatment.

    Chemotherapy was started from 1 month of age and he underwent 8 cycles of intensive chemotherapy over the next 3 months and at the age of 5 months had surgery to remove the tumour.

    But even this was not enough as this aggressive tumour needs further high dose therapy followed by stem cell transplantation for its treatment.

    The problem was that at this young age of 6 months and weighing only 6 kg, a transplant was a difficult proposition and very few institutions has the expertise for such a procedure.

    The BMT team at KDAH, which has the significant experience of doing paediatric, transplant was uniquely suited for this difficult task. Dr Santanu Sen, who had extensive experience of paediatric transplants in UK said that the fact that they have a complete multidisciplinary team with full time consultants makes it a safe place for such difficult procedures.

    The first major challenge was collecting the stem cells from the patient for the transplant. A special machine called a cell separator is used to centrifuge and filter out the stem cells from the blood but using it on such a small baby was challenging. This was because almost the entire child blood volume had to be cycled very rapidly and constantly through the machine. In fact the machine had to be primed (filled) with a separate blood unit from a donor prior to use as otherwise the childs own blood volume would have been inadequate to even start the machine. In fact the child blood was cycled through the machine once every 10-15 minutes for 6 hours to get enough stem cells for the transplant.

    The stem cell collection was done in the Paediatric Intensive Care Unit with both the Paediatric and Neonatal Intensive Care Consultants in constant attendance to monitor the baby. In fact, the Paediatric Cardiac Intensivist was at the bedside constantly monitoring the babys heart throughout the procedure to ensure the child safety.

    Successful collection of stem was done with no untoward events and a second collection was again done the next day.

    This was the first time that such a procedure has been done on such a small child in India and internationally, less than five such cases has been reported in the literature.

    The stem cell transplantation was successfully carried out and the child showed signs of recovery within 10 days which also is very early (usual is 14-21 days). In fact the child was discharged in a stable condition on the 18th day after the transplant which also is a record as usually it takes upto 4 weeks before a child is discharged.