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Pediatric Hematopoietic Stem Cell Transplantation in India: Status, Challenges and the Way Forward

Based on Dr. K. C. Chaudhuri Oration 2016

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Abstract

Hematopoietic stem cell transplantation (HSCT) refers to therapies that aim to eliminate a patient’s hematopoietic and immune system and replace it with his own (autologous) or someone else’s (allogenic) system. The applications of this therapy are vast and growing, and include several malignant and benign diseases incurable by any other existing modalities. Pediatric patients constitute a minority of HSCT recipients with unique concerns. Despite substantial progress in the last two decades, limitations due to financial, infrastructural, manpower and research constraints act as barriers to fulfilling the large need for pediatric HSCT services in our country. Limited availability of unrelated donors and cord blood units is another constraint. Here in this oration, we discuss the current issues pertaining to pediatric HSCT in India and describe our experience with the same.

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References

  1. Thomas ED, Blume KG. Historical markers in the development of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant J Am Soc Blood Marrow Transplant. 1999;5:341–6.

    Article  CAS  Google Scholar 

  2. Barnes DW, Corp MJ, Loutit JF, Neal FE. Treatment of murine leukaemia with X rays and homologous bone marrow; preliminary communication. Br Med J. 1956;2:626–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Passweg JR, Baldomero H, Peters C, et al. Hematopoietic SCT in Europe: data and trends in 2012 with special consideration of pediatric transplantation. Bone Marrow Transplant. 2014;49:744–50.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lucarelli G, Galimberti M, Polchi P, et al. Marrow transplantation in patients with thalassemia responsive to iron chelation therapy. N Engl J Med. 1993;329:840–4.

    Article  CAS  PubMed  Google Scholar 

  5. O’Brien SG, Guilhot F, Larson RA, et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2003;348:994–1004.

    Article  PubMed  Google Scholar 

  6. Cauvin HE. Cancer researcher in South Africa who falsified data is fired. N Y Times Web. 2000 Mar;11:A16.

    Google Scholar 

  7. Weiss RB, Gill GG, Hudis CA. An on-site audit of the south African trial of high-dose chemotherapy for metastatic breast cancer and associated publications. J Clin Oncol. 2001;19:2771–7.

    CAS  PubMed  Google Scholar 

  8. Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006;354:1813–26.

    Article  CAS  PubMed  Google Scholar 

  9. Chandy M, Srivastava A, Dennison D, Mathews V, George B. Allogeneic bone marrow transplantation in the developing world: experience from a center in India. Bone Marrow Transplant. 2001;27:785–90.

    Article  CAS  PubMed  Google Scholar 

  10. George B, Mathews V, Srivastava A, Chandy M. Infections among allogeneic bone marrow transplant recipients in India. Bone Marrow Transplant. 2004;33:311–5.

    Article  CAS  PubMed  Google Scholar 

  11. Chandy M. Innovative supportive care practices for stem cell transplantation in India. Biol Blood Marrow Transplant. 2009;15:95–8.

    Article  PubMed  Google Scholar 

  12. George B, Mathews V, Viswabandya A, Lakshmi KM, Srivastava A, Chandy M. Allogeneic hematopoietic stem cell transplantation is superior to immunosuppressive therapy in Indian children with aplastic anemia--a single-center analysis of 100 patients. Pediatr Hematol Oncol. 2010;27:122–31.

    Article  CAS  PubMed  Google Scholar 

  13. Yadav SP, Sachdeva A. Pediatric allogeneic stem cell transplantation: experience from the developing world. Pediatr Hematol Oncol. 2014;31:205–6.

    Article  PubMed  Google Scholar 

  14. George B, Mathews V, Lakshmi KM, et al. The use of a fludarabine-based conditioning regimen in patients with severe aplastic anemia--a retrospective analysis from three Indian centers. Clin Transpl. 2013;27:923–9.

    Article  CAS  Google Scholar 

  15. Shah SA, Shah KM, Patel KA, et al. Unrelated umbilical cord blood transplant for children with β-thalassemia major. Indian J Hematol Blood Transfus. 2015;31:9–13.

    Article  PubMed  Google Scholar 

  16. Shah CA, Karanwal A, Desai M, Pandya M, Shah R, Shah R. Hematopoietic stem-cell transplantation in the developing world: experience from a center in western India. J Oncol. 2015;2015:710543.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chandy M. Stem cell transplantation in India. Bone Marrow Transplant. 2008;42:S81–4.

    Article  PubMed  Google Scholar 

  18. Gratwohl A, Passweg J, Baldomero H, Horisberger B, Urbano-Ispizua A; Accreditation Committee of the European Group for Blood and Marrow Transplantation (EBMT). Economics, health care systems and utilization of haematopoietic stem cell transplants in Europe. Br J Haematol. 2002;117:451–68.

  19. Mitchell JM, Meehan KR, Kong J, Schulman KA. Access to bone marrow transplantation for leukemia and lymphoma: the role of sociodemographic factors. J Clin Oncol. 1997;15:2644–51.

    CAS  PubMed  Google Scholar 

  20. The six most expensive medical procedures as of 2015 | Finance | Healthcare Global [Internet]. Available at: http://www.healthcareglobal.com/financeinsurance/2077/The-six-most-expensive-medical-procedures-as-of-2015. Accessed on 19th June 2016.

  21. Philip C, George B, Ganapule A, et al. Acute myeloid leukaemia: challenges and real world data from India. Br J Haematol. 2015;170:110–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sharma SK, Choudhary D, Gupta N, et al. Cost of hematopoietic stem cell transplantation in India. Mediterr J Hematol Infect Dis. 2014;6:e2014046.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Shukla R. How India earns, spends and saves: unmasking the real India. Sage India; 2010. p. 232.

  24. Kumar R, Naithani R, Mishra P, et al. Allogeneic hematopoietic SCT performed in non-HEPA filter rooms: initial experience from a single center in India. Bone Marrow Transplant. 2009;43:115–9.

    Article  CAS  PubMed  Google Scholar 

  25. Kayal S, Sharma A, Iqbal S, Tejomurtula T, Cyriac SL, Raina V. High-dose chemotherapy and autologous stem cell transplantation in multiple myeloma: a single institution experience at all India Institute of Medical Sciences, New Delhi, using non-cryopreserved peripheral blood stem cells. Clin Lymphoma Myeloma Leuk. 2014;14:140–7.

    Article  PubMed  Google Scholar 

  26. López-Otero A, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. A simplified method for stem cell autografting in multiple myeloma: a single institution experience. Bone Marrow Transplant. 2009;44:715–9.

    Article  PubMed  Google Scholar 

  27. Arora RS, Bakhshi S. Indian pediatric oncology group (InPOG) – collaborative research in India comes of age. Pediatr Hematol Oncol J. 2016;1:13–7.

    Article  Google Scholar 

  28. Kekre N, Antin JH. Hematopoietic stem cell transplantation donor sources in the twenty-first century: choosing the ideal donor when a perfect match does not exist. Blood. 2014;124:334–43.

    Article  CAS  PubMed  Google Scholar 

  29. Switzer GE, Bruce JG, Myaskovsky L, et al. Race and ethnicity in decisions about unrelated hematopoietic stem cell donation. Blood. 2013;121:1469–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. DATRI Blood Stem Cell Donors Registry [Internet]. DATRI. Available at: http://datri.org/. Accessed on 19th June 2016.

  31. India’s first bone marrow registry matches 9 donors to transplant seekers [Internet]. http://www.hindustantimes.com/. 2015. Available at: http://www.hindustantimes.com/mumbai/india-s-first-bone-marrow-registry-matches-9-donors-to-transplant-seekers/story-KoPS0LjwmiBa20DdbUo4gL.html. Accessed on 19th June 2016.

  32. Kanga U, Panigrahi A, Kumar S, Mehra NK. Asian Indian donor marrow registry: all India Institute of Medical Sciences experience. Transplant Proc. 2007;39:719–20.

    Article  CAS  PubMed  Google Scholar 

  33. Gene Bandhu Homepage - Gene Bandhu [Internet]. Available at: http://genebandhu.in/. Accessed on 30th June 2016.

  34. Maiers M, Halagan M, Joshi S, et al. HLA match likelihoods for Indian patients seeking unrelated donor transplantation grafts: a population-based study. Lancet Haematol. 2014;1:e57–63.

    Article  PubMed  Google Scholar 

  35. Bahl A, Bakhshi S. Umbilical cord blood transplant for malignancies: a hope or hype. Indian J Pediatr. 2013;80:675–80.

    Article  PubMed  Google Scholar 

  36. Ballen KK, Gluckman E, Broxmeyer HE. Umbilical cord blood transplantation: the first 25 years and beyond. Blood. 2013;122:491–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. McKenna D, Sheth J. Umbilical cord blood: current status & promise for the future. Indian J Med Res. 2011;134:261–9.

    PubMed  PubMed Central  Google Scholar 

  38. Thornley I, Eapen M, Sung L, Lee SJ, Davies SM, Joffe S. Private cord blood banking: experiences and views of pediatric hematopoietic cell transplantation physicians. Pediatrics. 2009;123:1011–7.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Armson BA. Maternal/fetal medicine committee, Society of Obstetricians and Gynaecologists of Canada. Umbilical cord blood banking: implications for perinatal care providers. J Obstet Gynaecol Can. 2005;27:263–90.

    Article  PubMed  Google Scholar 

  40. American Academy of Pediatrics Section on Hematology/Oncology, American Academy of Pediatrics Section on Allergy/Immunology, Lubin BH, Shearer WT. Cord blood banking for potential future transplantation. Pediatrics. 2007;119:165–70.

  41. Tichelli A, Rovó A. Fertility issues following hematopoietic stem cell transplantation. Expert Rev Hematol. 2013;6:375–88.

    Article  CAS  PubMed  Google Scholar 

  42. Porada CD, Atala AJ, Almeida-Porada G. The hematopoietic system in the context of regenerative medicine. Methods San Diego Calif. 2016;99:44–61.

    Article  CAS  Google Scholar 

  43. Margini C, Vukotic R, Brodosi L, Bernardi M, Andreone P. Bone marrow derived stem cells for the treatment of end-stage liver disease. World J Gastroenterol. 2014;20:9098–105.

    PubMed  PubMed Central  Google Scholar 

  44. Currò D, Mancardi G. Autologous hematopoietic stem cell transplantation in multiple sclerosis: 20 years of experience. Neurol Sci. 2016;37:857–65.

    Article  PubMed  Google Scholar 

  45. van Laar JM, Sullivan K. Stem cell transplantation in systemic sclerosis. Curr Opin Rheumatol. 2013;25:719–25.

    Article  PubMed  Google Scholar 

  46. Rebeiro P, Moore J. The role of autologous haemopoietic stem cell transplantation in the treatment of autoimmune disorders. Intern Med J. 2016;46:17–28.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Sameer Bakhshi.

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Gupta, V.G., Bakhshi, S. Pediatric Hematopoietic Stem Cell Transplantation in India: Status, Challenges and the Way Forward. Indian J Pediatr 84, 36–41 (2017). https://doi.org/10.1007/s12098-016-2253-5

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