How does Haploidentical bone marrow transplant work for thalassemia patients?

Summary:

Haploidentical stem cell transplant is a transplant that offers an opportunity of transplant for almost all the patients for whom the transplant is indicated. Although it is associated with higher incidence of graft failure, graft versus host disease and non-relapse mortality as compared to matched donor transplant, but recent advances in the field have tried to mitigate these issues and offer haploidentical transplant as a safe and viable option to all the patients regardless of their age or sex. If you are looking for the best bone marrow transplant hospitals in India, then you can find them right here and you don’t even have to go far. You can find some of the best bone marrow transplant doctors in India.  The hospitals in India are quite advanced and have experienced doctors that make the treatment much more effective and efficient for the patients and comfortable for their families by providing the best services. They also make sure that all the needs of the patients are satisfied and fulfilled and ensure the safety of patients at all costs.

Article:

Haploidentical stem cell transplant is a therapy that is potentially curative for a variety of different kinds of blood cancers and genetic diseases.A related donor who shares at least one HLA haplotype with the recipient, with variable sharing of HLA genes on the other haplotype is an HLA-haploidentical donor. Biological parents and children can be potential haplo donors and also each sibling has a 50% chance of sharing at least one haplotype with the recipient which results in more than 90% of patients needing a transplant having a usually readily available haploidentical donor. Also, the cost of stem cell collection is also lower with haplo SCT than cord or MUD transplants. There was the idea that the broad HLA disparity involved in haplo-HSCT would result in a stronger graft-versus-leukaemia effect in comparison with HLA-matched transplants, however, these advantages were marred by higher rates of graft versus host disease (GvHD), graft failure, prolonged immune-suppression, and subsequent higher non-relapse mortality (NRM). The HLA reactive T-cells in haplo transplant may contain some memory T-cells, which make GvHD more difficult to manage and handle.

Commonly, more than one haploidentical donor is available for a given recipient. Final selection among them is guided by multiple factors which include degree of HLA mismatch, the presence of anti-donor antibodies, NK cell alloreactivity, non-inherited maternal or paternal antigens, and age.

Age and sex of the donor is also a factor that is taken into consideration while taking into account other factors as it is very important. Choosing a donor who is less than 30 years of age for haplo SCT is associated with superior transplant outcomes than a donor more than 30 years old and also compared to a female donor, haplo SCT using a male donor is associated with lower NRM and lower GvHD, together with better overall survival (OS).

Relapse rate after any SCT depends on some factors that are disease status at the time of SCT, risk stratification of disease, GvHD prophylaxis used and the type of conditioning. Relapse rate at 1 year was 45% while it was 22% with MA conditioning with Pt-Cy and RIC transplant. With Perugia regimen and mega CD 34 cell dose, relapse rate was 25% at 6 months, varying with 16% in those transplanted in remission versus more than 50% in those transplanted without remission. With the availability of better supportive care, antifungals, and increasing experience with different types of SCT, the outcome of SCT has improved for most patients over the years. This improvement is most marked in the outcomes of haplo SCT. The 5-year survival for children receiving transplantations from haploidentical donors has improved from 19% to 88%, from MUDs has increased from 37% to 61%, and from MSDs has increased from 24% to 70% which is quite an improvement. Blood and Marrow Transplant Clinical Trials Network also compared RIC haplo SCT with double-cord SCT in which conditioning regimen comprised of fludarabine, cyclophosphamide, 200 cGy of TBI with Pt-Cy in haplo arm and the results showed that both types had equivalent neutrophil recovery and 100-day cumulative incidence of Grade II–IV GVHD was 40% after dUCB and 32% after haplo-BMT. NRM and relapse at 1 year were 7% and 45%, respectively after haplo-BMT and 24% and 31% after cord SCT which is an improvement.

Because of the scarcity of randomized controlled trials comparing various alternative donor transplants and MSD, it is quite difficult to predict the best donor for any given patient in the absence of an MSD. Haploidentical SCT scores a point and is a much viable option in being a readily available donor in most cases, with a cheaper collection and improving but acceptable rates of graft failure, GvHD, and NRM. The spectrum of diseases where haplo SCT is utilized is still expanding with response rates and OS improving in almost all conditions and the doctors and researchers are working on improving the success rates even more which is quite an achievement in itself keeping in mind from where it started and how far we have advanced. This shows that with the ongoing research and the acumen of the doctors and researchers there is going to be an improvement in the present condition which is a very good thing indeed.

Conclusion:

Haploid bone marrow transplant in India is cost effective and time-saving and with the technological advancements and India adapting to these advancements, it would be the best idea to have the treatment in India as it would not only save your money but also ensure that you find a donor very easily. There will not be any deficiency in the services as India has the best set of doctors who are highly skilled and experienced and have been offering their services for many years and can provide the treatment specific to the patient which not only saves patient’s time but also ensures the patient’s safety. The doctors in India are highly trained and experts in their fields and can offer the best treatment according to the needs and demands of the patient and that too at a lower cost compared to other countries, thus making India the best option for the bone marrow transplant for patients of all age.