Bone Marrow Transplant

 A bone marrow transplant (BMT) is a medical procedure that replaces damaged or destroyed bone marrow with healthy bone marrow stem cells. This treatment is often used for patients suffering from conditions such as leukemia, lymphoma, severe aplastic anemia, and other blood-related disorders.

1.     Understanding Bone Marrow and Its Importance

Bone marrow is a soft, spongy tissue inside bones that produces red blood cells, white blood cells, and platelets. These cells are essential for carrying oxygen, fighting infections, and clotting blood. When bone marrow is damaged or diseased, a transplant can help restore normal function.

2.       Types of Bone Marrow Transplants

There are two main types of BMT:

Autologous Transplant – The patient’s own stem cells are collected before undergoing high-dose chemotherapy or radiation. After treatment, the harvested cells are returned to the body.

Autologous Bone Marrow Transplant (ABMT) is a medical procedure in which a patient’s own stem cells are collected, stored, and then reinfused after intensive chemotherapy or radiation therapy. It is commonly used to treat various cancers, such as lymphoma and multiple myeloma, as well as some autoimmune disorders. Unlike allogeneic transplants, which require a donor, ABMT reduces the risk of rejection and graft-versus-host disease.

The Process of Autologous Bone Marrow Transplant

ABMT is a multi-step process that involves several stages:

1. Stem Cell Collection

• The patient receives medication to stimulate the production of stem cells.Stem cells are collected from the bloodstream using a process called apheresis.The collected cells are frozen and preserved for later use.

2. High-Dose Chemotherapy or Radiation

• The patient undergoes high-dose chemotherapy or radiation therapy to eliminate cancer cells.This intense treatment also destroys the bone marrow, necessitating the reinfusion of stem cells.

3. Stem Cell Infusion

• The preserved stem cells are thawed and infused back into the patient’s bloodstream.The stem cells travel to the bone marrow and begin regenerating new blood cells.

4. Recovery and Monitoring

• The patient is closely monitored for signs of infection and complications.It typically takes a few weeks for the bone marrow to start producing healthy blood cells again.

Benefits of Autologous Bone Marrow Transplant

• Lower Risk of Rejection
• No Need for a Donor Match
• Effective for Certain Cancers

Risks and Challenges

• Infection
• Organ Damage
• Graft Failure

 Allogeneic Transplant – Stem cells are obtained from a donor, usually a close relative or a matched unrelated donor. This type requires careful matching to reduce complications.

Allogeneic transplantation is a crucial medical procedure used to treat various life-threatening conditions, including leukemia, lymphoma, aplastic anemia, and certain genetic disorders. This type of transplant involves transferring stem cells or bone marrow from a genetically matched donor to a recipient whose own marrow has been damaged or destroyed due to disease or medical treatments such as chemotherapy.

What Is an Allogeneic Transplant?

An allogeneic transplant is a type of hematopoietic stem cell transplant (HSCT) where the donor is a different individual from the recipient. Unlike autologous transplants, where the patient’s own cells are used, allogeneic transplants require a donor whose tissue type closely matches the recipient’s to reduce the risk of rejection and complications. Donors can be siblings, other family members, or unrelated individuals found through bone marrow registries.

The Process of Allogeneic Transplantation

1. Donor Matching: The first step in an allogeneic transplant is finding a compatible donor. This is determined through human leukocyte antigen (HLA) typing, which identifies genetic markers crucial for immune system compatibility.
2. Pre-Transplant Conditioning: The recipient undergoes conditioning therapy, which typically includes high-dose chemotherapy and/or radiation. This process eliminates diseased cells and suppresses the immune system to prevent rejection of the new stem cells.
3. Stem Cell Infusion: Healthy stem cells from the donor are collected and then infused into the recipient’s bloodstream through an intravenous (IV) line, similar to a blood transfusion.
4. Engraftment and Recovery: Over the next several weeks, the new stem cells migrate to the bone marrow, where they begin producing healthy blood cells. Close monitoring is essential to manage complications such as infections, graft-versus-host disease (GVHD), and immune suppression.

Potential Risks and Complications

• Graft-Versus-Host Disease (GVHD): This occurs when the donor’s immune cells attack the recipient’s tissues, leading to complications in the skin, liver, and gastrointestinal tract.
• Infections
• Graft Failure

Advantages of Allogeneic Transplant

• Potential Cure for Diseases
• Graft-Versus-Tumor Effect
• Availability of Healthy Cells

The Transplant Process

a. Pre-Transplant Preparation

Patients undergo a series of tests to determine their overall health and compatibility for the procedure. Conditioning therapy, which includes chemotherapy and radiation, is often required to destroy diseased cells and prepare the body for new stem cells.

b. Transplantation

The healthy stem cells are infused into the patient’s bloodstream through an intravenous (IV) line. These cells travel to the bone marrow and start producing new blood cells.

c. Recovery and Monitoring

The post-transplant period is crucial. Patients are monitored for infections, graft-versus-host disease (GVHD) in allogeneic transplants, and other complications. Recovery can take weeks to months, depending on the patient’s condition and response to treatment.

5.Costs of a Bone Marrow Transplant in India

The cost of a BMT in India varies based on the type of transplant, hospital, and the patient’s condition. Generally:

• Autologous transplants: ₹10 to ₹25 lakhs (approximately $12,000 to $30,000 USD)
• Allogeneic transplants: ₹20 to ₹50 lakhs (approximately $25,000 to $60,000 USD) The cost is generally lower in India compared to Western countries, and medical tourism for BMT is common.

6.Success Rates and Advances in BMT

Success rates depend on factors such as the underlying disease, patient’s age, donor compatibility, and overall health. Advances in stem cell therapy, improved donor matching techniques, and supportive care have significantly enhanced outcomes for BMT patients.

Kidney Transplant in India

 India has become a global hub for kidney transplants due to its advanced medical facilities, skilled surgeons, and cost-effectiveness. In this blog, we will cover everything you need to know about kidney transplants in India, from pre-transplant tests to post-transplant care.

 1. Pre-transplant Tests for Kidney Transplant in India

Before undergoing a kidney transplant, several tests are conducted to ensure compatibility and reduce the risk of complications. These include:

• Blood Tests: To determine blood type and tissue compatibility.
• HLA Typing: Human leukocyte antigen typing ensures the donor and recipient’s tissues match.
• Crossmatch Test: Ensures the recipient’s immune system will not attack the donor’s kidney.
• Imaging Tests: CT scans, ultrasounds, or X-rays of the kidneys and bladder.
• General Health Checks: Heart, liver, and lung function assessments to confirm overall health suitability for surgery.

 2. Factors Affecting Kidney Transplant Cost in India

Several factors influence the cost of kidney transplants in India:

• Type of Hospital: Private hospitals tend to be more expensive than government hospitals.
• Location: Metropolitan cities like Delhi, Mumbai, and Bengaluru have higher costs.
• Donor Type: Living donor transplants often cost more than deceased donor transplants.
• Pre- and Post-Surgery Care: Costs of medications, dialysis, and follow-ups.
• Additional Tests: Advanced diagnostic tests can add to the overall expense.

 3. Low-Cost Kidney Transplant in India

India offers some of the most affordable kidney transplant options globally without compromising quality. Patients from countries like the USA, UK, and Middle Eastern nations often choose India for medical tourism. To reduce costs, many hospitals offer packages that include:

• Pre-surgery evaluations
• Surgery charges
• Hospital stay
• Post-operative care and medications

 Kidney Transplant Cost in India

The cost of kidney transplants in India for international patients starts from INR 1,091,000 (USD 13,000) including pre-transplant evaluation, surgery, and other expenses, that’s comparatively lower than the cost for surgery in many other countries.

4. Types of Kidney Transplantation Programs in India

India offers several types of kidney transplantation programs:

A. Related Living Donor Transplant

• The donor is a close blood relative (parent, sibling, child, or spouse).
• These transplants have a higher success rate due to genetic compatibility.

B. Unrelated Living Donor Transplant

• The donor is not a blood relative but has an emotional connection (such as a spouse or close friend).
• Requires additional legal and ethical approvals under the Transplantation of Human Organs Act (THOA) in India.

C. ABO-Incompatible (ABO-i) Kidney Transplant

• The donor and recipient have different blood groups.
• Special medical treatments (like plasmapheresis) are used to reduce the risk of rejection.
• ABO-incompatible transplants expand donor options, especially for patients without a compatible relative.

D. Swap Kidney Transplant (Paired Exchange Transplant)

• Used when a donor and recipient are incompatible.
• Two incompatible donor-recipient pairs exchange kidneys.
• Increases the chances of finding a match without waiting for a deceased donor.

E. Altruistic (Good Samaritan) Kidney Donation

• A person voluntarily donates a kidney to an unknown recipient.
• Less common and requires ethical committee approvals.

 5. What Happens During Kidney Transplant Surgery?

A kidney transplant typically involves the following steps:

1. Preparation: The patient is given anesthesia, and the surgical area is sterilized.
2. Incision: A small incision is made in the lower abdomen.
3. Kidney Placement: The donor kidney is placed in the pelvic region.
4. Connection: Blood vessels and the ureter (tube connecting the kidney to the bladder) are attached to the new kidney.
5. Closure: The incision is closed, and the patient is moved to the recovery room.

The surgery usually takes 3-4 hours.

 6. Risks and Complications of Kidney Transplant Surgery

While kidney transplant surgery is generally safe, there are potential risks:

• Infection
• Bleeding
• Rejection of the new kidney
• Blood clots
• Side effects from immunosuppressive medications
• Long-term complications, such as high blood pressure or diabetes

 7. Kidney Transplant Survival Rate in India

The survival rates for kidney transplants in India are comparable to global standards:

• 1-Year Survival Rate: 95%
• 5-Year Survival Rate: 85%

These rates depend on factors like patient health, donor compatibility, and post-surgical care.

 8. Frequently Asked Questions (FAQ) About Kidney Transplant in India

Q: How long is the wait time for a kidney transplant in India? A: The wait time varies but is typically shorter for living donor transplants compared to deceased donor transplants.

Q: Is a kidney transplant covered by insurance in India? A: Many insurance providers cover kidney transplants, but it’s essential to check specific policy terms.

Q: What is the average recovery time? A: Most patients recover in 6-8 weeks, though it varies based on individual health.

Q: Can foreign nationals get a kidney transplant in India? A: Yes, but they must adhere to Indian legal requirements for organ transplantation.

 9. Best Kidney Transplant Hospitals in India

• Fortis Hospitals (Delhi)
• Medanta - The Medicity (Gurugram)
• Max Super Specialty Hospital (Delhi)

 

CAR-T Cell Therapy

 Chimeric Antigen Receptor T-cell (CAR-T) therapy is a revolutionary advancement in the field of cancer treatment, offering hope to patients with certain types of blood cancers where traditional therapies have failed. By harnessing the power of the immune system, CAR-T therapy provides a targeted and personalized approach to combating cancer.

What is CAR-T Cell Therapy?

Chimeric antigen receptor (CAR) T-cell therapy is a new innovative type of immunotherapy in which patient’s own genetically modified T cells are to target and kill cancer cells. In this therapy, the patient’s T cells, a type of immune cells, are collected and their genetic component is altered in a laboratory which enables them to identify the cancer cell receptors and attack them.

CAR-T cell therapy involves reprogramming a patient’s own T cells, a type of white blood cell, to recognize and attack cancer cells. This process includes:

1. T Cell Collection: T cells are collected from the patient’s blood through a procedure called leukapheresis.
2. Genetic Engineering: In a laboratory, the T cells are genetically modified to express chimeric antigen receptors (CARs) on their surface. These receptors enable the T cells to identify specific proteins found on cancer cells.
3. Expansion: The engineered T cells are multiplied to produce millions of copies.
4. Infusion: The modified T cells are infused back into the patient, where they seek out and destroy cancer cells.

A patient has to undergo an extensive evaluation for determining their eligibility for this therapy as it is a highly specialized treatment.

How Does CAR-T Therapy Work?

The engineered CAR-T cells act as a living drug. When infused back into the patient, they:

• Recognize cancer-specific antigens through the CARs.
• Bind to these antigens and become activated.
• Proliferate and release cytotoxic molecules that kill the cancer cells.

This targeted approach ensures minimal damage to healthy tissues, unlike traditional treatments such as chemotherapy or radiation.

Types of CAR-T Cell Therapy Approved by FDA

There are currently two types of CAR T-cell therapy approved by the Food & Drug Administration (FDA) that can be used for some leukemia cases:

1. KYMRIAH: This CAR T-cell therapy is FDA-approved for patients who have:
• Relapsed or refractory diffuse large B-cell lymphoma (DLBCL) in adults.
• Relapsed or refractory acute lymphoblastic leukemia (ALL) in young adult patients up to the age of 25 years.
2. YESCARTA: This was the first CAR T-cell therapy to be approved by the FDA for adult patients with certain types of B-cell lymphoma. The FDA has also approved the use of this therapy for patients who have the following conditions and either do not respond to or have relapsed following the standard line of treatment for these cancers:
• Diffuse large B-cell lymphoma (DLBCL)
• Primary mediastinal B-cell lymphoma
• High-grade B-cell lymphoma
• DLBCL that results from follicular lymphoma

Steps in the CAR-T Therapy Process

Patients who are approved for CAR T-cell therapy will undergo the following steps:

1. Collection of Cells: A technique called leukapheresis is used to harvest the white blood cells (including T cells) from the patient’s body.
2. Genetic Modification: The collected cells are sent to the manufacturing laboratory, where the T-cells are genetically altered using biotechnology tools to express a specific protein called chimeric antigen receptors (CARs) on their surface. This helps identify the targeted cancer cells.
3. Multiplication of Modified Cells: The genetically modified T cells are allowed to grow in the lab, to increase their number. When a sufficient amount of cells have grown, they are frozen and sent to the Cancer Center. This whole process takes about 2 to 3 weeks to complete.
4. Conditioning Chemotherapy: Patients will receive chemotherapy in the meantime, actually a few days prior to the infusion. This therapy is given to improve the ability of the CAR T-cells to expand and multiply in the body.
5. Infusion of CAR T-cells: Patients receive the CAR T cells as an infusion that goes directly into their bloodstream as a single infusion, similar to the process of a blood transfusion. This requires a hospital stay for 1-2 weeks after the infusion so that the medical team can monitor the patients for any potential side effects.

Cost and Availability of CAR-T Therapy in India

Traditionally, CAR-T cell therapies have been prohibitively expensive, with costs in the United States reaching approximately $400,000 per infusion. However, in India, homegrown CAR-T cell therapies have substantially reduced this financial burden.

The cost can depend on several factors:

• Treatment procedure
• Technology used
• Severity of defect
• Location
• Pre- and aftercare
• Services included

Similarly, the costof chemotherapy in India that lasts over a period of six months is between $2500 to $3500. This includes the session fees and the cost of chemotherapy drugs. However, the same drugs and treatment cost around $28000 to $30000 in the US, eight to nine times more than what it costs in India. The cost can depend on several factors:

• Treatment procedure
• Technology used
• Severity
• Location
• Pre- and aftercare
• Services included

Note: The treatment costs vary from case to case and a specialist review is advised to determine the best procedure/approach for treatment. Several external factors also impact the cost & quality of treatment including the method of treatment, room category, and several other factors. Please contact Lyfboat Care Team for a personalized quote and advise.

 Hospitals Offering CAR-T Cell Therapy in India

Several leading hospitals in India have begun offering CAR-T cell therapy:

• Apollo Hospitals: One of the first private hospital groups in India to successfully complete CAR-T cell therapy, Apollo Cancer Centres provide this treatment across multiple locations.
• Artemis Hospital, Kochi: It has introduced CAR-T cell therapy for blood cancers, marking a significant milestone in the region's medical advancements.
• Tata Memorial Centre, Mumbai: This renowned institution has successfully treated patients with blood cancers such as leukemia and lymphoma using CAR-T cell therapy.

Success and Applications

CAR-T cell therapy has shown remarkable success in treating certain hematologic malignancies, including:

• Acute Lymphoblastic Leukemia (ALL): Particularly in children and young adults.
• Diffuse Large B-Cell Lymphoma (DLBCL): The most common type of non-Hodgkin lymphoma.
• Multiple Myeloma: Approved therapies are demonstrating promising results.

The therapy is continually being researched and expanded to treat other cancers, including solid tumors.

Conclusion

CAR-T cell therapy represents a paradigm shift in cancer treatment, offering a beacon of hope to patients with few alternatives. As research progresses, this innovative therapy has the potential to become more accessible, affordable, and effective, transforming the landscape of oncology.