Haploidentical BMT

Nature shows the way

The saying that ‘nature is the mother of all inventions’ is not without reason. HLA antigens are inherited as a set from each of the parents. A mother nurtures a baby in her womb for 9 months without rejecting it even though the paternal HLA antigens inherited by the baby should cause a rejection. This is nature’s example of development of tolerance and thus, a child and the mother are natural donors for each other in most cases even though they are only half matched in their HLA antigens. Based on the pioneering work by doctors from Italy, BMT from a half matched (Haploidentical) donor from the family was developed.

Why do we need a centre for Haploidentical BMT

There are six private and two state-owned BMT centres in Delhi and NCR and one might query intuitively as to ‘why another one?’. To answer this we need to look at the Indian scenario in the field of BMT. It is estimated that over 30,000 patients per year in our country need a BMT to save their lives and the statistics from Indian Stem Cell Transplant Registry reveals that with over 40 centres across the country, only about 1000 transplants are performed annually. So is our venture just to add a few numbers to the mammoth need of our population? If all the centres performed 4 transplants per month which we are sure they are capable of, the need would be largely met. Then why is that not happening? The answer lies in the fact that BMT is dependent on availability of HLA matched donors from the family. However, this is available to only 20% of the patients by simple law of inheritance. Yet, Europe, USA and Japan meet their needs largely through Volunteer Unrelated Donor Registries which currently boast of 20 million donors. In India, such registries are in their infancy and the chance of finding a match from the foreign registries is less than 10%. More importantly the cost of procuring the blood or marrow products from Europe or USA ranges from 10,000-30,000 USD. Similar transplants can be performed from unrelated cord blood units at a similar cost, but the procedure is more challenging. Everyone has a donor and we are showing the way! In a country where alternate donor BMT is rarely available for patients lacking a matched family donor, Haploidentical BMT seems to be a logical option. However, the lack of expertise and infrastructure halted its development. Dr. Suparno Chakrabarti and Dr. Sarita Jaiswal pioneered the first Haploidentical BMT program in India. Their work and research has been widely presented and published in the last two years. Having performed over 20 such transplants, they wanted to develop this procedure further. Dr. Sarita Jaiswal trained under Prof. Franco Aversa from Italy, who is the pioneer of Haploidentical BMT. Prof Aversa and others have developed a completely new approach to Haploidentical BMT using Clinimacs based depletion of TCRalfabeta and CD19 cells from the stem cell product, which has drastically reduced the rate of complications and mortality experienced earlier. This is a labour intensive technology and carrying out such transplants without the right expertise or infrastructure can be disastrous. The experience at University of Parma under Prof Aversa amazed Dr Sarita as to how well such transplants can be carried out with the right expertise if a supportive infrastructure is provided.

OUR RESEARCH ON HAPLOIDENTICAL BMT:

• Jaiswal S et al.Contrasting Patterns of Alloreactivity Amongst Malignant and Nonmalignant Diseases Receiving Haploidentical PBSC GRAFT and Post-Transplant Cyclophosphamide. (Poster no 473). 2013 BMT tandem meeting.
• Jaiswal S et al. Persistently High GAM Levels Are Associated with Nonrelapse Mortality in HCT Recipients Irrespective of Invasive Aspergillosis: A Prospective Cohort Study. (Poster no 305). 2013 BMT tandem meeting.
• Jaiswal S et al. Second Haploidentical PBSC Transplantation From the Same Donor After Early Relapse without Gvhd in Patients with Acute Leukemia. (Poster no 474). 2013 BMT tandem meeting.
• Jaiswal S et al. Is Haploidentical Family Donor Transplantation The Best Form Of Alternative Donor HCT In Developing Countries? BTG 2013, Hongkong.
• Jaiswal S. Is Haploidentical Family Donor Transplantation The Best Form Of Alternative Donor HCT In Developing Countries? (ORAL PRESENTATION) ESH EBMT TRAINING COURSE ON HCT, ITALY, APRIL 2013.
• Jaiswal S. NK Alloreactive Donor Is Associated With Reduced Relapse In Refractory AML But High Nonrelpase Mortality In Patients With Aplastic Anemia Following T-Replete Haploidentical PBSCT With Post Transplant. 18th Congress of EHA, 2013.
• Jaiswal S et al. Comparable Outcome Of Haploidentical And Matched Sibling Donor Peripheral Blood Stem Cell Transplantation For High Risk Aplastic Anemia. 1st International Workup on Haploidentical Transplantation, 2013.
• Jaiswal S et al. Comparable Outcome Of Haploidentical And Matched Sibling Donor Peripheral Blood Stem Cell Transplantation Following Myeloablative Conditioning For Poor Risk Acute Myeloid Leukemia. 1st International Workup on Haploidentical Transplantation, 2013.
• Jaiswal S. Natural Killer Cells: A New Weapon in The Armamentarium. National Cancer Congress, 2014, DNSH (Dharamshila Narayana Superspeciality hospital), Delhi, 2014.
• Jaiswal S et al. Outcome Of Haploidentical PBSC Transplantation For High Risk Aplastic Anemia With Post-Transplant Cyclophosphamide Is Similar To Matched Sibling PBSCT And Depends On Choice Of Donors: Adverse Effect Of Natural Killer Cell Alloreactivity. 40th Annual Meeting of the European Society for Blood and Marrow Transplantation: April 2014 .Milan, Italy.
• Jaiswal S et al. Comparable Outcome Of Haploidentical And Matched Sibling Donor Peripheral Blood Stem Cell Transplantation Following Myeloablative Conditioning For Poor Risk Acute Myeloid Leukemia. 40th Annual Meeting of the European Society for Blood and Marrow Transplantation: April 2014 .Milan, Italy