Bone Marrow is a spongy brown tissue inside the bony cavity which is where all blood cells are formed. Almost all blood cancers arise from bone marrow. Hematopoietic stem cell transplantation or Bone Marrow Transplantation (BMT), as is popularly known, is a potentially life-saving procedure for a number of cancer and non-cancerous deadly diseases. It involves taking out the bone marrow stem (mother) cells from the donor, destruction of the diseased bone marrow of the patient and transfer (transplantation) of the harvested donor stem cells into the patient. During the entire process spanning 3-4 weeks, a highly specialized and devoted set-up with trained professionals is necessary to minimize and combat the numerous risks involved, as the patient temporarily losses the ability to fight infections and even the slightest infection can be lethal.

CIIHO- Central India Institute of Haematology & Oncology is a premier super-speciality hospital located near Lokmat Square at Dhantoli, Nagpur, dedicated to blood disease and cancer patients. It is well-equipped with a Bone Marrow Transplantation Unit, Neutropenic Care ICU, Blood Bank & Apheresis Unit, Hi-tech Laboratory and in-house Pharmacy, indispensible needs for conducting BMTs. Dr. Avinash Pophali, Haematologist & Medical Oncologist, Director of CIIHO, has trained in BMT from Hammersmith Hospital, London and also been awarded specialist certificate in Stem Cell Transplantation by the British Blood Transfusion Society & British Association for Tissue Banking (BBTS/BATB), UK. Dr. Surekha Pophali, Senior Anaesthesiologist, Critical Care & Cancer Pain Specialist, has a vast experience in her field.

Central India- the entire region encompassing Vidarbha, Chattisgarh, Madhya Pradesh and parts of Andhra Pradesh, was so far deprived of this facility and patients requiring BMT had to travel to other parts of the country, in addition to bearing the heavy expenses involved in the procedure itself (12-15 lakh rupees).

CIIHO recently announced the completion of two autologous BMTs performed simultaneously on two patients suffering from multiple myeloma- a cancer of blood cells called plasma cells. The first BMT was performed on a 58 year old male on 2^nd of March 2011 and second BMT was performed on 70 year old male on 3^rd of March 2011. Success of the procedure, as determined by engraftment (indicated by appearance of white blood cells in circulation of the patient), took place on 14^th March 2011 for both of them. Successful performance of two transplants has demonstrated that these complex procedures can be performed in tier-II cities like Nagpur and that too at a much lesser cost (5-6 lakh rupees).

Autologous BMT is the accepted standard of care for multiple myeloma patients all over the world and has been shown to prolong their life expectancy.

Autologous BMT means that the patient’s own stem cells are used for the transplant. These cells can be taken from bone marrow or even from peripheral blood. The method used at CIIHO was taking stem cells from peripheral blood. It involves highly specialized manipulations and obtaining stem cells by a unique machine called Apheresis machine.

Conducting the first ever transplants of central India at CIIHO, Dr. Pophali was fully aware of the possible risks involved and set up the protocols to be followed during the procedure, based on guidelines issued by American & British Societies of Haematology. The staff taking care of the patients during the procedure was imparted training and the BMT units were under vigilant monitoring 24X7. Drs. Avinash and Surekha Pophali were personally involved in the care of both patients.

The procedure of autologous BMTs performed was as follows:

1.    First, patients were selected who were diagnosed with multiple myeloma. These patients had received adequate chemotherapy before taking up for transplantation. Their physical fitness and thorough laboratory assessment along with imaging was satisfactory for such treatment.

2.    The patients were haematologically manipulated to get their stem cells into peripheral blood circulation. Then, with the help of Apheresis machine adequate numbers of stem cells were collected (harvesting). The uniqueness of this technique is that only stem cells are taken out from the donor and remaining blood in the machine is given back to the donor. These stem cells were checked for adequacy of dose by microscopy as well as a specialized method called flow cytometry.

3.    Then, the patients were given high doses of chemotherapy (conditioning) which would lead to complete destruction of their bone marrow- indicated by markedly decreased blood cell counts. Such treatment is highly toxic and will lead to complete destruction of cancer, but also invariably lead to permanent destruction of body’s blood forming capability. Hence, such toxic therapy can only be used if new normal blood stem cells can be infused and made to work in the patient’s body.

4.    The collected stem cells from the patients were transfused back into their body through the central venous line after twenty four hours (transplantation). The patients were nursed in a highly protective environment in specialized BMT unit to avoid life-threatening infections and other complications until the newly transplanted stem cells started functioning and producing blood cells in the patients’ body (engraftment). This took about eleven days in both patients.

5.    During this period, the patients were given freshly prepared home-cooked food, prophylactic and empirical antibiotic cover, white blood cell production stimulating injections, irradiated blood and platelets. The blood components prepared at CIIHO Blood Bank were irradiated at RST Cancer Hospital Nagpur before transfusion, to prevent a deadly complication called graft-vs-host disease.

Because of the high standards of sterility maintained during the procedures, only one patient developed a bout of fever indicating infection, which was treated promptly. Both the patients developed transient episodes of loose motions, indicating mucosal inflammation, which was also taken care of adequately.

Drs. Avinash and Surekha Pophali acknowledge the help rendered by all doctors and staff involved in conducting these successful procedures including Dr. Shantanu Chaudhury, RST Cancer Hospital, Nagpur, Mr. Rajgopal and Mr. Paramjeet, COM.TECH Apheresis and CIIHO nursing staff- Ms. Archana Gunde, Mr. Suraj, Mr. Jaffer, Mr. Ranjit, Mr. Sachin, Ms. Poornima, Ms. Reena, Ms. Sukeshni, CIIHO Blood Bank staff- Ms. Asawari Kher, Ms. Sampada Deopujari, CIIHO Laboratory staff- Mr. Falgun Ramteke, CIIHO Pharmacy incharge- Mr. Hooda and all the blood donors.

CIIHO is fully equipped to conduct this complex and potentially curative procedure of hematopoietic stem cell transplantation and CIIHO’s accomplishment of two successful BMTs is a pioneer effort for the medical community and a light of hope for the deprived patients of Central India: A new beginning in medical treatment in the region.