Narayana Health reports favourable outcome for amegakaryocytic thrombocytopenia in four-yr-old boy

The child was treated by India’s first haplo-identical stem cell transplant using TCR Alpha/Beta CD 19 depletion technique at the hospital

A four-year-old boy suffering from amegakaryocytic thrombocytopenia evolving into Aplastic Anaemia was successfully treated by India’s first haplo-identical stem cell transplant using TCR Alpha/Beta CD 19 depletion technique at Narayana Health City, Bengaluru.

Kulraj, son of a Sikh Afghan refugee, developed the disease when he was a year old. Dr Sunil Bhat – Senior Consultant and Head Pediatric Hematology, Oncology & Bone Marrow Transplant Unit, Narayana Health City said, “Kulraj came to us in a very bad condition. He lacked a matched related or unrelated donor, was in advanced stage of the disease and was heavily pretreated. We then decided to perform India’s first haplo-identical transplant using TCR Alpha/Beta depletion for this condition. This is an advanced BMT technique for haplo transplants known for potentially better treatment outcomes and has been mostly used to treat certain types of cancer only.”

Kulraj received India’s first haplo-identical stem cell transplant using TCR Alpha/ Beta CD19 depletion technique using his father’s stem cells with a 50 per cent match on November 15, 2014. Dr Bhat reported successful engraftment and stable full donor chimerism and normal blood count 1.5 months after treatment.

“We are proud to have adopted an advanced and new haplo-identical stem cell technique. We are using the technique on several other patients and will be publishing our results soon,” said, Dr Sharat Damodar – HOD & Senior Consultant Hematologist – Bone Marrow Transplant Unit, Narayana Health City.

Currently, residing at Delhi the boy went through various treatment modules for the past two years at different hospitals in Delhi before AIIMS, New Delhi refused treatment to the child on monetary grounds. Kulraj’s father Saajan Singh, filed an IPL in the Delhi High court earlier in 2014 under Article 21 of the Constitution for the State or Central Government to bear the entire cost of the treatment as he could not afford it. After the court ruled in his favour AIIMS declined bone marrow transplant as no matching donor was available to save Kulraj’s life. Dr Devi Shetty – Chairman, Narayana Health then offered treatment to the boy at Narayana Health, Bengaluru free of cost. “It gives me immense pride that the BMT team strived their best in finding a treatment for the little boy. It is the right of every patient walking into the hospital to have access to the best of medical advice, advanced level of treatment and care. It is our long term vision to ensure that Mazumdar-Shaw Cancer Centre at Narayana Health City offers the highest and most advanced level of Therapeutic and Curative treatment for the patients, by the experts.It will also be a constant endeavour to provide such high-end treatments at an affordable cost to patients in need,” Dr Shetty said.

Amegakaryocytic thrombocytopenia is a condition in which platelets are not produced in marrow and patients have life threatening bleeding manifestations. It can evolve into Aplastic Anemia wherein marrow fails to form all the blood components. The symptoms are unexplained infections (due to fewer white blood cells), unexpected bleeding (due to fewer platelets) and fatigue (due to fewer red blood cells). The only curative treatment available for this condition is blood and marrow stem cell transplant. Matched sibling or family donors with matching stem cells are available only in 20 to 30 per cent of the cases and to get a matched unrelated donor is difficult for Indian patients. For the remaining 60-70 per cent patients, half-matched or haplo-identical transplant from a family member is a viable option. Dr Damodar said that India needs more people to come forward and register with the bone marrow registry so that more lives can be saved.