Logo of Phnom Penh Post newspaper Phnom Penh Post - Cambodian Thalassemia kids given new lives after Indian help



Cambodian Thalassemia kids given new lives after Indian help

Content image - Phnom Penh Post
Dr Sunil Bhat poses for a photograph with a Cambodian family he successfully treated. Photo supplied

Cambodian Thalassemia kids given new lives after Indian help

With Saturday having celebrated World Marrow Donor Day, Mazumdar Shaw Cancer Centre at Narayana Health City, one of the leading blood and marrow stem cell transplant units in India, highlights the alarming cases of two Cambodian sisters aged nine and 11 – their heroes being an 11-month-old sibling and a half-HLA matched father.

With a bone marrow transplant being the only cure for Thalassemia, it becomes very important to find a matching donor for such treatment.

“It is highly unlikely to find an unrelated donor for Cambodian descent patients as there is no Cambodian donor registry and number of Cambodian donors in other registries are almost negligible”, said c, the head of paediatric oncology, haematology and bone marrow transplants at Mazumdar Shaw Cancer Centre at Narayana Health City. “Chances of a match with other ethnic backgrounds is extremely low.”

It was a huge shock for the couple from Cambodia to have two consecutive children – both girls, suffering from Thalassemia – a potentially lethal disease. Both sisters were diagnosed with Thalassemia major – a disease that requires life-long blood transfusion every few weeks. “Most of the affected patients usually die in the second to fourth decade of life, ” Dr Bhat said.

Fortunately, almost eight years after the second child was born, the family was blessed with a baby boy who did not suffer from Thalassemia. The father, a doctor by profession, had made every possible effort to provide the best care to both his affected daughters.

However, it was getting difficult for him in Cambodia. Giving adequate, safe and effective blood transfusions and managing the complications of iron overload was becoming a challenge to the family. They learned that a bone marrow transplant would be the only cure for the condition.

They began their search for a centre with experience in paediatric bone marrow transplants. Their research led to Narayana Health City in Bengaluru and Dr Bhat, who has remarkable experience in treating complex cases of blood disorders in children. The centre is also known for its innovative techniques in Haplo identical (half-matched) bone marrow transplants.

Affirming that a bone marrow transplant (BMT) is the only cure for many life-threatening diseases, Dr Bhat said: “For more than 100 potentially life-threatening diseases, bone marrow transplant or blood stem cell transplant is the only cure.

‘Bad cells taken out’

These diseases range from cancers such as leukaemia, lymphoma, solid cancers to genetic disorders of blood forming cells and immune system like thalassemia major, sickle cell anaemia, severe immunodeficiency disorders.

With increasing number of haematological disorders, the number of patients requiring a blood stem cell transplant is also increasing. One of the major differences between bone marrow transplant and solid organ transplants like liver and kidney is that in BMT we need to match HLA of the patient and the donor.

The chance of a patient finding a matched donor within a family is only 25 per cent to 30 per cent – this leaves about 70 per cent of patients needing a BMT for the cure of their disease but don’t have a matching donor”.

The younger sister was fortunate her brother was a HLA match who could donate – but he was only 11 months old! Extracting marrow stem cells from a donor who is an infant was a clinical challenge.

The team at Narayana Health City came up with an innovative plan of taking the bone marrow from the donor at two different time points, around four to six weeks apart, in order to have adequate marrow for a transplant.

The transplant was performed in March this year making the 11-month-old infant the youngest donor to have donated bone marrow for his sister. The girl is now completely cured of Thalassemia.

However, her elder sister was not so lucky as she couldn’t get a fully matched donor. Therefore, her transplant was even more challenging. She did not have an HLA matched donor either in the family or anywhere in the world. The next possibility was a Haplo-identical transplant.

Doctors at Mazumdar Shaw Cancer Centre at Narayana Health City decided to use the stem cells of the father who was a half match with the elder daughter. A new technique was used in haplo (half matched) transplant as the donor stem cells were not fully matching the patient.

“Her bad cells were taken out in a procedure called TCR alpha-beta depletion and only the good cells were given to the patient”, explained Dr Bhat. “This avoids the risk of donor cells attacking the patient’s body.”

Although this technique helps in the above mentioned mechanism, it would delay the immune recovery, which would put them at risk of serious infections.

“To address this issue of slow immune recovery, CD45RA depletion is an additional technique recently introduced,” Dr Bhat said. “This helps us to give memory cells, which can fight infections in the patient.”

The transplant using this technique was performed on the elder girl in June this year and she is also now completely cured of her disease.

Narayana Health

MOST VIEWED

  • Kingdom's Covid cluster cases jump to 194

    The Ministry of Health on February 25 confirmed 65 new cases of Covid-19, with 58 linked to the February 20 community transmission. The latest cluster cases include nine Vietnamese nationals, five Cambodians, one each from Korea, Singapore and Japan, with the rest being Chinese. This brings the total number

  • Locations shut, dozens more Covid-19 positive

    The Ministry of Health has closed 23 locations in connection with the February 20 community transmission of Covid-19 and summoned for testing anyone who had direct contact with affected people and places. The number of discovered related infections has risen to 76, including 39 women. In a press release,

  • Cambodia's Covid cluster cases rise to 137

    The Ministry of Health on February 24 recorded 40 more cases of Covid-19, with 38 linked to the February 20 community transmission. Of the 40, two are imported cases involving Chinese passengers. The 38 include two Vietnamese nationals and one Cambodian, with the rest being Chinese. This brings the total cases

  • Covid cluster raises alarm, health bodies urge vigilance

    The Ministry of Health and the World Health Organisation (WHO) in Cambodia have expressed great concern over the February 20 cluster transmission of Covid-19 in the community. Both entities appealed for vigilance and cooperation in curbing further spread of the virus. Ministry spokeswoman Or Vandine said

  • PM confirms third Covid-19 community transmission

    Prime Minister Hun Sen on February 20 announced the Kingdom's third outbreak of Covid-19 community transmission after 32 people tested positive in just over 10 hours. Addressing the public from his residence after an emergency meeting, Hun Sen said: "I dub it February 20 Community Event, in which 32 cases

  • Cambodia's cluster cases jump to 259

    The Ministry of Health on February 27 recorded 26 more cases of Covid-19 linked to the February 20 community transmission, bringing the total to 259 in one week. The 26 include three Vietnamese nationals and one Cambodian, with the rest being Chinese. The ministry noted that five of the Chinese