Experience of Conducting First 50 Stem Cell Transplants at a Tertiary Care Center of Jaipur

Background - Stem cell transplant is a curative modality for many benign and malignant disorders. Our country has a large population of almost 1.34 billion as per estimates in 2018 and one would expect a large proportion of people to be diagnosed with hematological disorders either benign or malignant, and a large sub group of such patients would also require stem cell transplant. However, a wide gap exists between establishing a diagnosis and obtaining standardized treatment. Therefore there is a large need for improving access to stem cell transplant in India.

Objective - We are hereby sharing the experience of conducting 50 successful stem cell transplants at our center, which is a tertiary care center based in the capital city of the state of Rajasthan, which mostly caters to patients belonging to rural areas.

Materials and methods - This is a retrospective analysis of 50 patients of benign and malignant disorders who underwent stem cell transplant at the department of Medical Oncology.

Results - The median age was 42 years (range – 3 – 67 years). In a total of 52 patients, there were 37(71%) male and 15(29%) female patients, and majority of the patients belonged to a rural background with only 20% patients reporting from an urban background. There were 35(67%) were autologous and 17(33%) were allogenic stem cell transplants. Median stem cell dose stem cell dose between 6 x 106 cells per kg. The mean stem cell dose was 7.5 x 106 cells per kg. 2 patients had stem cell dose of less than 1 x 106 therefore their transplant was aborted. In allogenic stem cell transplant majority patients achieved neutrophil engraftment on day +13 and in autologous transplant majority patients achieved neutrophil engraftment on day +10. In allogenic stem cell transplant majority patients achieved platelet engraftment on day +13. In autologous transplant majority patients achieved platelet engraftment on day +11 and +13. The median duration of stay in the BMT(bone marrow transplant) unit was 26 days in autologous stem cell transplants and 40 days in allogenic stem cell transplants. The overall median duration of stay was 28 days.

Discussion and conclusion - From a total of 54 transplants, there were 50 successful transplants, the transplant of 3 patients was aborted due to less stem cell count and one patient of severe aplastic anemia succumbed due to septic shock before completion of stem cell infusion. Our center is a high volume Oncology center with a young stem cell transplant unit which mostly treats patients belonging to rural parts of the state, and majority of these patients are financially compromised. Poor patients of the state suffering from life threatening haematological conditions are given a second chance by subjecting them to allogenic stem cell transplant which is a potentially curative treatment for such diseases, without any financial burden.