Principal Director and Head, Pediatric Hematology Oncology and Bone Marrow Transplant, Fortis Memorial Research Institute, Gurgaon, India
Part 9 of 14 in BMT in Sickle Cell Anaemia and Other Haematological Disorders
Non-Myeloablative Conditioning: Reducing Infertility Risk in Sickle Cell BMT
August 6, 2026
Non-myeloablative conditioning reduces the toxicity and infertility risk associated with bone marrow transplant for sickle cell disease, while preserving strong cure rates. Dr. Vikas Dua of Fortis Memorial Research Institute, Gurgaon, highlights this approach as one of the meaningful advances in how bone marrow transplant in India is now performed for sickle cell patients.
What Is Conditioning, and Why Does It Matter?
Before a bone marrow transplant, patients receive conditioning, a combination of chemotherapy and sometimes other agents, to prepare the body to accept the donor's stem cells. Dr. Vikas Dua references a 2007 publication showing that a conditioning regimen combining busulfan, cyclophosphamide and ATG achieved cure rates above 90% for sickle cell disease, while omitting ATG led to roughly 30% worse outcomes.
How Non-Myeloablative Conditioning Differs
Non-myeloablative conditioning uses a gentler approach than traditional, fully myeloablative conditioning. Dr. Vikas Dua explains that this results in less overall toxicity to the patient and a reduced risk of infertility, an important consideration given that many sickle cell transplant patients are children and young adults who will want to have families of their own later in life. Importantly, he notes that fertility can be preserved with this approach without sacrificing cure rates.
Why This Matters for Patients Choosing Bone Marrow Transplant in India
India's newer conditioning regimens for bone marrow transplant in India are specifically designed around this balance, reducing infertility risk while maintaining outcomes similar to older, more intensive protocols. For families weighing the long-term impact of a curative transplant, this is a significant reason to discuss non-myeloablative conditioning directly with the treating team when planning sickle cell bone marrow transplant in India.
← Cord Blood Transplant for Sickle Cell Disease: Is It Used in India? | Series index | Cost of Bone Marrow Transplant for Sickle Cell Anaemia in India →
This article is based on a Jivo Masterclass session conducted by Dr. Vikas Dua, Principal Director and Head, Pediatric Hematology Oncology and Bone Marrow Transplant, Fortis Memorial Research Institute, Gurgaon, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass — Dr. Vikas Dua taught doctors across Africa on July 28, 2024.
FROM THE LIVE Q&A
Dr. Paul
Is there a possibility for transplant in prostate cancer, and are there only two donor registry banks in the world?
Dr. Vikas Dua
There is no role of bone marrow transplant in prostate cancer — none, and no research on it either. On registries: the biggest bank is in Germany, the second biggest in the US, but there are many other banks in other parts of the world — there isn't even a single bank in Africa. That's one of the reasons transplants aren't happening in Africa, other than South Africa and some in Benin City, Nigeria. All of you need to come together and have your own registry, so that if somebody requires stem cells, you have your own bank — you people have to come out with the solution.
Frequently Asked Questions
Can the same principles apply in children with cerebral palsy?▼
That's a very good question, but there is no role of bone marrow transplant in cerebral palsy. There are researches going on about whether transplant helps for cerebral palsy, but we don't have an answer in black and white — at the present moment there is no indication for doing a transplant for cerebral palsy.
Is there any age limit for successful bone marrow transplant in sickle cell disease?▼
Sooner is better — it is better to do a transplant early — but we have done transplants even for adults. I showed a picture of a Nigerian person, Mr. Buhari, whose transplant was done at the age of 34, and he's doing well.
How much does the treatment cost, including accommodation, if the patient travels to India, and how long would they stay?▼
For a matched sibling donor transplant, roughly it is around $25,000 for the transplant; for a half-match transplant it is around $35,000. For accommodation and other logistics you need $10,000 more — so roughly $35,000 for a full match and $45,000 for a half match. The stay is around three months.
How do you find HLA compatible donors, and if they have to be found in the family, what criteria are used?▼
We do HLA typing of the patient and siblings — there's a 25 to 30% chance the siblings are a complete match to the patient on HLA. So you need to do HLA typing and you will come to know whether you have a full match in the family or not.
How long exactly are transplant children kept immunosuppressed?▼
Usually after one year we stop all the immunosuppression — only 10 to 15% of patients need it for a longer duration, but in the majority of patients we stop immunosuppression after one year of transplant.
What is conditioning in the context of bone marrow transplant?▼
Conditioning is a combination of chemotherapy and sometimes other agents given before transplant to prepare the body to accept the donor's stem cells.
How important is ATG in the conditioning regimen?▼
ATG is an important component. A 2007 publication found that omitting it from a busulfan and cyclophosphamide regimen led to roughly 30% worse outcomes.
What is the benefit of non-myeloablative conditioning?▼
Non-myeloablative conditioning uses a gentler approach than traditional myeloablative conditioning, resulting in less overall toxicity and a reduced risk of infertility, while maintaining similar cure rates.
Does gentler conditioning reduce the effectiveness of the transplant?▼
No. Fertility can be preserved with non-myeloablative conditioning without sacrificing cure rates, which remain similar to those of older, more intensive protocols.
In This Series: BMT in Sickle Cell Anaemia and Other Haematological Disorders
- 1.Bone Marrow Transplant for Sickle Cell Anaemia
- 2.Why Africa Has No Bone Marrow Donor Registry, and How Haploidentical Transplant Solves It
- 3.What Is the Best Age for Bone Marrow Transplant in Sickle Cell Disease?
- 4.Bone Marrow Transplant for Thalassemia in India
- 5.Cord Blood Transplant for Sickle Cell Disease: Is It Used in India?
- 6.Cost of Bone Marrow Transplant for Sickle Cell Anaemia in India
- 7.HLA Typing and Donor Matching for Bone Marrow Transplant in India
- 8.Matched Sibling vs Haploidentical Transplant for Sickle Cell Disease
- 9.Non-Myeloablative Conditioning: Reducing Infertility Risk in Sickle Cell BMT
- 10.Life After Bone Marrow Transplant: Recovery and Immunosuppression
- 11.Who Needs a Bone Marrow Transplant for Sickle Cell Disease?
- 12.Cure Rates for Sickle Cell Bone Marrow Transplant: What the Data Shows
- 13.Sickle Cell Disease Burden in Africa: Why Bone Marrow Transplant Matters
- 14.What Is Bone Marrow Transplant and How Does It Cure Sickle Cell Anaemia?