Question 1

What is the umbilical cord transplant about, and is it done for all babies or just sickle cell patients?

Dr. Vikas Dua · Accepted Answer

When a newborn baby is born, from the placental side of the cord, 25 ml of stem cells are collected and go to a public bank or a private bank, and later, if you want to do a transplant, you can use that unit. You can do it for any condition, but in India we don't prefer cord blood transplants because there are quite a number of issues with them — that's why we prefer adult donor transplants over a cord blood unit.

Question 2

Is there a possibility for transplant in prostate cancer, and are there only two donor registry banks in the world?

Dr. Vikas Dua · Accepted Answer

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.

Question 3

Can the same principles apply in children with cerebral palsy?

Dr. Vikas Dua · Accepted Answer

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.

Question 4

Is there any age limit for successful bone marrow transplant in sickle cell disease?

Dr. Vikas Dua · Accepted Answer

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.

Question 5

How much does the treatment cost, including accommodation, if the patient travels to India, and how long would they stay?

Dr. Vikas Dua · Accepted Answer

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.

Question 6

How do you find HLA compatible donors, and if they have to be found in the family, what criteria are used?

Dr. Vikas Dua · Accepted Answer

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.

Question 7

How long exactly are transplant children kept immunosuppressed?

Dr. Vikas Dua · Accepted Answer

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.

BMT in Sickle Cell Anaemia and Other Haematological Disorders

Questions Doctors Asked Dr. Vikas Dua