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, about 80 to 100 ml of cord blood, which is rich in stem cells, is collected from the placental side of the cord and stored in a public or a private bank. Later, if a transplant is needed, that cord blood unit can be used. It can be done for any condition, but in India we do not prefer cord blood transplants because there are quite a number of issues with them, so we prefer an adult donor transplant over a cord blood unit.

Question 2

Is there a role for bone marrow transplant in prostate cancer?

Dr. Vikas Dua · Accepted Answer

There is no role for bone marrow transplant in prostate cancer, and no research on it.

Question 3

Are there only two donor banks in the world, in the USA and Germany? And is the lack of a bank in Africa because there are no specialists there?

Dr. Vikas Dua · Accepted Answer

The biggest registry is in Germany and the second biggest is in the US, but there are many other banks in other parts of the world. In the whole of Africa there is not even a single unrelated donor registry. That is one of the reasons, because transplants are not happening in Africa other than in South Africa, and some in Benin City in Nigeria. All of you need to come together and set up your own registry, so that when someone needs stem cells you have your own bank. You have to come out with the solution.

Question 4

Do you have a donor bank in India?

Dr. Vikas Dua · Accepted Answer

Yes, we have a registry called DATRI.

Question 5

If we refer patients from Nigeria, where there is no transplant registry, will that be a challenge?

Dr. Vikas Dua · Accepted Answer

Yes, it is a serious challenge. If there is no full match donor in the family, the second-best option is an unrelated donor transplant, but without your own registry, the option left for an African patient without a full match in the family is a half-match transplant using the father or mother as donor.

Question 6

What process should be in place when referring patients, so they are not left without a match on arrival? Should the parents travel with them?

Dr. Vikas Dua · Accepted Answer

If a patient has no full match donor in the family or outside it, they can come with their parents. Half of any child's genes come from the father and half from the mother, so each parent is at least a 50% match. This is a haploidentical transplant: we can take the father or mother as the donor and transplant with good outcomes. So yes, the parents should undoubtedly travel with the patient to India.

Question 7

Can the same principles apply in children with cerebral palsy?

Dr. Vikas Dua · Accepted Answer

There is no role for bone marrow transplant in cerebral palsy. Research is ongoing into whether transplant helps in cerebral palsy, but there is no clear answer yet, so at present there is no indication for transplant in cerebral palsy.

Question 8

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 transplant early. But we have transplanted adults as well. One of the patients I showed in the presentation was transplanted at the age of 34 and is doing well.

Question 9

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, the transplant costs roughly $25,000; for a half-match transplant, around $35,000. Accommodation and other logistics need about $10,000 more, so roughly $35,000 in total for a full match and $45,000 for a half match. The stay is about three months.

Question 10

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 the siblings. There is a 25 to 30% chance that a sibling is a complete HLA match to the patient, so HLA typing tells you whether you have a full match in the family or not.

Question 11

How long exactly are transplant children kept immunosuppressed?

Dr. Vikas Dua · Accepted Answer

Usually we stop all immunosuppression after one year. Only 10 to 15% of patients need it for a longer duration; in the majority, immunosuppression is stopped one year after transplant.

Live Discussion with Dr. Vikas Dua