Bone-marrow transplantation is the first clinical application of stem cells. This procedure is used to treat diseases of the haematopoietic system, which are due to defective stem cells. These defects may be inherited as in thallassaemia or acquired as in leukaemia. Bone-marrow transplantation involves ablation of the defective stem cells by high dose chemotherapy or radiation and replacement by healthy stem cells from a HLA matched donor. The concept of bone-marrow transplantation is the direct outcome of experiments by Till and McCulloch in 1961, who demonstrated it in a mouse model. This was followed by the first human bone marrow transplantation by Dr Donnel Thomas at Seath, USA.
Bone marrow transplantation was carried out in India for the first time at the Tata Memorial Hospital in Mumbai in 1982. The transplantation group was headed by Dr Suresh Advani and comprised of physicians and scientists of the cell biology division of the Cancer Research Institute. The first case was a 10-year girl from Pune, who was suffering from acute myeloid leukaemia. Her HLA identical younger brother was the donor of the bone marrow. The transplant was a complete success and the patient was completely cured. Tata Memorial Centre then became the first hospital to establish a bone marrow transplantation unit in India.
Following the trend set by Tata Memorial, two other hospitals in India established bone-marrow transplantation units. They were the Christian Medical College, Vellore, Tamil Nadu and the Cancer Research Unit of the All India Institute of Medical Sciences, New Delhi. The BMT unit of CMC, Vellore, was headed by Dr Mammen Chandy and was established with support from the Department of Biotechnology. The AIIM's unit was headed by Dr Vinod Kochipillai. For many years these were the only bone-marrow transplantation centres in India.
In the last five years many private corporate hospitals have started bone-marrow transplantation. However, compared to the number of bone marrow transplantation done in US, UK, Europe and Japan, it is negligible. Similarly, the number of transplants done using umbilical cord blood is also hopelessly low in India as compared to USA, Europe and China. Though Tata Memorial Centre was the pioneer in the umbilical cord blood stem cell banking and transplantation, there are very few reported cases from India.
Haematopoietic stem cell transplantation using bone-marrow or umbilical cord blood has been shown to be a definitive treatment for several haematopoietic diseases such as leukaemia and anaemia. In India, however, this option is not available readily due to lack of reliable centres and unaffordable cost of bone-marrow transplants.
In US, when a patient is diagnosed as acute Myelogenous Leukaemia, the first option available is transplantation, which has the best chance of bringing about cure. The transplant physician sends a request for an HLA matched marrow to a national database of marrow donors, viz national marrow donor programme (NMDP). In case a mach is not available, NMDP forward the request to NETCHORD, EUROCHORD and ASIACHORD, which are data bases of cryopreserved umbilical cord blood stem cells in public cord blood stem cell banks. This invariably results in getting aN HLA matched marrow suitable for transplantation. Unfortunately, there is no marrow donor database in India. Several attempts were made to set up such a database but in vain, due to lack of effort and financial support. As far as public cord blood stem cell banks are concerned, in spite of several attempts no such bank exists. Therefore, sourcing an HLA-matched stem cell unit is the major hurdle for establishing transplantation.
If stem cell transplantation using bone-marrow / umbilical cord blood has to become established in the way it is in US, Europe and China, it is necessary to create public stem cell banks in India, no matter whether it is funded by the government or privately. For this to happen, the government should lay down a regulatory framework, which is now lacking. Till this happens, stem cell transplantation for haematopoietic and non-haematopoietic tissue regeneration will not thrive in the country.
CryoStemcell (Kar) Pvt Ltd, will establish a world-class allogeneic cord blood stem cell bank at Mumbai, which will hopefully a remedy to this lacuna to some extent.
(The author is with CryoStemcell (Kar) Pvt Ltd, Bangalore).