BMT in Thalassemia

What do parents feel when a doctor tells them that their 6-month old baby will need blood transfusions for the rest of her life? How do they manage their life and can they ever come to terms with a disease which would burden their baby forever?

Thalassemia is a disease which affects the production of blood. It runs in the family although the parents of affected children are seemingly normal. Such parents are said to have thalassemia minor. Their children however, have a 1 in 4 chance of suffering from a severe form of the disease called thalassemia major.

These children have a very low hemoglobin level. This can prove to be life-threatening if they are not given regular blood transfusions, every 2-3 weeks. After all, these children are unable to produce the normal hemoglobin HbA. Due to repeated transfusions iron builds up in the bodies of these children. This can easily be tested by checking the ferritin level in the blood. If the ferritin is more than 1000 ng/ml then we need to give medicines to decrease the level of iron in the body. However, not many children receive proper treatment and hence iron continues to build up in their bodies. This increased iron gets deposited in various organs of the body. By the time these children grow to be 20 or 30 years old their organs get damaged. The liver gets enlarged, the heart develops weaknesses and the body doesn’t grow either.

This can be prevented if the child is given medicines, called chelators. These medicines have to started early in childhood. They have to be given in proper doses and the ferritin needs to be checked frequently to ensure that the iron levels are not building up in the body. Once the organs of a patient’s body have started getting damaged it becomes very difficult and sometimes impossible to reverse this.

Bone marrow transplantation (BMT) is one treatment option for thalassemia. Best results from BMT can be obtained if it is done while the child is still young and while the body has not had too much damage due to iron overload. To do a BMT we need a donor who is HLA (human leukocyte antigen) matched with the patient. The chance that a brother or sister will have a complete HLA match with the patient is 1 in 4, i.e. 25-30%. While only 2-4% of parents will have a complete HLA match with a patient.

If an HLA-matched relative is present then they can donate stem cells from their bone marrow to the patient. These stem cells can then produce a new bone marrow and hence normal or near-normal blood. If the transplant is done early in life then about 80% of patients can be cured of thalassemia. The wonderful thing is that donors seldom ever have a problem during donation. Their bodies just produces new bone marrow! Thus BMT is an important treatment option for thalassemia in our country.

Dr. Sachin Jadhav, 

Consultant Haemotologist and BMT, 

BGS Global Hospitals, Bagalore
India

 

What is blood cancer?

Blood cancer is also called as leukemia. This is a disease which unfortunately, is not very rare. Within a population of 1,00,000 about 2-5 individuals will get blood cancer every year. In fact, there is some suggestion that the frequency of blood cancer might be increasing in the community.

There are many different types of leukemias and they are seen in people of all age groups. However, one type called acute lymphoblastic leukemia (ALL) is more common in children. There are several other types such as acute meyloid leukemia (AML) which are commoner in adults.

Our bone marrow is present in the bones. This is the factory where blood cells are normally made. There are three different kinds of blood cells; red blood cells (RBCs), white blood cells (WBCs) and platelets. 

Blood cancer arises when one of the normal stem cells in the marrow becomes cancerous. A cancer cell multiplies uncontrollably to form billions of leukemia cells. These are called blasts. These blast cells spread throughout the bone marrow and soon start circulating in the blood. 

The rapidly growing cancer cells replace the normal bone marrow. Due to this the marrow is not able to produce any normal RBCs, WBCs or platelets.  Patients soon develop problems from the deficiency of these normal blood cells.

These symptoms of blood cancer are:

• Low RBCs, which lead to low hemoglobin and hence symptoms of anemia, such as fatigue and inability to carry out routine daily activities.
• Low WBC, which are the soldiers of our body, lead to infections. Infections commonly occur in the lungs, causing pneumonia.
• Low platelets could lead to bleeding from the gums, urine, bowels and also the skin.

What are the problems with blood donation?

After donating blood some people may have giddiness. But this goes away in a short period of time. The doctors who are conducting the blood donation will check the donor for fitness. If the donor is healthy there are usually no problems. Blood can be safely donated every 3-6 months. I myself donate blood every 3 months and it gives me a lot of satisfaction to do so. So happy donatin

Milestones

• 1816 new Cancer patients registered from January 1st 2012
• Probably the first center in South India to do Hyperthermic intraperitonial Chemotherapy which results in better survival rates for patients with Ovarian Cancer
• Rare case of 13kg ovarian tumor successfully removed from a 30 year old lady
• 25 limb salvage surgeries like extracorporeal radiotherapy have been performed on bone Cancer patients
• First case of 8yr old boy on ventilator treated successfully with True Beam Stx for Brain tumour.The advanced technology of True Beam which reduces the duration of the treatment from 45 minutes to 5 minutes made the miracle possible and save the boys life
• 195 patients successfully treated on True beam.
• 30 Gynec Onco surgeries of Ca ovary, Ca cervix treated with 100% success rate.
• Successfully done Breast reconstruction surgery.
• 92 Head and Neck surgeries operated successfully

 

 Unique initiatives

• Launch of GCI privilege card for Cancer survivors
• Walkathon "Pledge to Quit" campaign to spread awareness about Oral cancer
• Breast cancer awareness talks in different corporate like Bosch, Bhel, Mindtree, HCL, lady police officers.

 

TAKE CHARGE OF YOUR HEALTH!

Breast and Cervical cancers are curable when detected early

By being aware of the changes taking place in our body we can be proactive and take charge of our health.

We all know that cancer is on rise in India. More than 70 % of the population in the age group of 30 - 69 years has been affected by cancer in the year 2010. Out of this number, 1, 93, 300 were female. Urban women are affected by 25 to 33% of all cancers. Out of these more than fifty percent are diagnosed in stage 3 and 4. Early detection is hence of prime importance.

Certain cancers are more common in women. Cervical cancer is first, most common cancer in women. Breast cancer is the next most common cancer. It is the second most common cause of death due to cancer in women (after lung cancer), and the main cause of death in women aged between 45 and 55. 

Cervical cancer is found to be more common amongst rural women whereas breast cancer is more common amongst urban women.Cervical cancer is more common amongst women having multiple sexual partners and is caused by certain types of viruses. Breast cancer is more common in obese women, those who have no children, have not breast fed, women who had their first child after the age of 30 yrs, women on OC pills and HRT, having a family history of breast cancer. Investigations to prove the diagnosis are FNAC/ Biopsy, Mammogram USG Breast and sometimes MRI scan.

With the recent advances in technology and improvisations in surgical skills, the treatment for breast cancer not only generates good outcomes and prognosis but also a higher possibility of the woman retaining her feminity and body image.

Breast conservation surgery is the treatment of choice in most of the patients at BGS Global Hospitals, depending on the size of the tumor. In this type of surgery, the lump in the breast is removed and axillary clearance (fat in the armpit) is done, but the entire breast is not removed.

The Breast Conservation Surgery is a specialized service provided at BGS Global Hospitals, with the advent of newer chemotherapy and Hormone therapy drugs; treatment of breast cancer has become far simpler with much better outcomes.

Further, TrueBeam STX, the world’s most advanced radiotherapy technology and the first of its kind in Asia Pacific was commissioned at BGS Global Cancer Institute, BGS Global Hospitals. This machine targets only that part of the breast afflicted with cancer and causes least impact of radiation to the surrounding normal tissue, thereby enormously decreasing the side effects.

The treatment is also amazingly quicker compared to other conventional radiotherapy machines. The technology brings phenomenal speed, precision and accuracy. Both breast & cervical cancers cannot be prevented in the true sense but early detection and early treatment is surely the way out. 

All women above 20 years of age need to learn breast self examination and get examined by a Breast Surgeon on a regular basis. In addition, women above 40 yrs of age need to undergo a Mammogram once in a year and a PAP smear once in three years to detect the disease early, even before it causes symptoms.

Both breast cancer and cervical cancer when detected and treated early can be completely curable. Let us take charge of our health. It is in our hands!

The author, Dr. Jayanthi Thumsi is Consultant, Breast Cancer Surgeon, BGS Global Cancer Institute at BGS Global Hospitals, Bangalore

NEW RAY OF HOPE FOR CANCER PATIENTS

Radiation therapy revolutionized with TrueBeamSTx

A 40 year old lady with metastatic abdominal nodal disease received a new lease of life with advanced stereotactic body radiation therapy with TrueBeam STx at BGS Global Hospitals. The tumours which are located very close to critical organs cannot be treated to high doses of radiation that is required for cure. Hence such cases will be considered for palliation only. However with TrueBeam STx, curative treatment was offered to this patient for just 5 days without harming the kidney, intestines, spinal cord and the aorta.

Radiation therapy plays a very important role in the treatment of cancer as more than 70% of all cancer patients require radiation therapy at sometime during the course of their treatment. Hence it is important for one to know about the best equipment available in radiation therapy.

Radiation therapy in treating cancer has evolved from the time when radiations were used in the crude form, ie., the era of deep X-ray therapy to high energy linear accelerators. The main aim of radiation therapy is maximum radiation dose to tumour with maximum protection of normal tissues. To achieve this, technicalities like 3D CRT, Intensity Modulated Radiotherapy, RapidArc, Stereotactic Radio-therapy and Radiosurgery evolved. But all these features were not available in one machine. A center would have 2 to 3 machines to treat all kinds of tumors. 

The latest in radiation therapy technology currently available in the world is the TrueBeam STx, a versatile machine which is capable of treating any type of tumor situated in any part of body with any of the technology at a shorter time supported with image guidance before and during treatment.

The TrueBeam STx enables faster, accurate tumor targeting in the treatment of challenging cancers throughout the body. This latest technology targets cancer cells in tumors even in organs that move with respiration (lungs, liver and kidney) with amazing accuracy while sparing the surrounding normal healthy tissues. Radiation oncologists at BGS Global Hospitals routinely perform complex procedures with precision and patient comfort. 

Patient Benefits derived with TrueBeam STx :

Accuracy and Precision – in targeting tumours

Faster treatment – Treatment in a few minutes

Quick Imaging - On Board imaging enables doctors to actually “see” the tumor they treat and target tumors with sub-millimeter accuracy. It takes care of internal organ motion and day to day set up variations.

Respiratory Gating - Tumours in organs that move along with respiration are taken care of by respiratory gating

Reduced duration of treatment – Overall duration of treatment for some tumours reduced to few days

A ray of hope – For many cancers which were hitherto written off as having no cure, there is new ray of hope with Truebeam STx.

Maximum Patient Comfort – owing to the above factors

This endeavour is ably supported by a compassionate team of specialists who offer organ specific cancer treatment. BGS Global Cancer Institute is at the forefront of cancer treatment in India offering end to end cancer care from prevention to diagnosis to rehabilitation.