One fine morning, in mid of 2019, a 11 years old girl from rural background was walking with the support of her mother into my OPD. Her skin was full of black patches and mother had given history of multiple blood and platelet transfusions. She had persistent fevers and bleeding manifestations. After extensive workup including bone marrow studies and genetic analysis, Aplastic anemia was diagnosed, a life threatening benign bone marrow diseases which kills the patients with severe bleeding or bad infections. The treatment options are less and requires high end procedure to save a life. Luckily her sister is a full HLA match and the family was advised an Allogeneic bone marrow/stem cell transplantation with intention to cure her disease. This procedure, also known as Hematopoietic stem cell transplant (HSCT), was not available in the entire state of the Andhra Pradesh, at that time.

But this expensive procedure was unaffordable for the family. Luckily we could arrange funds with the support of Govt of Andhrapradesh and NGOs. So i took her for a first ever allogeneic bonemarrow/stem cell transplantation of our state. With the help of our trained staff and team of transplant, her disease got cured and now she is going to school, happily.

Since then we as a team of doctors, Nurses, supportive staff and other para medics attained more confidence to do more procedures including complicated ones. Our transplant list is a mix of tiny babies, toddlers, young adults and fragile older individuals. Even, during challenging Covid pandemic times our journey has not stopped and completed around 100 bone marrow transplants by the mid of 2022, which include HLA matched allogeneic, Haplo identical, Unrelated (MUD) and autologous transplants. The diseases included are acute myeloid leukemia, acute lymphoblastic leukemia, multiple myeloma, lymphoma, benign diseases like aplastic anemia, thalassemia, fanconi anemia etc.

Since then we continued our best work with transplanting incurable blood diseases and we are proud to announce that our success rate is more than 90 percent in both allogeneic and autologous types.

HSCT is often the only curative option in many malignant and nonmalignant blood conditions. The stem cell transplants have been done for many decades in world and are constantly evolving. Although the transplants have improved a lot over the time it still remains a complex procedure that requires a commitment from the patient, caregiver and the transplant team. As the treatment is a long and complex process the focus remains on making the procedure safer as well as more effective.

Establishing a HSCT unit in resource limited setting like India remains a challenge. It is more complicated to run such units as social and economic distribution is quite variable in our country. The disease burden is high and HSCT is required in large number of patients. Even increased number of HSCT units in India is falling short for these needs. For a HSCT facility to come up, apart from huge cost, health worker training, location, equipment, and laboratory advancement are needed.

Sustained availability of trained personnel is one of the main hurdles in advanced care units. It includes clinician, staff nurses, lab technicians, social worker, and psychologist.  Dr Chandrasekhar has trained at various prestigious institutions of India like Narayana hrudayalaya, Christian medical college(CMC, Vellore) and Nizams institute of medical sciences(NIMS Hyderabad).

HSCT is an expensive modality requiring lots of medication, blood products, supportive care apart from infrastructure, and human cost. State sponsorship and donation/help from nongovernment organization must be active for HSCT programme.

Depending upon the donor, the transplantation is called an allogeneic or autologous. The source of these hematopoietic stem cells could be the bone marrow, peripheral blood or umbilical cord blood. A haplo identical stem cell transplant is a more complicated procedure where a half HLA matched family donor can be taken as donor.

In allogeneic bone marrow transplant (allo BMT) the normal hematopoietic stem cells are derived from a donor. The donor may or may not be related to the patient (sibling donor BMT or unrelated donor BMT). In autologous BMT (ABMT) the patient's own stem cells are harvested during remission and used for hematopoiec rescue after supralethal chemo and radiotherapy. The mechanism by which allo BMT is supposed to cure malignancy is by the anti cancer effect of drugs as well as by the immunological reaction between graft and cancer cells known as graft versus leukemia effect(GVL). This second mechanism is important to eradicate minimal residual disease.

As more cost is involved in the transplantation process, we mainly takes the help of the govt schemes like arogyasri, EHS, ECHS, corporate and other nongovernment organizations. More than 90 percent of our transplants are performed under these schemes and the entire procedure is done for free.