CHENNAI: In 2004, flight attendant Kaveri Mandanna was battling frequent fevers, cold, and dipping haemoglobin. Life was an endless series of check-ups and blood transfusions. After consultations with a haematology specialist, tests and procedures ensued. Kaveri's condition was found to be leukaemia -- it meant that her bone marrow tissue was rapidly producing abnormal numbers of a certain type of blood cell, crowding out the others.
Although shaken, she didn’t want to lose hope. "I had to be alive for my daughter -- that was the only thought pushing me to fight," says Kaveri who was in her 30s then.
A bone marrow transplant, also called a stem cell transplant, was recommended as a recourse. That gave Kaveri additional succour.
"Today, people suffering from rare diseases like certain types of cancer, sickle cell anaemia, immune conditions, and other conditions affecting the production of blood, have a shot at being cured through such stem cell transplants," says Dr G Buvaneswari, infertility specialist, Rela and GBR Hospitals.
Stem cells are special cells which can create copies of themselves. "These are the body’s raw cells -- they keep dividing and evolving into other cell types such as the bones, heart muscle, nerves, other organs and tissue," explains Dr Buvaneswari.
It’s a match
The tricky part of such transplants? Finding an immunologically compatible donor. As Kaveri had two siblings, who are natural genetic matches, they were HLA-typed.
Explaining this, Dr Buvaneswari says, "This procedure identifies protein markers on cells and tissues. The markers help determine whether or not a donor and a beneficiary match."
The more the markers, the fewer the risks of infection. To Kaveri's luck, her younger brother was found to be eligible to donate.
Uthappa, Kaveri’s brother and donor, was glad that he could potentially save his sister's life. However, he was apprehensive, too.
"Blood from one of my arms was collected every day, for five days, for a few hours. It was a smooth process, but, still, I was worried I'd experience side effects after giving away my stem cells," says Uthappa. But there was no cause for concern, he found, as donors are given injections to replicate extra bone marrow stem cells.
On D-day of the transplant process, Uthappa's stem cells were introduced into Kaveri's body via a catheter. Meanwhile, Kaveri had undergone chemotherapy which emptied her bone marrow of all its blood cells, including the healthy ones, to make space for the donor's stem cells.
With time, the transplanted stem cells travelled to Kaveri’s bone marrow, where it started producing healthy red blood cells, white blood cells, and platelets of its own.
Kaveri still needed to do check-ups at regular intervals. "At first, I had to meet my specialists every week. Then, the frequency reduced to quarterly sessions, and later, once a year," Kaveri recounts. Subsequent signs of her cell count returning to the normal number indicated disease remission.
Almost six years later, from the day of the transplant in 2004, Kaveri's cancer was cured. "The transplant's success and the blessing of being declared cancer-free gave me the confidence to resume my globe-trotting life," she exclaims.
Banking for the future
While Kaveri was lucky enough to find a biologically-related donor, the odds in general are not quite high. Contacting a registry of voluntary unrelated donors is the only option then. Healthy individuals between the ages of 18 to 60 can register to donate their blood stem cells, says Sumati Misra, head, counselling and transplant centre management at DATRI blood stem cell registry. Having a wide pool of registered donors increases the odds of finding HLA matches for those needing transplants, she says.
"At DATRI, we have 1,800 patients registered with us who haven’t found a match yet from our registry of almost four lakh registered donors," shares Sumati.
Another factor in HLA typing is ethnicity, thus, it's hard to find a European registry match for an Indian. A large Indian donor registry solves that problem, she suggests.
Did you know that umbilical cord blood is a rich source of stem cells?
"The cord and the placenta, generally discarded as medical waste. They can be saved, and the stem cells from the tissue and the blood extracted, and stored for future transplant use," says Dr Buvaneswari.
As the blood is tested for infections, the likelihood of a person's body rejecting stem cells from cord blood is lesser than from bone marrow.
Some parents pay for their children's cord blood cells to be cryo-preserved in private banks for an extended period of time. They can be used in the rare event of a child developing a condition, in the future, that can be treated with stem cell therapy. The child's sibling’s stem cells, too, if they are HLA matches, can prove helpful.
"If the child is found to be an HLA match with another child, alternatively, parents can take a call on donating the banked cord blood. As cord blood banking is an expensive undertaking, donating them may be ideal," suggests Dr Buvaneswari.
Research on stem cells is underway to see if they can treat various conditions that affect different systems and parts of the body. Stem cell therapy could be a prospective game-changer in not just regenerating tissues but also organs, says Dr Buvaneswari, who is currently researching the use of stem cells in infertility treatment.
Sharing a recent trend from the field, the doctor says, "After pre-clinical trials with animals, it was observed that stem cell therapy could restore their ovarian and even testicular functions."
"After more phases of the trials with human cells, the results, if favourable, could lead to advancements in reproductive care," she concludes.