ABOUT
ABOUT
APOLLO
APOLLO
prasthaIndraprastha
Apollo Hospitals,
ApolloIndia’s
Hospitals,
first JCI
India’s
accredited
first JCI hospital,
accredited is hospital,
a joint venture
is a joint between
venturethebetween
Govern-the Government
of Delhiofand
Delhi
Apollo
and Hospitals
Apollo Hospitals
EnterpriseEnterprise
Limited.Limited.
Commissioned
Commissioned
in July 1996,
in July
it is1996,
the third
it is super-spe-
the third super-specialty
tertiarytertiary
care hospital
care hospital
set up set
by the
up by
Apollo
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over 15over
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houses
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ith moremore
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specialists
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moremore than than
600 operational
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beds,
operation
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138 ICU138 ICU beds,
round-the-clock
round-the-clock
pharmacy,
pharmacy,
NABL accredited
NABL accredited
laboratories,
laboratories,
24-hour emergency
24-hour emergency
services andservices
an active
and an active air
mbulance ambulance
service. Apollo
service.
Hospitals
Apollo Hospitals
Delhi has Delhi
the leading
has theprogramme
leading programme
in kidney and in kidney
liver transplant
and liver transplant
in in the
ountry.country.
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first successful
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paediatrics
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and adult
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in India were
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hospital
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of medical
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and expertise.
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latest of
diagnostic,
latest diagnostic,
medical medical
and surgical
and surgical
facilitiesfacilities
for the care
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ospitalThe
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What is Bone Marrow
Transplant (BMT)?

Bone marrow transplant also called as

hematopoietic stem cell transplant (HSCT) is the
procedure that is used to replace the unhealthy
bone marrow with new and healthy bone marrow.
This is an intensive medical procedure and curative
treatment option for cancerous & non cancerous
diseases of blood and disorders of metabolism &
Immune system. Bone marrow is the soft, spongy
tissue inside our bones and is the ‘factory’ that
makes blood. It is responsible for producing white
blood cells (to protect against infection), red blood
cells (to carry oxygen around the body) and
platelets (to prevent bleeding). Stem cells are blood
cells at their earliest stage of development in the
bone marrow, before they have become committed
to developing into white cells, red cells or platelets.
They replace the diseased marrow as well as
provide immunity against cancers and infections.

What are the different types of bone

marrow transplants or stem cell transplants?

Autologous bone
marrow transplant
(high dose chemotherapy & Autologous stem cells rescue)-
In such transplants patient is himself / herself the donor
The stem cells are taken from the patient prior to procedure,
frozen and stored and then reintroduced in the patient’s system
after the patient has received chemotherapy, through a vein. This
type of bone marrow transplant is typically used for cancers and
solid cancer like neuroblastoma, medulloblastoma. Wilm’s
tumor, Germ cell tumor, lymphomas, multiple myeloma etc and
also for autoimmune diseases like multiple sclerosis etc.
Allogenic bone marrow transplant-
In this type of transplant, stem cells donated by someone
else are used. Depending on the donor, it can be further divided into:

• Matched related donor transplant- Donation made by a

HLA matched family member like brother & sister and
sometimes father, mother, son and daughter.
• Matched unrelated donor transplant- Donation is made
by someone other than a family member who is found to
be complete HLA match with the recipient.
• Haplo-identical transplant- Donor and the patient are a
half match like a parent and offspring etc. (Any match
<90% is considered as half match).
• Umbilical cord blood transplant- Umbilical cord blood
rich stem cells are taken from the umbilical cord and
placenta of the baby. It is frozen and stored for use in the
time of need.

A word about Haploidentical transplant

• T-Cell depletion is mandating in haploidentical transplant.
• T-Cell depletion can be done in two ways: INVIVO ( T cell depleted by using high dose of chemotherapy inside the
body) or INVITRO ( T cell depletion by using a machine outside the body). Both these modalities have their
advantages and disadvantages. Choice depends on a number of patient and donor related factors.

In Vitro- T cell depletion

What is the
basic process?

There are three main steps in the transplantation process-

The first step- The aim here is the collection of the bone marrow or stem cells (the harvest) from the donor. We
now know that the umbilical cord blood is also a rich source of stem cells.
The second step- The aim in this step is to completely destroy the existing bone marrow and thereby help the
patient receive the new stem cells.
The third step- The aim here is to infuse the bone marrow or the stem cells through the intravenous route, like a
blood transfusion. There may be no signs of new bone marrow growing for 2-3 weeks, and occasionally it may be
a few months before the new bone marrow produces all the components of the blood adequately.

When is bone marrow

transplant required?

Allogenic bone marrow transplant is

typically recommended to treat certain medical
conditions where the bone marrow/immune
system is dysfunctional. Most common indications
are Acute Leukemia (AML/ALL), Myelodysplastic
Syndrome, Aplastic anemia & other bone marrow
failure syndromes. Hemoglobinopathy like
transfusion dependent thalassemia, severe form of
sickle cell disease, Congenital immunodeficiency &
metabolic disorders.
Autologous bone marrow transplant is
recommended to treat where we need to give high
dose of chemotherapy to treat underlying disease
following which autologous harvested stem cells is
given as rescue.
It can also be used to treat various autoimmune
diseases, the commonest indication being
multiple scelerosis.
Bone marrow &
peripheral blood stem cell harvest
Most commonly stem cells are collected
from the donor just like platelets are
collected. In this process the donor
receives injections in the skin just like
insulin injection for 4-5 days. With these
injections, stem cells that are normally
found in bone marrow come into the
blood stream. This blood is taken by veins
and filtered in the apheresis machine and
given back to the donor through another vein and approximately 300ml of filtrate is collected which is rich in blood
stem cells.

Sometimes, especially for non-cancer conditions, stem cells are collected from bone marrow, where under general
anesthesia multiple needle punctures are made at waist bone.

What are the

adverse effects?

For the donors:

Donating stem cells is very safe. We take the utmost care to minimize side effects of stem cell harvest.
However, a donor of a bone marrow transplant produce may experience the following side-effects-

• Chest pain

• Stiffness of hands also known as tetany

• Low blood pressure

• Fever, chills, flushing

• Foul taste in mouth

• Headache, Hives, Nausea, Pain

• Shortness of breath
For the recipient:
While the bone marrow transplant is mostly considered to be a safe procedure, there are several factors that
determine the type of complications that might arise after the transplant. The factors may result in some
complications that the recipient of the bone marrow transplant might experience. Some of them are as
mentioned below-
• Anaemia
• Bleeding in the lungs, intestines, brain and other areas of the body
• Graft failure, which means that the new cells do not settle into the body and start producing stem cells.
• Graft-versus-host disease in which the donor cells attack the recipient’s body.
• Infections
• Inflamation and soreness in the mouth, throat, oesophagus and stomach
• Pain
• Stomach problems, including diarrhoea, nausea and vomiting.
• Damage to the kidneys, liver, lungs and heart
• Late effects- growth issues, early menopause, possible infertility

Follow up
For the first two to three months after leaving the
hospital, the patient will need to undergo frequent
blood tests to monitor the blood counts. Regular
doses of several different drugs to reduce the risk of
infection or graft versus host disease will be
necessary and these will be monitored regularly.
It is essential that the patient takes good care of
his/her health during this time. There are a number
of possible problems that might occur because of
the reduced immunity.
The patient should get in touch with the hospital
immediately if he or she experiences any of the
following symptoms-
• Feels unwell
• Persistent temperature of over 37.5-degree Celsius
for more than 2 hours
• Infections e.g. in the skin or oral cavity
• Skin rash
• Several loose motions
• Shortness of breath or breathing difficulties
• Any other untoward symptoms or incident

How will life be after a transplant?

For the first few months after a transplant, while the immune system is in the process of returning to normal, it is
important to eat a healthy and balanced diet and take care to avoid all possible risk of infection from food. Avoid
uncooked food, subsequently in 6-12 months immune system is back to normal, life returns to normalcy.
Bone marrow
transplantation in children

The procedure for transplanting bone marrow in

children is the same as those for adults. In planning
the transplants, doctors will consider very carefully
the effects of the intensive preparatory regime to
minimize the long-term effects, for example on the
child’s growth, development and future fertility.
Consult your BMT physician prior to surgical/
dental/ medical invasive procedures, since your
immunity is still developing over 1-2-year period.

Diseases treated by BMT

• Thalassemia • Juvenile myelo monocytic leukemia
• Sickle cell disease • Immunological diseases such as SCID
• Other transfusion dependent Anemia • Inborn error of metabolism
• Aplastic anemia • High grade lymphomas
• Inherited bone marrow failure syndromes including • Solid tumors
Fanconi anemia, diamond black fan anemia, etc. • Plasma cell disorders like Myeloma
• High risk leukemias • Auto immune diseases like multiple sclerosis

Take Home Message

Bone marrow transplant is the best and effective therapy for Aplastic anemia, Thalassemia , Acute Myeloid
and Lymphoblastic leukemias, Multiple Myeloma and relapsed Hodgkin and Non Hodgkin lymphoma. These
patient should be timely reffered to specialized centers to treat these patients to get best outcome.
 Dr. Gaurav Kharya
Senior Consultant
Centre for Bone Marrow Transplant and Cellular Therapy
Paediatrics Hematology Oncology and Immunology
Indraprastha Apollo Hospitals
+919213132168
Gaurav.kharya@gmail.com

Dr. Gaurav Kharya is a Clinical Lead Centre for Bone Marrow Transplant and Cellular Therapy, Senior Consultant Paediatric
Hematology Oncology and Immunology at Indraprastha Apollo hospital, New Delhi. He has been trained in premier institutes in
India and abroad. He did his formal training at Sir Ganga Ram hospital, New Delhi. There after he has been trained at The Great
North Children’s hospital, Newcastle upon tyne, United Kingdom in paediatric hemato-oncology, immunology and bone
marrow transplant and St. Mary’s hospital, Imperial College NHS trust, London, United Kingdom in the field of paediatric
hematology and BMT.
He moved back to India in March 2014 and joined back BLK super speciality hospital as a consultant paediatric
hemato-oncology & BMT. After working at BLK super speciality hospital, he joined Artemis hospital in December 2016 as a Senior
consultant & Head in Paediatric Hematology Immunology & Bone Marrow transplant. He expanded the BMT program and took
it to the next level and made it one of the high-volume transplant centres of the country Apart from paediatric acute leukemias,
lymphomas, paediatric solid malignancies, he is keenly interested in hematopoitic stem cell transplant especially alternative
donor transplants (voluntary unrelated donor & Haplo-identical donor). Dr. Kharya has a vast experience in transplanting
patients with various blood disorders benign or malignant, immunology diseases, auto immune diseases (like multiple sclerosis),
etc nationally and internationally. He has presented many papers in national and international conferences and has published
many papers in national and international journals.
Dr. Kharya is credited for doing the first haploidentical bone marrow transplant for sickle cell disease in India & and also for doing
first invitro TCR alpha beta CD 19 depleted haploidentical BMT in a 5-month-old baby suffering from severe combined
immunodeficiency which is one of the youngest children to receive bone marrow transplant in India. Till date Dr. Kharya has
done close to 800 transplants for various diseases along with his team members.
Dr. Kharya is of the opinion that none of the children who needs treatment for cancer, immunological disease or bone marrow
transplant should be refrained from treatment due to lack of funds. To fulfil this goal, he has tie-ups with NGO’s which provide
financial & social support to these kids & their families.
He is the recipient of the prestigious YOUNG ACHIEVERS 2017 award, awarded by the Times of India group.
Dr. Kharya joined Indraprastha Apollo hospital as a clinical lead for centre for transplant with the aim of making it one of the best
centres of the country. His future interests are in cellular and Gene therapy.

Dr. Amita Mahajan

Senior Consultant
Paediatrics Oncology and Hematology
Indraprastha Apollo Hospitals
+919810734137
mahajanamital@gmail.com

Dr. Amita Mahajan is a Senior Consultant Paediatrics Oncology and Hematology, with an experience of 29 years. She pursued
her MBBS in the year 1990 from All India Institute Of Medical Sciences, New Delhi and then went on to complete her MD in the
year 1992 from AlIMS as well. She worked for over a years in UK at a number of centres and gained experience in Paediatric,
Hematology Oncology and BMT. She joined Indraprastha Apollo Hospitals in 2002 and setup the Paediatric, Hematology
Oncology service. She is Medical advisor in a number of support groups working in the field of Paediatric, Hematology Oncology
as well as Executive member of Indian Paediatric Oncology. She was working as a consultant at Llandough Hospital, Cardiff,
which was the Regional centre for Paediatric Oncology in that region. She worked in Bone Marrow Transplant (Royal Hospital for
Sick Children) unit, which was the busiest bone marrow transplant unit in UK at the time and was routinely involved in the
 management of both children and adults. She has been a part of International Society of Paediatrics, Oncology Indian Academy
of Paediatrics, Thalassemics India Foundation. She is an experienced, skilled and awarded doctor in her field of specialization.

Dr. Shishir Seth

Senior Consultant
Hemato-Oncology and Bone Marrow Transplant
Indraprastha Apollo Hospitals
+9190135 86776
drssrseth@gmail.com

Dr. Shishir Seth is a Senior Consultant in Hemato-Oncology and Bone Marrow Transplant at the Apollo Cancer Institute. He is an
MD and a DM in Clinical Hematology (Mumbai). In addition, he has completed a Fellowship in Leukemia and Blood and Marrow
Transplant (BMT) at the Division of Hematology, Vancouver General Hospital, Vancouver, Canada.
He specialises in blood and marrow transplant (BMT), blood cancers (leukemia, lymphoma, multiple myeloma), anemia,
thalassemia, bleeding and clotting disorders. He has successfully performed over 200 hematopoietic stem cell transplants, out of
which 40 percent were allogeneic including haplo-identical and antigen mismatch transplants.
Over the years, Dr. Shishir Seth has been associated with several prestigious hospitals in Mumbai and Delhi. He initially was
Junior Resident at Seth GS Medical/KEM Hospital, Mumbai, after which he served as Senior Assistant Medical Officer (AMO) at
Bombay Hospital, Mumbai. He then was posted as Clinical Assistant (Hematology) at the PD Hinduja National Hospital in
Mumbai. His next two positions were in New Delhi, first as Senior Resident at the GTB Hospital and subsequently as Consultant
at the Moolchand Hospital. He returned to the Seth GS Medical College/KEM Hospital in Mumbai as Senior Resident while he
pursued his DM and proceeded to Canada for the above-mentioned fellowship at Vancouver General Hospital. His next
professional stint was as Consultant (Hemato-Oncology and Stem Cell Transplant) at the Rajiv Gandhi Cancer Institute, New
Delhi, before he took up his present position at Apollo.
Besides his regular professional commitments, Dr. Seth has devoted his time to research as well. Several of his research papers
and articles have been either published in peer-reviewed journals or presented at medical conferences. He is a member of various
associations and bodies related to his field.
Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi - 110076 | Call: +91 88 00 99 00 00 | Email: infodelhi@apollohospitals.com
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