Wednesday, September 9, 2015
Bone Marrow Transplant in process
QUESTION: Is there a CURE for SICKLE CELL ANAEMIA (Haemoglobin SS)?
ANSWER: YES, there is a cure for sickle cell in the form of Bone Marrow Transplantation (BMT). BMT for sickle cell has been around since the late 1980’s - although still not widely available.
WHAT YOU SHOULD KNOW ABOUT BONE MARROW TRANSPLANTATION (BMT):
1. WHAT IS BMT? BMT for sickle cell is a procedure whereby cells from the bone marrow of a donor (ie someone who is Haemoglobin AA or AS) are transplanted into someone with Haemoglobin SS
2. WHERE DO THE DONATED CELLS COME FROM?: Bone marrow cells are usually taken from the hip bone of the donor – who must have either Haemoglobin AA or AS. Usually, a brother or sister of the patient is preferred.
3. BEFORE BMT CAN PROCEED, 3 MAJOR REQUIREMENTS MUST BE MET:
i. Identify the best donor (ie best match for the patient). Blood tests will determine who the best match is.
ii. Next, both the donor and the patient will have pre-transplant evaluations of the heart, lungs, kidney, etc.
iii. Counseling and interviews with a psychologist and a social worker also are an important part of the process.
4. BMT must be done under sterile conditions and the recipient will be on admission in hospital for about 10 days before the transplant procedure and for up to 1 month after the procedure
5. The actual BMT procedure is in the form of transfusion (just like the usual blood transfusion); the donated bone marrow is in a blood bag and passed into the patient’s body through a vein over a few hours.
6. After the transfusion, the patient is monitored in hospital (on admission) over the period of about 1 month – under sterile conditions because they are vulnerable to infections at this time
7. The patient continues to be monitored after discharge for several months to be sure the marrow has “taken”.
8. THE PATIENT IS CURED BECAUSE:
a. They no longer have sickle cell crises and other symptoms of sickle cell
b. They begin to live life normally like people who are Hb AA or AS – without frequent visits to the hospital, etc
c. After the BMT procedure, when their genotype is checked by a blood test, they are found to have become Hb AA or AS – depending on the genotype of their donor.
9. IMPORTANT!: Although the patient is cured - as evidenced by cessation of crises and other symptoms of sickle cell, as well blood test showing a change in their genotype, they need to be aware that they can still pass the Sickle Cell gene (S gene) to their children. This is important.
10. BMT IS NOT RECOMMENDED FOR EVERYONE WITH SICKLE CELL:
a. BMT is associated with risks and sometimes serious complications
b. The doctors who carry out the procedure insist that a number of criteria are met
c. The doctors will often consider the severity of the patient’s sickle cell condition vis a vis the risks of the procedure, before recommending it
11. BMT IS EXPENSIVE: Most people travel abroad for the procedure and total cost of the procedure, air travel, food and board for about 6 months for patient and care giver add up to about a whopping N25m (twenty-five million Naira) per patient!
SICKLE CELL FOUNDATION NIGERIA OFFERS BONE MARROW TRANSPLANTATION (BMT)
For the past 4 years, 45 persons have benefited from the Sickle Cell Foundation Nigeria BMT Project. In collaboration with IME Rome, these 45 persons with sickle cell anaemia received BMT in Rome and are all cured today. The arrangement with IME Rome is for TECHNOLOGY TRANSFER, so the good news is that by the first quarter of 2016, BMT will be done here locally by the Foundation in collaboration with Lagos University Teaching Hospital (LUTH). Doctors and nurses have already gone for the necessary training in Rome.
Once we begin to provide BMT locally as stated above, the cost of the procedure will be a lot less and more Nigerians will be able to access it. The cost can be brought down to N5m per patient.
BMT IN UNIVERSITY OF BENIN TEACHING HOSPITAL (UBTH)
Dr. Bazuaye of UBTH has also performed about 3 BMTs for sickle cell successfully over the past 3 years at the teaching Hospital. Sickle Cell Foundation Nigeria and LUTH plan to work together with the Benin Team for the benefit of Nigerians with Sickle Cell.
Friday, June 12, 2015
Mrs. Ayo Otaigbe (Expert Genetic Counsellor Sickle Cell Foundation Nigeria).