Miracles Do Happen and For 4 Year Old, Kulraj, An Afghan Boy, Life Has All Been About Hope.

~ Becomes first child in Asia to be cured with an advanced and new
Haplo-identical Stem Cell Transplant technique ~
Son of an Afghan Sikh Refugee, Kulraj was diagnosed with Amegakaryocytic Thrombocytopenia evolving into Aplastic Anemia, a life threatening genetic bone marrow disorder at the age of 2 years. Young Kulraj, a Sikh refugee from Afghanistan, was denied treatment at the top medical institution in the country due to the huge treatment costs involved. Dr. Devi Shetty, Chairman Narayana Health, came forward to take this case at Mazumdar Shaw Cancer Centre, Narayana Health City, Bangalore.
 
About the Disease
Amegakaryocytic Thrombocytopenia is a condition in which platelets are not produced in marrow and patients have life threatening bleeding manifestations. It can evolve into Aplastic Anemia wherein marrow fails to form all the blood components. The symptoms are unexplained infections (due to fewer white blood cells), unexpected bleeding (due to fewer platelets) and fatigue (due to fewer red blood cells). The only curative treatment available for this condition is blood and marrow stem cell transplant.
 
About Bone Marrow Transplant
Bone Marrow Transplant is the only curative option available for a number of life threatening diseases. Bone Marrow Transplant is a highly advanced procedure that involves transfusion of bone marrow stem cells from a healthy donor to a patient. In the last few years, it has emerged as an effective and long term cure for diseases such as Leukemia, Thalassemia, Immunodeficiency disorders and Aplastic Anemia which were not curable earlier. There are three sources of donors from where the bone marrow can be collected – related donor, matched unrelated donor and haplo-identical donor. 
Matched sibling or family donors with matching stem cells are available only in 20 to 30% of the cases and to get a matched unrelated donor is difficult for Indian patients. For the remaining 60-70% patient half-matched or haplo-identical transplant from a family member is a viable option.
 
Narayana Health City – Restoring Hope
His parents and elder brother underwent human leukocyte antigen (HLA) tissue matching test. Unfortunately none of the family members was a complete match with him. As a next step, donors were looked-up at the public stem-cell registries, but that too failed as there were none matching in the database.
 
In the month of October 2014, when Kulraj arrived with his family at Narayana Health City, Bangalore the boy’s condition was steadily deteriorating, the Bone Marrow Transplant team decided to go-ahead and used his father’s stem cells with a 50% match to perform India’s first haplo-identical stem cell transplant using TCR Alpha/ Beta depletion for this condition.
 
Commenting on Kulraj’s condition and line of treatment, Dr. Sunil Bhat – Senior Consultant and Head Pediatric Hematology, Oncology & Bone Marrow Transplant Unit, Narayana Health City said, “In most cases, success of a Bone Marrow Transplant depends on how well the donor’s and recipient’s HLA tissue types match. Transplant has best results when all the known major HLA antigens are a match. In Kulraj’s case this was the biggest challenge as no matching donor was available. We then decided to perform India’s first haplo-identical transplant using TCR Alpha/ Beta depletion for this condition. This is an advanced BMT technique for haplo transplants known for potentially better treatment outcomes and has been mostly used to treat certain types of cancer only.”
 
“We are proud to have adopted an advanced and new haplo-identical Stem Cell Technique. The 14-bedded BMT unit at Narayana Health City, Bangalore is one of the largest in India, managed by an excellent team of hematologists. The unit was established with a vision to make this treatment affordable to the common man,” said, Dr. Sharat Damodar – HOD & Senior Consultant Hematologist – Bone Marrow Transplant Unit, Narayana Health City.
 
Today, 4 year old Kulraj is cured of Aplastic Anaemia and his body has started generating new platelets (white blood cells). He has been discharged from the hospital and will go back to Delhi in the next two weeks. He will be able to go to school next year and lead a normal life like any other child.
 
Milestones of the Department
Since its inception in 2009, it has accomplished more than 400 bone marrow transplants with 70% of them being allogeneic stem cell transplants.

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