Over 1500 Bone Marrow Transplants performed in Pakistan including 609 at NIBD-Tahir Shamsi


 Punjab to establish 500-Bed PIBD and BMT Center

Over 1500 Bone Marrow Transplants performed
in Pakistan including 609 at NIBD-Tahir Shamsi

Donor shortage, financial constraints, human
resource are the major problems faced

LAHORE: Dr. Tahir Shamsi from National Institute of Blood Diseases Karachi delivered Prof. Shaukat Raza Khan Memorial lecture at the Children Hospital and Institute of Child Health Lahore annual symposium held recently. The topic of his presentation was “Bone Marrow Transplant- a priority in Child Health”.  He pointed out that so far over fifteen hundred Bone Marrow Transplants have been performed in Pakistan which includes 609 at NIBD and the main problem was shortage of donors besides financial constraints as well as human resources.

Dr. Tahir Shamsi

The first BMT in Pakistan, he said, was performed on October 13th 1995 at Ziauddin HospitalKarachi. Stem cell transplantation not only eradicates the disorder but it also destroys haemato poietic and immune system.  Transplant re-establishes this system. If these children are diagnosed early, with minimum infection, they can be cured for life. Aplastic anemiapatients have their missing cells replaced within a yearbut 90% of them die in a year and only few respond to immunosuppressive therapy. Dr. Tahir Shamsi made it clear that there was a risk of 10-30% mortality and the patients may die due to procedure related mortality. BMT started in 1980’s and now millions of bone marrow transplants are performed all over the world.  Most of these BMTs are autologous but in Pakistan most of the BMTs are allogenic.  We have three and a half centers doing Bone Marrow Transplants in Pakistan. About ten thousand patients 50% of which are children need bone marrow transplant every year. In United States most of the BMTs are autogenic.  Blood transfusion is the major cause and indication for Bone Marrow Transplantation. AML is the other cause besides aplastic anaemia. Majority of the patients having Bone Marrow Transplants in the world are over fifty years of age. We in Pakistan have 10% of our population which is over fifty years of age. We need to focus more on patients who are under twenty five years of age which makes it 50% of the population.

Giving details of the fifteen hundred BMTs performed in Pakistan, Dr. Tahir Shamsi said it included one thousand patients of AML, one thousand NHL, two hundred cases of Hodgkin’s lymphoma, Myeloma one hundred cases and one hundred cases of other disorders. We need to do over  ten thousand Bone Marrow Transplants every year but we at present are doing just about one hundred and twenty. We have just three BMT centers though we require about twenty to two hundred centers all over Pakistan. But since it is not possible to establish two hundred centers, we can concentrate on establishing twenty centers and these will be feasible and manageable too.

Dr. Tahir Shamsi further stated that for the last twenty years, we have been able to retain our staff at NIBD. BMT facilities are available at Ziauddin Hospital, AFBMT, AKUH, SKMH, PIMS, Shifa International Hospital, Kidney Center and NIBD.  Four more centers were developed but were not functioning which include Ghambat in Sindh, SIUT and NICH at Karachi besides BV Hospital Bahawalpur. The three centers functioning at present were performing between120-250 Bone Marrow Transplants. Of the six hundred patients managed at NIBD, 251were suffering from thalassemia and most of these children were male. Their age group was between thirteen months to twelve years. We do not use radiation at all but only use chemotherapy, he remarked. About 63% of these patients Dr. Tahir Shamsi said were disease free for the last ten years. Giving further details he said that these patients included poor risk one hundred eleven, goodrisk 76. Our experience shows that three out of four of these patients will survive for more than ten years and most of the mortality is during the first year. In Thalassemiapatients, there is overall 90% survival but in poor risk patients, one out of three will not survive. As regards patients suffering from AML, one out of two will die.

Speaking about the complications Dr. Tahir Shamsi stated febrile neutropenia 77%, fungal infections 5%. Twenty five percent of our patients had HLA identical sibling donor and 50% of our patients had HLA sibling.  About 70% HLA identical donors are at Rawalpindi center. There is no voluntary donor and no donor registry.  We have started Halo identical BMT at NIBD and so far done twenty eight cases. We had rejection in three patients, relapse in two and we lost five patients. As regards cost of BMT, it is between two to 4.6 Million rupees. There is a great disparity in need and available resources. Lack of health insurance was another factor. Chief Minister Punjab and the Federal Government has now promised to provide funding for one hundred Bone Marrow Transplants each so about two hundred BMTs will be funded by the governments every year. He also disclosed that Punjab government t is planning to establish a 500-bed Punjab Institute of Blood Diseases and Bone Marrow Transplant center.