Coronavirus casts shadow on stem cell treatment in India

The COVID-19 pandemic has brought life to a screeching halt for many, but those with serious ailments such as blood disorders have been pushed to the edge with their lives now hanging by a thread in the absence of necessary medical interventions.

Sonia Ghakkar, a Gurgaon resident, had been desperately looking for help, as her husband, a leukemia patient, waits for bone marrow transplant (BMT).

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"About two months ago, my husband was diagnosed with leukemia. Bone marrow transplant is his only chance of survival. We have sought permission from the health ministry for transport of blood stem cells, but to no avail. The match cannot reach the hospital under the present circumstances," she said.

Stem cell transplant is the only cure for many patients suffering from blood disorders.

According to a hematologist, it takes months, sometimes years, to find a donor, and many "high-risk" patients have limited time left.

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Transplants have come down to a meager 20 per cent nationwide, as most hospitals have postponed such processes, and prescribed additional chemotherapy sessions for the time being, in the wake of the coronavirus crisis, he said.

Mumbai resident Danish Merchant had his BMT scheduled in March-end, but doctors had been postponing the process, citing logistical challenges as the reason.

"I am dependent on chemotherapy sessions for now. It is not just shooting up my bills, but also leaving me weak and scared. I pray that the situation comes under control at the earliest and my BMT procedure takes place before it gets too late," the 32-year-old said.

Renowned hematologist and Padma Shri awardee Mammen Chandy said medical establishments have been conducting elective transplants.

"We have not stopped functioning; elective transplants are being conducted. Because of this lockdown, the blood platelet donation has also gone down. Nevertheless, all procedures are being done following the guidelines laid down to contain COVID-19," Chandy, Director, Tata Medical Centre, told PTI from Vellore.

Lalit Kumar, the head of the oncology department at Delhi's All India Institute of Medical Sciences (AIIMS), said the process could be delayed to an extent for the ones suffering from Thalassemia, but "high-risk" patients need doctor's intervention.

"Lockdown has affected transplantations, for sure. It has gone down to 20-30 per cent. There are patients located in Bihar, Uttar Pradesh, Rajasthan who cannot travel (to Delhi) as of now. The process can be delayed for patients suffering from thalassemia, but doctors have to take a call on high-risk patients suffering from Acute Myeloid Leukemia, Chronic Myeloid Leukemia, among other severe blood disorders.

"We have advised our patients after evaluating their health conditions to go for an extra session of chemotherapy to delay the process till an alternative can be worked out,” he said.

According to Kumar, voluntary donation has also dipped since the imposition of the lockdown on March 25.

Expressing concern, Santanu Sen, a consultant in pediatrics, pediatric oncology and stem cell transplantation at Kokilaben Dhirubhai Ambani Hospital in Mumbai, said six critical patients were sent home, keeping in mind their safety amid the pandemic.

"All six of them were about to start their conditioning therapy. We have safely rescheduled the procedure keeping in mind the safety of the patients. Secondly, we also require a lot of blood support products. As of now we have sent them home. We are working very closely with the government to find an alternative, which will be beneficial for the patients," he said.

Asked if setting up ‘green corridors’ would help in the movement of donors from one state to another, Sen said, "We have a patient whose brother is a match, but he is stuck in Rajasthan and cannot travel due to the shutdown.

"A special pass for these donors or a green corridor will definitely help. However, shortage of blood and necessary drugs at this juncture could also pose a problem,” he explained.

According to Sumati Misra, the head of counselling and transplant centre at DATRI -- the country’s largest unrelated blood stem cell donors' registry -- the last donation was made by a man from Kochi to a recipient in Chennai in March-end.

Germany-based DKMS BMST Foundation India, a non-profit bone marrow donor centre working from Bengaluru, said many donors are scared of contracting coronavirus.

Talking to PTI, the organisation's CEO in India, Patrick Paul said, "We conduct donation and cell collections in cooperation with hospitals. We also have international donors listed. Special care is taken to bring the donated stem cells in cargo planes. Donation, however, has been affected big time as people are scared of virus transmission," he said.

A top official at the Union health ministry responsible for policy-making said states have been told to facilitate emergency medical services, but creating corridors at this point in time was "practically impossible".

"As per our policy, the family member of a patient should approach the hospital or the institution concerned, which could then write to the state government for issuance of passes for hassle-free movement of donors and recipients,” he said.

The health ministry official also said that the national helpline number ‘104’ was also meant to provide assistance in cases of emergencies other than COVID-19.

"They can dial 104 for information and also reach out to ‘1075’ separately for such specific issues," he added.