The bone marrow transplant: first time in Bangladesh

A historical landmark was achieved with the introduction of the first Bone-Marrow Transplant (BMT) unit by Dhaka Medical College Hospital (DMCH) in March 2014. It was a successful collaboration between the best hospitals of Bangladesh and America under the watchful stewardship and assistance of A K Khan Healthcare Trust (AKKHT) and the Ministry of Health & Family Welfare (MHFW), Bangladesh.
Concept
Bone Marrow Transplantation (BMT) is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow. The procedure involves the expertise and efforts of a well trained and motivated team of physicians, nurses and medical technologists. Bone Marrow Transplant is given to those patients who are suffering from various types of blood cancer, certain genetic, blood and immunity disorders like Leukemia, Thalassemia, and severe Aplastic Anemia. Stem Cells are collected from the following sources: Bone marrow, Bloodstream, Placenta or Cord Blood.
Currently all patients are being treated with ‘Autologous’ procedure that uses one’s own bone marrow. The other procedure is ‘Allogenic’, in which marrow from a sibling or donor is used to treat the patient after it properly matches the recipient. Patients who are suffering from Lymphoma, Leukemia, aplastic anemia, thalassemia, Sickle cell anemia, congenital thrombocytopenia etc can be treated by Allogeneic transplantation.
The first bone marrow transplant procedure in Dhaka Medical College was performed on March 2014 and the patient was Omar Ali. The excitement and anticipation in the unit before the operation almost reached fever pitch. Doctors, nurses and everyone involved were pensively awaiting Omar Ali’s complete recovery. The expression of joy and relief after the procedure was apparent in the faces of all medical personnel and Omar’s family as Omar Ali recovered lucidly from this operation.    
A total number of 16 patients received bone marrow transplants successfully till date. They have been treated by autologous transplant. Sources said that, the next step of Dhaka Medical College Hospital is to start Allogeneic Transplantations soon.
The bone marrow transplantation team of DMCH is hopeful that the cure rate of the procedure will be 90% however the patients might suffer from some side effects like anemia and infections. This is the cheapest bone marrow transplantation facility in the world. It costs only 5 Lakh Taka, which is approximately 6440 US Dollar. If we see the cost of bone marrow transplantation in other countries we will find that it costs above 40 Lakhs Taka in USA and India and 50 Lakhs Bangladeshi Taka in Singapore. So undoubtedly it’s a great achievement for Dhaka Medical College and extraordinarily good news for patients in our country.
Common side effects
In these circumstances (Autologous and Allogeneic transplantation) the patients may suffer from following side effects like:
Infection from low immunity during transplantation process
Graft versus host disease which is commonly associated with Allogeneic transplantation
High doses of chemotherapy possibly affecting organs and causing life-threatening side effects including mouth sores, nausea, vomiting, diarrhoea, cramps, ulcers etc.
Stem cell transplantation
Before treatment:
The patient will first be evaluated for eligibility. The physician will decide the type of treatment, set a treatment plan before the transplantation, and use chemotherapy and/or radiation in the preparation process.
During treatment:
The patient will be admitted to a special sterile room to reduce the risk of infection. The patient will then receive chemotherapy and/or radiation to kill abnormal cells (normal cells can also be damaged by the treatment).
After the chemotherapy and/or radiation, the peripheral stem cell transplantation will be administered. It also takes time for the bone marrow or stem cells to work properly. The patient will need to be under close observation by specialized physicians, nurses and take precautionary measures so as to prevent possible complications.
History of the bone marrow transplant unit
It was the brain child of Dr. Bimalangshu Dey, the cancer specialist at Massachusetts General Hospital of Boston M A, USA, who instilled his thought in the mind of the health minister of Bangladesh of that time. Prof. M A Khan, the head of Hematology Department of DMCH also helped enormously to materialize this vision.
The unit’s formation had to start from scratch. Starting from staffing, training medical personnel in the ways of bone marrow transplants, arranging logistics and equipment and all the other organizational aspects of restructuring the unit had to be done slowly and meticulously. The unit also needed expert nurses who would give special nursing care to the patient of transplants during Bone Marrow Transplantation (BMT).
With generous contributions from Boston’s Massachusetts General Hospital (MGH) (especially Dr. Bimalangshu Dey), and the Ministry of Health & Family Welfare (MHFW), the AKKHT started the Nursing Training Program on February 19th 2013 giving.
The team from AKKHT along with the nurses from MGH successfully completed this program having 20 BMT expert nurses by the beginning of 2014.
The nurses were certified as BMT specialized nurses by Massachusetts General Hospital (MGH), Directorate of Nursing Service (DNS) of Bangladesh and A K Khan Healthcare Trust (AKKHT). The Nursing Bridge Program (NBP) of AKKHT focuses on improving clinical knowledge and exposure to latest innovation. The training also provided basic computer skills and helped to improve analytical abilities. After completion of training the medical team is more skilled, competent, and motivated on Bone Marrow Transplantation.
 They are taking better care of patients, their behavior & attitude improved and the contribution to the unit is remarkable. Hopefully a new era of treating patients with blood and immunological disorders is upon us and this will have an enormous impact on the lives of the sick and ailing population in our country.
Md. Farhad Hossain,
Senior Nursing Faculty,
A K Khan Healthcare Trust
Dhaka, Bangladesh