Stethoscope: Thank you Sir, for your time. Please tell our readers about the various treatment options available at BMTU in DMCH.
Prof. M A Khan: As the name suggests our BMTU deals mostly in treating tumors of blood and lymph nodes by transplanting diseased bone marrow with healthy marrow. There are two types of bone marrow transplants:
Autologous Bone Marrow Transplant:
In autologous transplants, the transplanted stem cells come from the body of the patient having the transplant. The doctors remove the stem cells from the patient, store them, and then put these cells back after destroying the cancer or diseased cells with conditioning. Till date we have performed 21 successful bone marrow transplants. The patients we have treated are mostly patients of lymphoma, multiple myeloma and myeloid leukemia.
Allogeneic Bone Marrow Transplant:
For some diseases, the transplanted stem cells come from another person, called a donor. Donor transplants are called allogeneic transplants. Why use another person’s stem cells? Often the patients own blood cells are simply too diseased to be given back to them. We have not yet performed any allogeneic transplants yet but we hope to start this December.  
Stethoscope: Sir, you just mentioned that only Autologous transplants are being done now. Please tell our viewers, why the delay in performing Allogeneic Bone Marrow Transplants? What potential challenges lie ahead?
Prof. M A Khan: Allogeneic bone marrow transplants are performed by harvesting marrow from a donor. The challenges of doing allogeneic transplants are several. First; transplanting marrow from a donor requires the donor’s Human Leukocyte Antigen (HLA) to match with the recipient’s HLA type. In principle, the HLA is an antigen similar to the antigens and antibodies which determine a person’s blood type; however the HLA has greater specificity in determining if a graft, tissue or organ will be better able to survive inside a recipient following a transplant. If the HLA between donor and recipient is not compatible then graft rejection will definitely develop. Even if HLA types match, the chances of graft versus host disease cannot be ignored completely. Graft-versus-host disease (GVHD) is a complication that can occur after a stem cell or bone marrow transplant. With GVHD, the newly transplanted donor cells attack the transplant recipient's body.
That’s why a patient who receives a transplant from a donor must be treated, for long periods with steroids, immunosuppressive drugs and followed up frequently and vigorously. Even in countries with well established BMTUs, the mortality rate of allogeneic transplant patients is as high as 15%. In autologous transplant the patient is receiving his own marrow and that’s why mortality rate is much lower. I would like to make a humble request to all patients, their caregivers, health professionals and news agencies to remember this fact that mortality soon after allogeneic transplants is common and despite these tremendous odds we ask for your confidence, patience and cooperation in the days which follow. The journey ahead for allogeneic transplants will be one of hope and heartbreak.
Harvesting bone marrow is another problem. Traditionally siblings make the best donors for any transplant procedure as the chances of HLA match are much higher. Because of reduced family size, potential donors are growing thin. So here at DMCH we are making an inventory of donors based on Human Leukocyte Antigen; something similar to a blood donor’s inventory. The Bone Marrow Donor will donate his or her marrow without any payment. The recipient’s party will be required to pay for procedures like the HLA testing, bone marrow harvesting and other procedures.          
Stethoscope: What other challenges are you facing in your endeavors here at DMCH?
Prof. M A Khan: Optimum levels of cleanliness and hygiene have to be maintained at every stage of a bone marrow transplant. Thorough asepsis is mandatory to keep patients safe and this can be very expensive indeed. We, at the BMTU are indebted to the Ministry of Health for all its cooperation in this regard; however files, funds and paperwork take a long while to process. Sometimes this wait can really slow down our work. Often we find patients whose tumors need to be down-staged with other forms of cancer treatment. This may often require significantly more funds then what the patients can afford.    
A public private partnership is required especially keeping in mind the specific services, finances and treatment options required for individual patients. I would like to make an appeal to all philanthropists and benevolent people in Bangladesh; a generous contribution to the DMCH BMTU can easily pay for all services and logistics needed for sterilization. Donations can also help less financially solvent patients pay for the full treatment regimens they need to fight their tumors.
Stethoscope: Do you have any plans to help patients with Thalassemia?
Prof. M A Khan: We intend to start soon. The main challenge is that, children with Thalassemia have problems with iron overload and other metabolic disturbances. It is also good to remember that children with advanced disease and visceromegaly (enlargement of organs mostly liver and spleen) may not respond well to bone marrow transplant. But children diagnosed at an early stage of the disease can be and will be treated after we have formulated and efficient protocol.
Stethoscope: Thank you Sir for your time and best wishes for BMTU from everyone at The Independent.