Q: The following case is of my grandson. Are there any stem-cells bank in India for supply of implant in Thalassaemia major cases - If so, where? and what is the procedure to get H.L.A. test match implant? What is the risk involved in stem-cell implant in a boy of age 20 years with moderate enlargement of liver and diabetes mellitus?

A:To the best of my knowledge, one of the earliest Haematopoietic Stem Cell Bank, was set up at the Armed Forces Medical Colleges (AFMC) Department of Transfusion Medicine at Pune in early 2001. The Department of Biotechnology (DBT) has launched three major programmes on stem cell research aimed at treating blindness, some types of brain disorders and Thalassaemia. The institutes involved are The LV Prasad Eye Institute in Hyderabad, National Brain Research Centre (NBRC) in New Delhi and National Centre for Cell Science in Pune. Another institution actively working in this field is the National Centre for Biological Sciences in Bangalore and Maulana Azad Medical College in New Delhi. The Reliance Life Sciences Laboratory at Sir Hurkisondas Nurrotumdas Hospital and Research Centre in Mumbai has started functioning only from early this year. A new institution called Pacific Healthcare Womens & Childrens Hospital and Pacific Healthcare Biomedical Research Centre is being set up in Hyderabad for Cord Blood Banking & Stem Cell Research. Prior to marrow or stem cell transplant, the patient is treated by a number of drugs or radiation therapy. Typical regimens use high doses of chemotherapy or chemo-radiotherapy to ablate recipient hematopoiesis and to prevent graft rejection. The widespread use of this treatment has been limited by toxicity, risk of end-organ damage, and donor availability. Criteria for inclusion usually include: 1. Have related donors who are identical at 6 HLA loci (A, B and DR) by molecular typing 2. Have a performance status from 0-2 3. Transfusion dependence, defined as a transfusion requirement of greater than or equal to 6 units of packed red blood cells over the past 12 months 4. Iron over load, defined as serum ferritin greater than 500 in the absence of infection or biopsy-proven iron overload 5. Presence of 2 or more alloantibodies against red cell antigens Exclusion criteria: 1. Pregnancy 2. Acute hepatitis (transaminases greater than 3 times the normal value) 3. Cardiac ejection fraction less than 30 percent 4. Severe renal impairment (glomerular filtration rate less than 30 percent of predicted normal value) 5. Severe residual functional neurologic impairment (other than hemiplegia alone) 6. Seropositivity for HIV The beneficial results of stem cell transplantation from HLA identical family members for patients with severe Thalassaemia are clear. Class I patients have a very high probability of cure with a very low early and late morbidity and mortality. Delay of transplantation until the patient is in a risk category beyond class I substantially reduces the probability of transplant success and jeopardises the reversibility of liver and cardiac damage. But the attendant risks of the procedure itself need to be discussed with your physician and then a decision may be made.