Q: I am a 27 years old boy having hypoplastic anaemia and the doctor has given me a total estimate of Rs. 8.44 lakhs as the cost of treatment using ATG at a dose of 40 mg/kg x 5 days. My weight being 67-68 kg, Is it reasonable? Even with such exorbitant cost, the response to it is 65%. I got last transfusion 21 days back. Fortunately, my platelet count has increased in last 3 weeks from 0.18 lakhs/cu mm to 0.32 lakhs/ cu mm though Hb decreased from 10.3 g/dL to 7.6 g/dL. Should I proceed with homeopathy, which expects to cure me in a month or so, without any damage to my immune system? Is it advisable to go for ATG + Cyclosporine, after 8-9 days of homeopathic treatment? Can I get a matched donor for BMT from outside family? Because if in case ATG + Cyclosporine fails, I have been advised BMT even with 7/8 match with father.

A:Dose of ATG in most of published literature is ATGAM 40 mg/kg/day for 4 days. MRP of ATGAM vial is 15,600 INR (250 mg). You will require 43 vials according to your weight and cost will be 6,70,800 INR. This is the cost of ATG only. Cost of cyclosporine and blood product support during therapy will be additional. We do not recommend any alternative form of treatment (either allopathic or homeopathic). Any herbs may cause fungal infection, which may be detrimental in situation like aplastic anaemia. In aplastic anaemia recommendation about Bone marrow transplantation is as follow:

1. - Sibling HLA match (6/6 or 10/10) stem cell transplant.
2. - No match sibling donor - Immunosuppressive therapy (ATG + cyclosporin therapy)
3. - If there is no response to ATG based therapy - search for unrelated HLA match donor form worldwide bone marrow registry (cost goes up to 30 lakhs for this kind of transplant)
4. - If no HLA match donor available on donor search outside family
5. - Give second course of ATG therapy (Preferably rabbit if earlier ATGAM [Horse] is used).
6. - If no response with second course of ATG - look for cord blood stem cell transplant.