Q: Which hospitals in India carry out a bone marrow transplant to cure CLL? What is the approximate cost involved? What is the success rate for these transplants?

A:Chronic lymphocytic leukaemia (CLL) is a type of blood cancer characterised by a progressive accumulation of a type of white blood cells called lymphocytes in the blood. The incidence of this disease is much higher in Western populations compared to Asians, though now it is beginning to show a rising trend here as well. It is a disease of the elderly (sixth decade), but is now increasingly being seen in people in their 30s. The onset of CLL is insidious and the diagnosis is often made incidentally when a blood test is done for some other reason. Treatment is governed by the stage of the disease and primarily comprises chemotherapy, including the use of monoclonal antibodies. The role of marrow transplant in CLL was previously restricted due to the age of the patients (most over 60 years), risk of BMT, absence of a suitable donor, increased number of leukaemic cells in marrow, etc. Lately, there is a trend for BMT though the indications for it are limited and the patient selection criteria strict. The facility is available at a large number of institutions in the country including All India Institute of Medical Sciences, New Delhi, Tata Memorial Hospital, Mumbai, Christian Medical College, Vellore, Manipal Hospital Bangalore, Gujarat Cancer Research Institute, Ahmedabad, Jaslok Hospital, Mumbai, Apollo Hospital, Chennai and many more. The cost will vary with the institution but is generally around Rs 6-8 lakh for autologous and 10-12 lakh for allogeneic transplant. The success rate varies at each institution depending on the experience of the centre. You should consult your primary treating physician and he/she would be able to guide you.