Bangladesh begins bone-marrow transplant

Bangladesh on Monday started pushing back stem cells of a blood cancer patient at Dhaka Medical College and Hospital in what the health minister formally announced was its first bone-marrow transplant.

“We have successfully begun it today,” Mohammed Nasim said at a crowded press conference flanked by his junior minister and other health administrators at DMCH where the first-ever bone-marrow transplant unit is housed.

He said it opened “a new era” of medical opportunities in Bangladesh where he said more than 11 percent of the total cancer patients suffer from blood cancer that affects production and function of blood cells.

“But patients have to travel abroad and spend Tk 5 million to Tk 10 million for such transplant,” he said but added they were yet to decide how much the centre would charge a patient.

In-Charge of bone-marrow centre Prof MA Khan said it would take two or three weeks to complete the process of pushing back stem cells of the patient and then the 52-year-old man suffering multiple myeloma might be released.

He did not name the patient or present his relatives before media for privacy.

“Ninety percent patients cure fully and internationally it is seen that in 10 percent cases the disease recurs,” he said.

The process of introducing such sophisticated medical technology began in Oct 20 when the centre was inaugurated.

The government tied up with the Boston’s Massachusetts General Hospital (MGH) and trained up nurses and doctors for the procedure.

“We were preparing the patient in the meantime (until Sunday) and at the same time taking ‘fail-safe’ mechanism before starting the final process (of pushing back stem cells),” Prof Khan said.

Doctors call his transplant procedure ‘autologous’ in which the patient’s own bone marrow is used.

Stem cells were harvested from him and frozen while drugs were given to remove the cells causing the damage.

Now doctors started transplanting the cells back to regenerate normal blood cells.

The hospital has selected some patients for carrying out the procedure free of cost at least for the next three months.

The centre has five isolated cabins where as many patients can be treated at a time. But it has decided not to do more than 20 cases in the first six months to learn about the whole procedure ‘effectively’.

“We took all measures so that nothing goes wrong in the first case,” Prof Khan said and added doctors and nurses had to undergo extensive training beforehand.

He said before starting the final process on Monday they had to take go ahead call from the MGH.

“A specialist from Vellore Christian Medical College and Hospital visited the centre on Feb 1 and reported back. MGH doctors analysed the report and then said ‘now you can do’,” Prof Khan said.

Officials earlier said for an autologous procedure the hospital will charge between Tk 0.5 and 0.6 million while for the allogeneic in which bone marrow of siblings or donors are used would be between Tk 1 million and 1.5 million depending on patients.

The second procedure, allogeneic, is more critical and so Prof Khan expects to start it once the autologous procedure became successful.

He said they would look forward to form public-private partnership (PPP) or cost-sharing ways to keep the prices low.

Dr Bimalangshu Dey, a Bangladesh-born American at the MGH who acted as a coordinator to set up the centre in Dhaka, said it was a “very high-level technology”. “We have to maintain it”.

He said they tried to ensure that “the standards are as high as those in Boston”.

“This is the way it should be done,” he said and added “if we can maintain this we can keep rich patients who go abroad here”.

But it would be challenging since he said the manpower trained would often need further training at home and even in the US.

“Allogeneic is a more difficult business to carry on.”

He suggested the government tailored a budget for that.

However, there is no provision that can prevent transfer of these trained staff from the state-run DMCH.

Doctors fear there is always the chance of their transfer since there is no guidelines on training and posting of doctors and nurses in Bangladesh.

The health minister, replying to a question, said he had stopped all transfer and posting for now but there is no official order to that end.