Paediatric Haematology Oncology and BMT

PAEDIATRIC HEMATOLOGY

Blood disorders are not uncommon among children; however awareness about them is lacking, leading to a delay in diagnosis and treatment. Blood disorders include inherited or acquired problems with red blood cells, white blood cells, platelets, clotting factors or bone marrow. Also, blood disorders in the Paediatric age group are often different from that in adults hence needing specialised care. Paediatric Hematology is a branch of medicine that deals with the diagnosis and treatment of children with blood disorders.

The department of Paediatric Haematology at FMRI cares for children with all blood disorders including:

  • Anaemia- such as Nutritional Anemias, Thalassemia, Sickle cell disease, hereditary spherocytosis, Pure red cell aplasia, Diamond Blackfan anemia, etc
  • Bleeding disorders
  • Coagulation disorders
  • Thrombocytopenia or low platelets
  • Leucopenia (low white blood cell count) or neutropenia (low neutrophil count)
  • Aplastic anaemia
  • Inherited bone marrow failure syndromes
  • Splenomegaly and disorders of splenic function
  • Hemophagocytic Lymphohistiocytosis (HLH)
  • Langerhans cell histiocytosis (LCH)
  • Primary Immunodeficiency disorders
  • Inborn errors of metabolism
  • Blood cancers

The Division of Paediatric Hematology at FMRI, Fortis comprises of a team of well qualified and experienced Paediatric Hematologist’s who have been trained in the field from some of the prestigious institutes in the world. We also have the support of an in-house modern, well equipped laboratory with dedicated haematopathology services and an in-house blood bank providing comprehensive care for these children.

We as a team are trusted by many countries and we have treated children from all across the world with excellent outcomes.

Paediatric Bone Marrow Transplant (BMT)

Transplantation is the process of taking an organ or living tissue and implanting it in another body. Bone marrow transplant is performed to replace unhealthy bone marrow stem cells with healthy ones. This is a relatively newer branch of medicine and the first successful Paediatric BMT was performed in 1968 at the University of Minnesota, USA. In India, the first successful Paediatric allogeneic bone marrow transplantation was done at Tata Memorial Hospital on March 20, 1983, on a nine-year-old girl with acute myeloid leukemia. Since then, many sophisticated Paediatric hematopoietic stem-cell transplant centers (HSCT) have been established across the nation. Over 1000 successful BMT have been done in FMRI, Fortis for the past 10 years. For BMT in Paediatric patients, Fortis Memorial Research Institute, Gurugram has a dedicated team of doctors and nurses who are very well trained and experienced in caring for children.

Bone marrow in our bones contains a subset of cells known as “hematopoietic stem cells” or simple “stem cells” which are responsible for the formation of blood cells. These cells have special characteristics i.e. they can renew themselves, and have the capability to develop into any type of blood cells. Nowadays, hematopoietic stem cells can also be obtained from peripheral blood after treatment with certain growth factors or from the umbilical cord. During Paediatric Bone Marrow Transplantation, the stem cells are injected into a recipient after a short course of chemotherapy called conditioning. Today, this is a viable option for several genetic disorders, blood disorders, and childhood cancers and with continued research, success has remarkably improved. 

The process of donating stem cells is just like donating blood or platelets and poses no risk to the donor.

Different Types of Paediatric BMT

There are two types of Paediatric BMT:

Paediatric Allogeneic BMT: Donor and Recipient are two separate individuals and BMT is done using the stem cells of the donor. It may be:

Matched Related, where the donor is HLA matched relative usually a sibling.

Matched Unrelated, where the donor is not a relative of the patient and usually found from one of the various national or international registries.

Partially Matched Related, where the donor is from a patient's family but partially matched (haploidentical).

Paediatric Autologous BMT:Donor and Recipient are the same individuals. BMT is done using the patient's stem cells. The procedure involves giving a high dose of chemotherapy to the patient to remove the primary disease. Thereafter, an autologous transplant is conducted to rescue damaged bone marrow. This type of transplant has a minimal complication and is preferred for diseases like neuroblastoma, high-risk medulloblastoma, lymphomas, etc.

Who requires Paediatric BMT?

The following are some of the indications for BMT in children:

  1. Blood cancers:
  • Acute Myeloid Leukemia (AML)
  • Chronic Myeloid Leukemia (CML)
  • Hodgkin Lymphoma (HL)
  • Non-Hodgkin Lymphoma (NHL)
  • Myelodysplastic syndrome (MDS)
  1. Non-Cancerous Conditions:
  • Thalassemia
  • Sickle cell anemia
  • Aplastic anemia
  • Inherited Bone Marrow Failure Syndromes
  • Metabolic disorders
  • Immunodeficiency states

HIGHLIGHTS OF OUR UNIT INCLUDE:

  • Expertise: FMRI is home to a national and international leader in Paediatric bone marrow transplantation and graft-versus-host disease.
  • Research: Our team of experts leads to groundbreaking research in many aspects of Paediatric BMT and other related fields.
  • Early Intervention: As Paediatric BMT experts, we specialize in identifying the first signs of this condition to protect your child from severe complications.
  • Safety: As an experienced transplant program, we take every precaution to ensure all children have a safe procedure

With the technological advances and use of newer agents for Paediatric BMT, the success rate of Paediatric BMT has improved tremendously. The cure rates depend on the disease being treated and the condition of the patient at the time of the transplant. In general, the younger the patient, the better the outcomes.

PAEDIATRIC ONCOLOGY

Paediatric Oncology as a speciality was virtually nonexistent in India until the late 1980s. Most children with cancer were treated by adult oncologists in a few cancer centers.  The Paediatric Oncology Group at Fortis Memorial Research Institute, Gurugram comprises of a dedicated team of doctors and nurses who are  very well trained and experienced in caring for children with cancer.

Diagnosis of cancer is upsetting at any age, but especially so when the patient is a child. The initial diagnosis can be frightening for the parents as well the child. There is a lot of misconception and lack of information about childhood cancer.

Cancers in children are not always treated like adult cancers. Also, the type of cancers that children get are different from that seen in adults. Paediatric Oncology is a medical speciality focusing on effective treatment of children with cancer and is associated with excellent outcomes. So bottom line is that ALL CHILDHOOD CANCERS ARE TREATABLE AND MAJORITY ARE CURABLE.

In general, cancer can affect any part of the body. The most common cancer being – leukemia (blood cancer), brain tumor, cancer affecting the bone or muscle. The other types of childhood cancers are lymphomas (cancer of the lymph nodes), neuroblastomas (adrenal gland), Wilm’s tumor (kidney), sarcomas (muscle and bone) and other cancers seen in the very young children (embryonal cancers). As of today, >80% of children with cancer are cured, depending on the type of cancer they are suffering from.

We have a dedicated team of well-qualified Paediatric Hematologist/Oncologists here at Fortis Memorial Research Institute, Gurugram, who have been trained in the field from some of the prestigious institutes in the world.

We as a team are trusted by many countries and we have treated children from all across the world with excellent outcomes.

HIGHLIGHTS OF PAEDIATRIC ONCOLOGY SPECIALITY

Individualised treatment

The type of treatment that a child with cancer receives depends on the type and stage of cancer. Common treatments include: chemotherapy, radiation therapy, immunotherapy, surgery and stem cell transplantation.  The treatment is based on risk stratification and is individualized.

Dedicated Paediatric Hematology-Oncology-BMT tumor board

We have weekly tumor board meetings where all new cases and medically relevant issues are discussed during these sessions.

Versatility in capability

As a Paediatric Oncology group, we see a gamut of diseases which include Leukemia, Lymphoma, Bone tumors, CNS tumors, sarcomas, neuroblastoma, renal tumors, germ cell tumor, etc.

Survivorship/ Late Effects Clinic

With prolonged survival, late effects of cancer are being recognised which vary with the type of cancer, the child’s age, the type of treatment and other factors. Therefore, it is essential for these survivors to receive follow-up care to monitor their health after completion of treatment.

 Support group meetings – They are conducted every 4 months in our hospital, which is a boost for our patients and their families.  We also organise Children’s Day and Christmas party for all our patients once a year which is a platform to celebrate our champions (all the children battling cancer).

As Danny Thomas (founder of St Jude Cancer Research Hospital, USA) said “No child should die in the dawn of life”  – this is what we as a group are striving for.

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