Blood and Bone Marrow Transplantation in India: Past, Present, and Future

Abstract

Interest in the field of bone marrow transplantation was kindled in the early 1950s when laboratory and clinical experiments had begun in the US and France, triggered by the injury caused by nuclear warfare, during and post-WWII. Animal and laboratory experiments provided proof of the principle. As many patients with marrow aplasia and advanced leukemia had no curative treatment, clinical transplants were done as experimental procedures; however, due to lack of adequate knowledge in transplantation immunology and inadequate supportive care, most of them died either due to relapse, infection, or severe graft-versus-host disease (GVHD). took conviction of Thomas, first at Cooperstown, then at Fred Hutchison Cancer Research Center (FHCRC), Seattle, to pursue the procedure; better understanding of transplantation immunology through the works of many biologists, specially by Peter Medawar and dog experiments at Seattle, helped to find effective conditioning regimens and GVHD prophylaxis and soon led to a series of successful human allogeneic bone marrow transplants in acute leukemia and severe aplastic anemia. By the late 1970s and early 1980s, the field exploded with many centers performing the procedure across the world. In subsequent years, the indications expanded with autologous transplants for chemosensitive diseases such as lymphomas, myeloma, and some childhood tumors; dearth of matched sibling donors made it necessary to explore matched unrelated donors (MUDs) and umbilical cord blood as sources of hematopoietic stem cells. In recent years, the use of haploidentical transplants has shown exponential increment.