Haematopoietic Stem Cell Transplantation in A Government Setup in India: New Directions in Indian Healthcare; Way To Go!

Introduction: Haematopoietic stem cell transplant (HSCT) is indicated for several haematological disorders as potentially curative treatment option.However, establishing a stem cell transplant unit demands infrastructure, multi-disciplinary services, medical supplies and skilled health care professionals.We established a transplant unit in a government hospital and provided a free of cost HSCT.We are sharing our experience of developing such unit, along with the outcomes of the first 35 HSCTs performed at our center.Methods: It is a retrospective observational study that included patients with hematological disorders, both benign and malignant, who underwent autologous or allogeneic stem cell transplant between September 2021 and August 2023 at Employees' State Insurance Corporation and Medical College and Hospital, Faridabad, India.Results: Of the 35 patients, 15 underwent autologous SCTs (Multiple Myeloma=12 and Classical Hodgkin Lymphoma= 3) and 20 underwent allogeneic SCT (Matched Related Donor (MRD)=9 and haploidentical donor=11).The median recipient age was 35 (range 13-67) years.The median time to neutrophil engraftment was 10(8-21) days, 13(10-14) days and 17(14-19) days for autoSCTs, MRD and haploSCTs respectively.The median time to platelet engraftment was 12(11-27) days for autoSCTs, 15(12-17) days for MRD and 18(15-20) days for haploSCTs.Acute GVHD was seen in 5(25%) patients, whereas 2(10%) had chronic GVHD.The median follow-up duration was 248(15-780) days.Overall survival (OS) and Progression free survival (PFS) for entire cohort was 248(15-780) days and 192(15-780) days respectively.Overall survival and PFS in in auto SCTs cohort was 224 (57-780) days, in MRD transplant group it was 511(94-687) days and 180 (94-687) days respectively whereas in haploSCTs it was 248 (15-519) days and 192 (15-519) days respectively.The OS rate at last follow-up for whole cohort was 91.43%.Precisely, OS for autoSCTs, MRD and haploSCTs was 100%, 88.89% and 81.82% respectively.The progression free survival rate at last follow-up for whole cohort was 77.14%.PFS for autoSCTs, MRD and haploSCTs was 100%,77.78% and 45.45 % respectively.Conclusion: Our experience illustrates that the developing a SCT unit and performing HSCTs including haploSCTs is possible, even in resource limited settings.We strive to constantly improve our outcomes and provide this life saving modality of treatment to substantial number of patients.