Transplant & Cellular Therapy

Haematology Consultation Services

Our Centre provides specialist consultation for the treatment of blood disorders and blood cancers. These include various types of anaemia (e.g. Sickle Cell Anaemia, Fanconi Anaemia, Aplastic Anaemia, among others), thalassaemia, marrow aplasias, coagulation disorders, acute and chronic leukaemias, myelomas, lymphomas, and lympho-proliferative disorders.

Haematopoietic Stem Cell Transplant Programme

Our Centre supports and coordinates all activities of transplants including classical allogeneic stem cell transplant, non-myeloablative allogeneic stem cell transplant (or mini-transplant), autologous stem cell transplant and umbilical cord blood transplant.

Outpatient Chemotherapy

Our Centre has a day care facility for patients to receive outpatient chemotherapy.

Blood Transfusion Services

Transfusion of red blood cells, platelets, plasma, and other blood products are available at our Centre for those who need blood transfusion.

Supportive Care Programme

A sophisticated supportive care programme is available to help patients who are convalescing from chemotherapy and stem cell transplant. This includes day care, teaching class on the care of central venous catheters, outpatient antibiotics, and infusional therapy.

Apheresis Programme

Our apheresis programme includes the collection of stem cells, white blood cells, platelets, plasmapheresis, and photopheresis.

Biological and Cellular Therapy

We provide treatment and facilities for the administration of monoclonal antibody, interferons, growth factors, and other specific agents.

Haematopoietic Stem Cells are blood cells at the earliest stage of development in the bone marrow. Within the bone marrow, stem cells develop into different blood cells. These blood cells include erythrocytes (or red blood cells), leukocytes (or white blood cells), and thrombocytes (or platelets).

Erythrocytes (Red Blood Cells)

The erythrocytes, or red blood cells (corpuscles), contain haemoglobin (substance that is able to bind with oxygen). Oxygen from the lungs is carried by the erythrocytes to all the tissues of the body. A person who has anaemia, a condition caused by too few erythrocytes in the blood, may experience weakness, fatigue, and shortness of breath.

Leucocytes (White Blood Cells)

There are five different types of leukocytes, or white blood cells, within the body, including the following:

• Neutrophils
• Basophils
• Eosinophils
• Monocytes
• Lymphocytes

These cells fight viral, bacterial, and other infections, and participate in the hypersensitivity responses seen in allergic reactions.

Thrombocytes (Platelets)

Although platelets are classified as a type of blood cell, they are actually just pieces of megakaryocytes (bone marrow giant cells that contain a many-lobed nucleus [cell center]). Platelets are the major blood-clotting elements of the body. They group together to seal off blood vessel damage caused by cuts or other traumatic injuries.

A person with low level of platelets in the circulating blood (thrombocytopenia) may experience excessive bleeding.

Haematopoietic Stem Cell Transplantation is a medical treatment by which non-functioning, deficient bone marrow or malignant cells are eliminated using high-dose chemotherapy, with or without radiation therapy. This is followed by bone marrow or peripheral blood stem cell (PBSC) or cord blood replacement or rescue in order to restore haematologic and immunologic function.

Purpose of Haematopoietic Stem Cell Transplantation

Haematopoietic Stem Cell Transplantation will allow high doses of chemotherapy, with or without radiation therapy to be given. Because of the intensity of this treatment, the patient’s ability to produce blood cells is destroyed. Healthy stem cells (harvested from bone marrow or peripheral blood or cord blood) are infused or "transplanted" into the patient. It takes about two to three weeks for the stem cells to re-grow (engraft) in the bone marrow space, and eventually produce blood cells.

Applications of Haematopoietic Stem Cell Transplantation

• Replacement therapy for severe aplastic anaemia (marrow failure) and congenital immunodeficiency disorders
• Gene therapy for thalassaemia major and sickle cell anaemia
• Cell and immunotherapy for the treatment of leukaemias and other haematological malignancies
• Stem cell rescue therapy, used mainly for certain haematological malignancies, like lymphomas and myelomas
• Restoration of deranged immune system as in severe auto-immune disorders

Sources of Haematopoietic Stem Cell

• Compatible sibling/family member (Allogeneic Haematopoietic Stem Cell Transplantation)
• Unrelated donor (Unrelated Allogeneic Haematopoietic Stem Cell Transplantation)
• Umbilical cord blood
• An identical twin (Syngeneic Haematopoietic Stem Cell Transplantation)
• Patient’s own cells previously collected and suitably stored (Autologous Haematopoietic Stem Cell Transplantation)

Process of Haematopoietic Stem Cell Transplant

• Consultation with Dr. Patrick Tan, Medical Director & Haematologist, for medical assessment and evaluation for suitability for transplant
• Discussion with patient and family
• Planning for transplant and financial counselling
• Pre-transplant investigations for patient and donor
• Pre-transplant family conference
• Conditioning regimen
• Infusion of stem cell on the day of transplant
• Post transplant management
• Medium and long term follow-up

A team of doctors and other healthcare professionals will be involved in the transplant. The transplant health care team includes:

• Haematologist (Primary Physician)
• Infectious Disease Physician
• Intensivist
• Renal Physician
• Respiratory Physician
• Radiation oncologist
• Transplant Co-ordinator
• Nurses
• Dietitian
• Pharmacist
• Other clinical support staff

Other specialists may also be asked to see the patient if any other problems should develop.