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Apollo Proton Cancer Centre, Chennai, performs total marrow irradiation

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Saves 35-year-old nurse from Oman battling for life with chronic myeloid leukaemia (CML) in blast crisis

Apollo Proton Cancer Centre (APCC), Chennai successfully performed total marrow irradiation (TMI) as a conditioning protocol prior to bone marrow transplant.

Dr Preetha Reddy, Vice Chairperson, Apollo Hospitals Group said, “The Apollo Proton Cancer Centre has opened new frontiers in cancer care and it is a proud moment today, just a few months after the launch, to see the APCC achieve this significant landmark with two successful cases of total marrow irradiation for the first time in the country. This achievement validates our investment in the APCC in bringing this best and latest medical technology to India. We are sure that the future will see the APCC achieve many more milestones and take the battle against cancer forward not just for patients in India but also from South East Asia.”

A 35-year-old nurse from Oman underwent the procedure at South East Asia Proton Therapy Centre. She was diagnosed with chronic myeloid leukaemia (CML) with mixed phenotypic acute leukaemia. After the diagnosis, she underwent chemotherapy 2 cycles at Oman and achieved remission and then referred to Apollo for bone marrow transplant. The doctors at Apollo decided to proceed with total marrow irradiation based conditioning for the transplant.
The total marrow irradiation was successfully conducted from April 18-20 and it was followed by two days of chemotherapy. The patient subsequently underwent the peripheral blood stem cell transplantation on April 23, 2019.

“The 35-year-old patient was admitted to our hospital last month and after detailed diagnosis, we decided to proceed with total marrow irradiation followed by chemo and peripheral blood stem cell transplantation. The patient’s brother turned out to be a full-matched donor. The patient has responded very well to the treatment and is getting ready for discharge,” said Dr Jose M Easow.

“The advantages of total marrow irradiation over total body irradiation is that only the bone marrow is irradiated and the normal organs are spared like eyes, thyroid, heart, lungs, kidneys, ovaries, both large and small intestines. So a higher dose can be delivered to the bone marrow sparing the normal organs, whereby long term side effects can be minimised,” said Dr Srinivas Chilukuri, Senior Consultant Radiation Oncology.

People with certain types of cancers or other diseases including leukaemia, lymphoma and multiple myeloma can undergo a BMT as part of their treatment. Before the transplant, chemotherapy and/or radiation may be given to eradicate any cancer in the marrow. Traditionally, total body irradiation (TBI) is part of the conditioning regimen before the bone marrow transplantation. This procedure involves providing radiation to essentially the entire body.

“The challenge in this case was to be able to deliver adequate doses of radiation to bone marrow and sparing other normal organs such as lungs, heart, bowel, kidneys, liver, eyes and oral cavity. With modern radiation technology it is now possible to deliver total marrow irradiation (TMI) which spares the normal organs from radiation induced damage thereby improving survivorship without altering high survival rates of bone marrow transplantation,” added Dr Chilukuri.

“TMI is an extremely time and labour-intensive procedure with gratifying possibilities and will provide hope to patients towards a better life free of major morbidities,” added Dr Jose M Easow.

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