June 2014 saw the first allogeneic bone marrow transplant (BMT) performed on Sri Lankan soil, more than 50 years after Dr. E Donall Thomas performed the first such successful transplant globally, for which he was awarded the Nobel prize. This heralded a new era in the history of medicine in Sri Lanka by making available this life saving procedure to myriad patients, the vast majority of who are unable to muster up the ‘millions of rupees’ required to travel overseas to get a transplant. Asiri Central Hospital proudly celebrates the 10th Anniversary of this pioneering effort in June 2024. The team at Asiri Central Hospital have not restricted themselves to providing excellent care for patients attending the Bone Marrow Transplant Centre at Asiri but have been happy to share their experience by way of training and mentoring transplant teams consisting of doctors and nurses preparing to start bone marrow transplant in state hospitals. BMT start-ups at Lady Ridgeway Hospital (LRH) and TH Jaffna were 2 such hospitals that ‘Team Asiri Central’ have assisted.
This ‘team’ is headed by Prof. Lallindra Gooneratne, Professor in the Department of Pathology, and Honorary Consultant Haematologist, Faculty of Medicine, University of Colombo, and the Director of the Clinical Haematology and Bone Marrow Transplant unit at Asiri Central Hospital since its inception. He, together with Dr. Ruwangi Dissanayake, Senior Lecturer in the Department of Paediatrics, Faculty of Medicine University of Colombo and Consultant Paediatrician at LRH and a team of very dedicated nurses pioneered BMT in Sri Lanka. The start-up was facilitated by Dr. Lawrence Faulkner and a team of doctors and nurse from ‘Cure-2-children’ foundation Italy, who were present on site for over a month overseeing the first 2 transplants and providing hands on training to the local team. This was preceded by a number of virtual training sessions by the Italian team.
Allogeneic transplants entail removing the patients diseased bone marrow with very high doses of chemotherapy, thereby providing space for ‘new bone marrow’. A genetically compatible donor has to be identified and willing to donate stem cells which are collected from the bone marrow or mobilized into the circulation by way of a course of injections and connecting the donor to a device called an apheresis machine. The donor stands to lose almost nothing as his blood cells are replenished in a few weeks. This is in contrast to solid organ transplants such as kidney transplants, where the donor loses for example a kidney. Therefore, finding a genetically compatible donor is mandatory. However, with advances in BMT techniques transplants can now be carried out with just a 50% genetic match between patient and family donor, making BMT possible for most patients. This complex procedure is gaining favour worldwide due to the availability of a donor at hand in most instances. The BMT unit at Asiri Central has also adopted and mastered this technique and has been performing such ‘haplo-identical transplants’ over the past few years. They have also been doing unrelated donor transplants, where stem cells from compatible donors in other countries such as India are flown to Sri Lanka and provided to the patient.
BMT is a life-saving procedure for conditions such as aplastic anaemia and myelodysplastic syndrome which result in bone marrow failure and likely death. It can also cure certain high risk or relapsed leukaemias and lymphomas. It is currently the only widely available cure for children with thalassaemia and immunedeficiency disorders. BMT is also offered to patients with multiple myeloma. The BMT unit at Asiri Central has been providing these services to both children and adults over the past 10 years and their pride is that they don’t just save lives but develop long term relationships with patients and their families for life. The numerous testimonials from patients and parents bear witness to the dedication and commitment of the team during the grueling journey of transplant.
The Unit also provides a facility to treat patients with all types of blood and bone marrow cancers such as leukaemia, lymphoma and myeloma by administering chemotherapy as ‘in-patients’ and in a day-care setting, maintaining the highest standards of care 24/7. Asiri Central is the only private hospital in the country which has a blood irradiator, mandatory for blood products used for BMT and treatment of some types of blood cancer, the Asiri Group also houses the only PET scan machine in the private sector, which is essential for staging and monitoring of certain blood cancers. Asiri also has a facility to give radiotherapy to patients with blood and bone marrow cancers needing them and total body irradiation to patients who require same for bone marrow transplants. Therefore, it is the only group of private hospitals in the country which has all the necessary facilities to treat blood and bone marrow cancers and perform bone marrow transplants at the highest level of care.
The BMT Unit at Asiri Central Hospital is accredited by the Postgraduate Institute of Medicine, University of Colombo as a training facility for postgraduate trainees in Clinical Haematology.
The BMT team at Asiri Central includes experienced consultants in specialties such haematology and clinical haematology, paediatrics, adult medicine, transfusion medicine, nephrology, psychiatry, radiology, microbiology, radiation oncology, paediatric surgery, anaesthesiology, genetics, intensive care and others. In addition, its treasure lies in the highly committed and experienced nursing team headed by Sister Mahawatte.
A team which has been in existence for a decade acquires a lot of experience in handling diverse complications which are common and varied in BMT. This together with the level of dedication and commitment of its members and the futuristic vision of its leaders provides the backbone for the success of the oldest BMT unit in Sri Lanka.