Myelodysplastic Syndrome TP52 Gene Flaw Immunotherapy BMT

Sample Opinion // Myelodysplastic Syndrome Neoplasms// Acute myeloid leukemia (AML) // TP53 gene flaw // Immunotherapy // Allogenic Bone Marrow Transplant // Treatment in India

Diagnosis: 

According to the reports shared, the patient is a potential case of Myelodysplastic Neoplasm. The Next Generation Assay report indicates a strong indication of TP53 gene flaw. 

The TP53 gene is a crucial tumor suppressor gene that produces the TP53 protein, which regulates cell division and prevents uncontrolled cell growth.

Myelodysplastic neoplasms or Myelodysplastic Syndrome (MDS) are a group of blood cancers where immature blood cells in the bone marrow fail to mature into healthy, functional cells. This ineffective blood cell production leads to low levels of red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia), resulting in fatigue, increased infections, and bleeding issues. Symptoms include shortness of breath and tiredness from anemia, easy bruising or bleeding from low platelets, and infections from low white blood cells

Myelodysplastic syndromes (MDS) are a group of cancers where the bone marrow produces abnormal blood cells that don’t mature properly, leading to low blood cell counts and potentially progressing to acute myeloid leukemia (AML). 

Acute myeloid leukemia (AML), also known as acute myelogenous leukemia, is a cancer of the blood and bone marrow where abnormal blood cells called blasts rapidly multiply, creating shortage of white blood cells, Red Blood Cells and platelets.

We will need to do some tests before going ahead with the treatment. 

Investigations Needed: PET CT, Biopsy, Molecular studies, a fresh Bone Marrow aspiration and other routine tests.

Treatment Plan: 

After clinical evaluations if the diagnosis is confirmed, the following needs to be considered. Patient may first require Chemotherapy + Immunotherapy for 3- 4 cycles. A normal chemo is often found to be less effective in TP53 gene mutation. Thus, he may need immunotherapy. 

Once Remission is achieved, Patient will need to proceed to Allogenic Bone Marrow Transplant.

Bone Marrow Transplant is the transplantation of hematopoietic stem cells, usually derived from b one marrow, peripheral blood, or umbilical cord blood. Allogenic Bone Marrow transplant takes place when we take Bone Marrow Donation from a matching donor.

When the donor is a complete match and is from the same family, it is called full matched allogenic transplant. It is mostly biological siblings who come out to be a complete match.

If at all, we do not get full matched donors from within the family, we can take half matched donors. This is called Haploidentical Bone Marrow Transplant. These donors can be half matched by siblings or parents. Though in this case, fully matched is preferred for better outcomes.

Kindly Note: The plan advised is solely based on the reports shared with us. The final line of treatment will be decided post the physical and clinical evaluations of the patient on arrival only.

We’d recommend the following hospitals having acclaimed Bone Marrow Transplantation doctors as below:

1. BLK-MAX Super Specialty Hospital // Dr. Dharma Choudhary  

2. Manipal Hospital-New Delhi // Dr. Divya Bansal  

3. Amrita Hospitals // Dr. Pravas Mishra 

4. Artemis Hospital, Gurgaon // Dr. Gaurav Dixit   

5. Sarvodaya Healthcare, Faridabad // Dr. Dinesh Pendharkar 

Estimated costs:

Estimated cost of Initial Evaluations will be approx. USD 1800-2400 on OPD basis

Estimated cost of Chemotherapy + Immunotherapy Per cycle at various hospitals will be approx.:-

Estimated cost of Allogenic BMT at various hospital will be approx.:-

In case, there is no full matched donor available, and Haplo identical allogenic bone marrow transplants need to be done, an additional cost $6000-$9000 is incurred over and above the cost given above for full match Allogenic BMT.

Stay in India: Patient will need 5-7 days for investigations as outpatient.

For Chemotherapy – The patient may require 2 months for chemotherapy which will be done on day-care basis, in case the disease is still active.

For BMT – The transplant will take 21 days stay in hospital. Post-Transplant he will still take another 30-45 days of post BMT OP follow up before he can fly back.

In total he may need to plan for about 3- 4 months stay in India.

Kindly Note – The given cost is a tentative cost based on the shared information. The exact line of treatment and cost can be provided only after reviewing the latest investigation. Kindly note that costs may change in case the diagnosis or line of treatment changes or is due to any other prevailing situation.

Inclusions of BMT Package: –

1.  Pre transplant work up includes confirmation of disease with staging, hematological and biochemical            work up, virological screening, echocardiogram, pulmonary function test and other investigations
2.  Hospitalization for the patient for 3 weeks in HEPA filter room
3. Hickman catheter insertion
4. Immunosuppressive drugs
5.  Growth factors (G-CSF), Antibiotics, Antifungal and Antiviral drugs
6. Blood products (PRBCs, Platelets, FFP).
7.  Laboratory investigations during transplant (Hematological, biochemistry, blood culture, drug assay for cyclosporine).
8.  Radiological investigations
9. Doctor’s fees & Nursing charges

Exclusions:

1.      Any consultation other than in discussion
2.      Extended stay.
3.      Treatment for any other illness.
4.      Take home medications 
 
On Arrival: Patient will be received at the airport by our Representative. Apart from the medical and nursing team, one Case Manager will take care of all the needs. We shall also assist the family with reasonably charged accommodation near the hospital. They may prepare USD 30-50 per day for accommodation in the guest house after discharge from the hospital.

Regards,

Aabbhik