Refractory Acute Myeloblastic Leukaemia Allogenic Bone Marrow Transplant

Clinical Case Report: Case study of 53-year-old female from Kenya with Refractory Acute Myeloblastic Leukaemia (AML) suggested for Induction Chemotherapy followed by Allogenic Bone Marrow Transplant

According to the medical reports shared with us, the patient has been diagnosed with Refractory Acute Myeloblastic Leukaemia (AML).

Acute myeloid leukaemia (AML), or acute myeloblastic leukaemia, is an aggressive cancer of the blood and bone marrow that progresses rapidly, requiring immediate treatment. It occurs when myeloid stem cells mutate, causing an overproduction of immature, non-functional white blood cells (blasts) that crowd out healthy cells.

Refractory disease is those which has been treated in the past but has come back again.  

Investigations needed to confirm the diagnosis and plan the treatment – Patient will need to go through detailed physical and clinical investigations which will include –

NGS-based karyotyping, cytogenetics, molecular study, bone marrow aspiration and biopsy, etc along with other routine tests. Post the investigative outcomes, we will be in a definitive position to suggest a possible line of treatment.

Possible Line of Treatment / Plan: Once diagnosis of relapse is confirmed, the patient will need –

• If the disease is active, he will need Induction chemotherapy followed by Allogenic Bone Marrow Transplant.
• If the disease is in remission (not active) – She will be taken for directly for Allogenic Bone Marrow Transplant.

Induction chemotherapy is the first and strong dose of chemo given to quickly shrink or kill cancer cells. It’s used in aggressive cancers like leukemia or high-risk tumors. The goal is to achieve remission (reduce cancer signs) before further treatments like consolidation or stem cell transplant. This will be aggressive chemotherapy, and the treatment may take 3-6 months.

Allogenic Bone Marrow / Stem Cell Transplant uses healthy blood stem cells from a matching donor’s body to replace bone marrow that’s not working properly. For this, a Healthy and matching donor is needed. This is usually a DNA-matched sibling. (If a matching donor is not available, then we may take a donation from a half-match donor such as either of the parents or less matched siblings. This is called Haplo Identical BMT).

Kindly note: The advised plan 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 Best Hospitals and top doctors for the patient:

1. Amrita Hospitals, Faridabad // Dr. Pravas Mishra

• Artemis Hospital, Gurgaon // Dr. Gaurav Dixit

• Yashoda Medcity, New Delhi // Dr. Nivedita Dhingra

• BLK-Max Super Specialty Hospital, New Delhi // Dr. Dharma Choudhary

• Manipal Hospital, New Delhi // Dr. Divya Bansal

• Sarvodaya Healthcare, Faridabad // Dr. Dinesh Pendharkar

Estimated costs:

Estimated cost of Initial Evaluations will be approx. USD 1200-1600 on OPD basis. 

The estimated cost of Induction Chemotherapy at the various hospitals will be approx  

Estimated cost of Allogenic Bone Marrow Transplant will be approx.: –

In case a matching donor is not available and we have to do a haploidentical BMT, the cost will go up by $6000-$8000.

Kindly note: The above rates are on an approximate basis; actual charges will depend upon the final plan confirmed on the basis of medical evaluation at the hospital.

Stay in India:

For induction chemo– The patient may require 2 months on a day care basis.

For BMT – The transplant will take a 25- 27-day stay in the hospital. Post-transplant, he will still take another 4-5 weeks of follow-up before he can fly back. She will need to stay in India for this.

Total Stay in India- 4-5 months.

Inclusions are the cost of Chemotherapy –

1. All needful investigations

2. Doctor’s fee and chemo charges

3. All consumables, medicines and chemo drugs for induction therapy

4. Complementary Airport transfers in India

Inclusions of BMT Package: –
1. Pre-transplant workup includes confirmation of disease with staging, hematological and biochemical workup, virological screening, echocardiogram, pulmonary function test and other investigations
2. Hospitalization for the patient for 3 weeks in a HEPA filter room
3. Hickman catheter insertion
4. Immunosuppressive drugs
5. Growth factors (GCSF), 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. COVID tests
 
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 towards accommodation in the guest house after discharge from the hospital.

Regards,

Ankush