CANCER patient requiring a bone marrow transplant can become a complicated case if he or she belongs to Jehovah’s Witness Christian denomination as blood transfusion is a taboo for the community even during life-threatening conditions.
However, a four-yearold boy from Dar es Salaam, who was suffering from a fourth stage abdominal cancer, and belongs to Jehovah’s Witnesses, successfully underwent a bone marrow transplantation (BMT) in Bengaluru, India in a surgery performed without the transfusion of allogeneic blood or blood products.
The treatment usually entails five to six blood transfusions, but in this case, doctors at Mazumdar Shaw Cancer Centre, Narayana Health City in India increased his blood levels three weeks before the procedure. Ittai Moshi underwent the transplant in September 2019 and is recovering.
His parents, IT employees in Tanzania, shifted to Bengaluru in late 2018 for his treatment. “In mid-2018, my son started having high fever, body pain and stomach cramps.
No medicine helped despite repeated consultations with paediatricians in Tanzania. By October 2018, he stopped walking,” narrates James Moshi, the father of the boy.
A private hospital in Bengaluru first treated Ittai for bacterial infection. “His infection had spread to the skeletal system. On seeing no recovery, a battery of tests was done.
He was then diagnosed with cancer,” recalled Moshi. As chemotherapy alone could not cure him, he was advised to undergo a bone marrow transplant.
As the child and family were followers of Jehovah’s Witnesses they were not open for a blood transfusion which is a crucial aspect in bone marrow transplant.
Owing to the complexity of the case, the hospital the child was being treated at referred him to Mazumdar Centre for further care.
Abdominal cancer is a type of cancer that occurs when there is an uncontrolled growth of abnormal cells anywhere in the abdomen, the area between the lower chest and the groin.
The abdomen consists of many organs, including the stomach, intestines, liver, gallbladder, pancreas, oesophagus and numerous blood vessels.
Scholastica Musokwa, Ittai’s mother said they had heard about the hospital treating their community members, hoping there would be a way without blood transfusion.
“Before the procedures, we discussed with the medical team for them to clearly understand our concerns. Now I am glad to see my son playful and cheerful,” she explained She added, “We had lost all hope.
We were contemplating to go back home. However, lead Doctor and his team’s confidence instilled some optimism in us.
We appreciate their honesty as they elaborated to us right in the beginning itself about the complexity of the procedure.
Further, they even patiently stood with us even emotionally through our tough times,” Mazumdar Centre, Director and Clinical lead, paediatric oncology, haematology and BMT, Dr Sunil Bhat who conducted the surgery said the boy’s recovery has been phenomenal.
“Before removing his tumour in the abdomen through a bloodless surgery in July 2019, the boy’s stem cells were harvested from his bone marrow as he further required BMT.
The boy underwent the transplant in September 2019, with no blood transfusion in which we had to increase his blood levels three weeks before the procedure,” he explained.
Respecting the child and the family’s religious beliefs, the doctors decided to work on the child three weeks in advance and put him on medications that helped in increasing his blood levels.
Once the body started responding positively and his blood levels were optimal they performed the procedure. Firstly they removed the cancerous tumour surgically.
The surgery was followed by the bone marrow transplant. “BMT is a complex procedure in general.
In the case of Ittai, it was a highrisk case as we could not use any banked blood products on him. We had to depend on his body to produce the necessary blood,” said Dr Bhat elaborating about the case.
Dr Bhat further said despite medications, many times the blood products may not be optimal. Further, owing to the low production of platelets there was a high chance of developing bleeding which can affect the survival of the child.
“The success rate of bone marrow transplant without the support of blood transfusion is very low and many would not even attempt it.
However, with the help of our expert team we managed to successfully perform the bone marrow transplant,” he noted. Within four to six weeks the child body recovered and was discharged.
Currently, the child is on a follow up. Plans were underway for Tanzania through Muhimbili National Hospital (MNH) to commence offering BMT service this March 2020.
MNH will be the first health facility in East Africa to offer BMT services with the first batch of 11 experts completed their specialised training in July 2019 at Apollo Hospital in India.
According to MNH’s director of medical services, Dr Hedwiga Swai in preparations to start offering the services, the government had disbursed 6.2bn/-where 3.7bn/-was meant for purchasing various equipment.
African countries that offer bone marrow transplant include South Africa, Tunisia, Morocco, Egypt, Nigeria and Comoro, she said.
“The availability of this service will help many patients to access the service within the country, reducing the financial burden of seeking the service abroad and building capacity to local experts,” she said.
According to Dr Swai, it is estimated that the patient seeking allogeneic stem cell transplant abroad can spend 200m/-for the service while autologous stem cell transplant costs not less than 150m/-.
The cost of the procedure within the country is expected to drop by 50 per cent per patient.