Dr (Brig.) A K Dhar is an experienced Oncologist specialized in Bone Marrow Transplants and Acute Promyelocytic Leukemia. Dr Dhar has over 40 years of rich experience and has treated more than thirty thousand patients. He pioneered the technique of Autologous Transplant in India and has to his credit more than seventy Bone Marrow Transplants. Dr Dhar is currently the Director at the Department of Medical Oncology in Fortis Memorial Research Hospital in Gurgaon and has an illustrious career serving in Army Hospitals, including being the Head of Oncology Division at Army Hospital (R&R), Delhi Cantonment.
Autologous Transplant in India
I started my journey of Cancer Treatment in 1990. When I began my career at Tata Memorial Hospital Mumbai, we had a lady who had Multiple Myeloma, and she was very sick. Somehow we treated her and made her mobile, and subsequently, as a life-saving procedure, we did autologous transplantation on that lady. Later on, we realized that it was the first autologous transplantation on multiple myeloma in India, and I was a part of that team. She survived for 17 more years after that.
Autologous and Allogeneic Transplant
In an autologous transplant, we take the stem cell directly from the patient itself. But in an allogeneic transplant, we need a donor to donate for the patient. For this donation, the donor should match the receiver. We require a donor for an allogeneic transplant, but for autologous transplantation, the patient himself is a donor.
Bone Marrow Transplant in Malignant Disorders
Bone marrow transplant is basically done for benign and malignant disorders. It is done in benign disorders like aplastic anemia, sickle cell anemia and thalassemia, malignant disorders like acute or chronic leukemia, Lymphoma and multiple myeloma, and sometimes in children with solid tumors where bone marrow transplant is needed. We can say that it is done in hematolymphoid malignancy, which means solid cancer and liquid cancer. But basically, the bone marrow transplant is effective in liquid cancers.
Acute Promyelocytic Leukemia
Acute Promyelocytic Leukemia used to be a very deadly condition. When I joined Tata Memorial Hospital, nine out of the ten patients used to die since there were no medicines for this condition. Then we got into the research and found a drug called All-Trans-Retinoic Acid (ATRA). We started using ATRA, and we found that the results were excellent. I still remember that I did a study on 20 patients in Tata Memorial Hospital Mumbai, and 17 of my patients survived. Since then, a lot of research has taken place and now it is called curable cancer, and 90 out of 100 patients can survive.
Solid and Hematological Malignancies
These are basically lymph gland cancers. There are glands in our body, which cause cancer when they enlarge. Basically, in cancers like Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma, the problem is not in the blood but is in the lymph glands. These glands enlarge and spread to various parts of the body like the liver, lungs, and sometimes they even spread to the brain and cause problems. But luckily, we are able to cure these cancer types.
Challenges as an Oncologist
The only challenge that I have faced has been the bureaucracy. When I went back to the Armed Forces from Tata Memorial Hospital Mumbai, they refused to believe that I could do a bone marrow transplant. It took me seven years to convince them that there is something called bone marrow transplantation.
There is no ethical committee required for bone marrow transplantation because it is a transplantation, and we are not taking any organ out of the body. Similarly, when I moved after that, it was tough to convince the authority that we could perform bone marrow transplantations.