Homi Bhabha cancer hospital performs India’s first tandem transplant for brain cancer

Visakhapatnam: When three-year-old M Sristhi (name changed) from Visakhapatnam was diagnosed with embryonal tumour with multilayered rosettes (ETMR), her parents were devastated. The tumour is among the rarest and most aggressive brain cancers seen in very young children. It has historically been associated with poor survival even with surgery and chemotherapy. What followed, however, has turned her case into a milestone in paediatric cancer care in India.Doctors at Homi Bhabha cancer hospital and research centre (HBCHRC) in Visakhapatnam, a unit of Tata Memorial Centre functioning under the department of atomic energy, performed India's first tandem (double) autologous stem cell transplant for ETMR. While tandem transplants for this tumour have been reported in countries such as USA, Spain, Germany, Russia, and South Korea, the procedure had not previously been documented in India. The case is now drawing attention not only because of the surgery itself, but because it demonstrates how complex cancer therapies are increasingly becoming feasible in public hospitals.How stem cell transplants helpOne of the major challenges in treating ETMR is that the high doses of chemotherapy needed to kill tumour cells can also severely damage the child's bone marrow. When bone marrow function collapses, the immune system becomes extremely weak, leaving young patients vulnerable to severe infections and life-threatening complications. Over the past decade, advances in high-dose chemotherapy strategies combined with stem cell rescue techniques have offered a way to push treatment intensity while helping the body recover. Dr Swetha Venkatareddy Velagala, assistant professor of medical oncology (paediatric) at the HBCHRC, told STOI that in an autologous stem cell transplant, doctors collect the patient's own blood-forming stem cells before giving high-dose chemotherapy."These cells are carefully processed and stored in specialised cryopreservation facilities. After chemotherapy destroys cancer cells, the preserved stem cells are infused back into the patient's bloodstream to rebuild the immune system and restore blood cell production," she added.What makes tandem transplant differentA tandem autologous transplant takes the same principle a step further. Instead of performing the transplant once, doctors repeat the entire process twice within a few months. The patient first receives high-dose chemotherapy followed by reinfusion of stored stem cells. After the body recovers sufficiently, another cycle of high-dose chemotherapy is administered and the second transplant is carried out. The goal of this double-cycle approach is to eliminate any microscopic tumour cells that may survive the first treatment.Dr Umesh Mahantshetty, director of HBCHRC, said ETMR remains one of the most aggressive paediatric brain tumours. "Conventional treatments alone have yielded poor long-term outcomes. However, combining intensive chemotherapy with tandem autologous transplantation can significantly improve survival. Evidence from international centres supports this approach. A tandem transplant involves two sequential transplants, typically performed within six months. This approach uses two cycles of high-dose chemotherapy to eliminate residual microscopic tumour cells and improve survival outcomes," he explained.The entire treatment is provided free of cost through support from national and state health schemes, along with patient-assistance programmes. "This makes HBCHRC a compelling option for delivering comprehensive cancer care at an affordable cost to underprivileged patients" Dr Umesh added.The child's treatment journeySristhi's treatment began at Tata Memorial Centre in Mumbai where she underwent brain tumour surgery followed by intensive chemotherapy. Because her family is from Visakhapatnam, doctors later referred her to the Visakhapatnam centre for advanced transplant procedure. At HBCHRC, she received additional chemotherapy before undergoing the tandem autologous stem cell transplant between Dec 2025 and Jan 2026. After completing the second transplant cycle, she recovered steadily and was discharged in the fourth week of Feb without any major transplant-related complications.Dr S Vignesh, medical office (paediatric oncology) at HBCHRC, said performing such a complex procedure in a young child requires highly specialised infrastructure and coordinated teamwork across several medical disciplines. "Stem cells must first be harvested using advanced apheresis machines that separate blood-forming cells from the bloodstream. These cells are then preserved at extremely low temperatures in cryopreservation facilities until they are needed for reinfusion," he said. The transplant itself must be carried out in dedicated bone marrow transplant units equipped with HEPA-filtered isolation rooms and positive-pressure sterile environments to prevent infections. "Continuous monitoring, specialised laboratory testing to ensure stem cell viability, and round-the-clock intensive care support are essential components of the process. The treatment team typically includes paediatric oncologists, haematopathologists, transfusion medicine specialists, oncology nurses, and transplant unit staff working together in a highly coordinated manner," Dr Vignesh added.