From a Slum in India to Leading Bone Marrow Transplant Specialist in U.S.
Dr. Prakash Satwani on how his brother’s death inspired him to help kids with leukemia in the U.S. and India.
My parents fled from Pakistan in the early ’70s due to the Indo-Pakistani war. I was born in a city called Bhopal in India. My parents did not get the opportunity to attend school, and we were very poor. My mother was a housewife, and my father was a dairy farmer. Every morning we milked the cows, and I went door-to-door and delivered milk to people’s houses. We lived in a slum in a small house, half of which was occupied by cows. Our room was about 10 feet by 10 feet.
My visionary mother knew that the best way for her five kids to get out of that kind of life was to have us educated. I was the second born and the first to go to high school, and the first to go to college. In addition to delivering milk, after passing fifth grade I worked in a pharmacy after school dispensing medicine to help pay for my education.
My mother wanted me to become a doctor. She insisted, and so I agreed to pursue medicine. My job in the pharmacy was also instrumental because I was exposed to doctors and patients; I developed empathy toward patients early in my life.
It took on new meaning after my brother Ramesh, who was three years younger than me, was diagnosed with acute myeloid leukemia — and ultimately died from leukemia without getting any proper treatment. He died when I was in eighth grade. That solidified the idea not only of becoming a doctor, but a doctor who could cure children with cancer.
I graduated from medical school in Bhopal in 1996, and I did my pediatric residency in Mumbai.
After I finished my training in 1999, I discovered there were not many programs in India that offered pediatric hematology and oncology training, so my opportunities were extremely limited. My mentor in Mumbai, Dr. Rashid Merchant, was a visiting professor at The Brooklyn Hospital Center, and he advised me to come to the U.S. to get proper training in pediatric oncology.
Once I completed my residency, I entered a pediatric hematology/oncology fellowship program in South Carolina, but my wife received a residency in pediatrics at The Brooklyn Hospital Center. Because of her, in 2002 I transferred to NewYork-Presbyterian/Columbia University Irving Medical Center, which fortunately had an open position for a second-year fellow. I had no idea that this move would be life-changing.
During my fellowship, I was fascinated by the science of bone marrow transplantation, as this procedure has the potential to cure many difficult cases of leukemia and other malignant and nonmalignant diseases. To better understand the field, I did a one-year fellowship in pediatric bone marrow transplantation, also at NewYork-Presbyterian/Columbia University Irving Medical Center.
Since then, I have been involved in research in the bone marrow transplant field, focusing on how to decrease organ injury in patients receiving a transplant. When patients receive a transplant, they frequently have multiple organ injuries due to the high doses of chemotherapy and infections. I have published several papers on organ damage in these patients and how it affects the outcome. More recently, I have worked on reducing the complications, which ultimately reduces the cost of bone marrow transplantation in children.
Currently, I am director of the Pediatric Cellular Therapy Program. We perform novel cell infusions called CAR T-cell therapy for relapsed refractory acute lymphoblastic leukemia. There are only about 32 centers in the U.S. where children can get CAR T-cell therapy, as it requires a very good intensive care unit to handle the possibly dangerous side effects of the procedure.
For CAR T-cell therapy, we extract the immune cells from the patient. These cells are genetically engineered so they bind to the leukemia cells and kill them. It’s as if they become sharp shooters; they shoot exactly what they are intended to shoot. Once infused CAR T cells meet leukemia cells, they start to proliferate rapidly and kill leukemia cells very efficiently.
Although the work I am doing now keeps me very busy, I always felt that I needed to give back to my home country. So with the help of Mr. Sajid Shapoo, the father of one of my patients who came to me from Delhi and in collaboration with various government officers, we opened a bone marrow transplant unit at Maharaja Yeshwantrao (MY) Hospital in Indore, in central India. In India, most of the healthcare is provided in private and corporate hospitals, and poor people cannot afford treatment in these hospitals. After discussion with government officials in my state of Madhya Pradesh, I was able to convince them to build a six-bed bone marrow transplant center in MY, a government hospital for families living below the poverty line.
Typically, abandonment of treatment is a big problem. When a transplant is recommended, patients learn that it could cost $20,000. Costs can go as high as $50,000 if there are complications. I wanted to avoid that situation. In our unit, we can manage all the complications without worrying about money, since our operations are free of cost to the patient. However, the medical team has to raise funds through corporate donors, which is approximately $10,000 per patient.
In 2017, we hosted camps in several cities, where we did cheek swabs of patients and their siblings to collect cell samples to determine matches for bone marrow transplants. We identified 50 children who were matches. Right now, we are prioritizing patients under the age of 12 who have thalassemia, a genetic disorder in which children need lifelong blood transfusions. A bone marrow transplant negates the need for blood transfusions, allowing these kids and their families to lead better lives. Other than thalassemia, we see many patients with life-threatening disorders such as bone marrow failure, leukemia, sickle cell disease, and immunodeficiencies that could benefit from bone marrow transplantation. As of now, the Madhya Pradesh government has started construction of a separate pediatric blood disorder unit adjacent to the blood marrow transplant unit, as these patients have to be optimally managed for a successful bone marrow transplantation in the future.
Currently, two pediatricians who were trained at NewYork-Presbyterian/Columbia University Irving Medical Center are conducting bone marrow transplantation at MY Hospital in Indore. I monitor patients on a daily basis through electronic health records and help the pediatricians with patient and donor selection and day-to-day management of cases. Our first 20 patients were discharged after their bone marrow transplantation. We plan to conduct three or four transplants per month, as we have a growing waiting list of 50 to 60 patients.
Making a difference in the life of a patient and their family is what makes me wake up every morning and helps me sleep every night. But I can’t do all these things on my own. I’m grateful to be part of a system that is committed to improving health of children in the U.S. and globally. I am constantly inspired by the resilience of the patients I treat, and I believe that every child, rich or poor, has a right to a healthy life. By treating these patients, I am giving them what my brother Ramesh never had: hope for a bright future. I am not poor anymore, but I have not forgotten the impact of poverty on children.
Prakash Satwani, M.D., is the director of the Pediatric Cellular Therapy Program and director of the Pediatric Hematology/Oncology/BMT Fellowship at NewYork-Presbyterian/Columbia University Irving Medical Center. Dr. Satwani was inducted into the Academy of Clinical Excellence and the Virginia Apgar Academy of Medical Educators. He is a world expert in the field of pediatric bone marrow transplantation for children with leukemia and hemoglobinopathies. His research is focused on decreasing cost and complications after bone marrow transplantation.