Bone Marrow/Blood Stem Cell Transplant

Many early side effects and risks are possible because the new bone marrow is not working yet and also due to the effect of the cancer treatments. Medicine and blood products may be given to prevent or treat these problems. Some of these side effects and risks include:

• Increased risk for serious infection because of reduced neutrophils, a type of white blood cell (neutropenia [new-troh-PEE-nee-uh]) 
• Bleeding due to low number of platelets (thrombocytopenia [throm-boh-sahy-tuh-PEE-nee-uh]) 
• Tiredness from low number of red blood cells (anemia)
• Sores in the mouth (mucositis) that are painful
• Diarrhea, vomiting, and nausea
• Hair loss

Other risks and side effects include:

• Damage to organs
• Graft-versus-host disease (GVHD), a very serious complication that can occur in patients who received an allogeneic transplant. When the patient is the donor this is not a risk. In GVHD, immune cells from the donor attack the child’s tissues, especially the liver, skin, and gastrointestinal tract. GVHD can happen suddenly (acute) or occur over time (chronic). It can be mild to severe. Treatments are given before transplant to help prevent GVHD.
• Graft failure is rare, but occurs when the donor cells don’t take hold in the patient’s bone marrow. The risk can depend on the type of transplant as well as complications that occur during the process.

A blood stem cell transplant may treat or cure several diseases, including cancers like leukemia that start in the bone marrow. For some cancers, a transplant may allow the use of very high-dose treatments because the transplant will replace the bone marrow that the chemotherapy or radiation therapy destroys.

Your child’s transplant team will discuss how you and your child should prepare for the transplant.

Finding a matched donor may be the first step if your child is not his or her own donor.

A blood stem cell transplant may require weeks of hospitalization for your child. It is important to make plans in advance about how to manage family, finances, employment, etc. It’s also important to get written approval from your insurance provider. A transplant can cost more than $100,000.

Shortly before the transplant, your child may need a minor surgical procedure to place a tube into a vein in the chest. This tube, called a central line, will be used to infuse the many medications and treatments your child will receive.

A bone marrow or blood stem cell transplant is usually done in a medical center that specializes in this procedure. Your child will likely stay in a special unit in the center to limit the chance of getting an infection.

Bone marrow or blood stem cells are given through an IV (intravenous) infusion, usually through the central line. The cells make their way through the bloodstream until they reach the bone marrow and start producing blood cells. This process is called engraftment.

The time until engraftment occurs depends on the type of disease that is being treated and the type of transplant, but it usually happens between 2 to 3 weeks after the transplant. Daily blood cell counts are used to measure engraftment.

Your child will require monitoring for long-term complications after discharge. Frequent follow-up visits with the transplant team may be necessary.

Recovery can be intensive after a bone marrow or blood stem cell transplant. The transplant team will be very involved in providing daily treatments and monitoring your child for possible complications, especially infection.

During hospitalization, extra care will be taken to avoid exposing your child to unnecessary germs. Certain foods may need to be avoided, and visitors will need to follow special procedures. The risk for infection is lower after engraftment, but still possible.

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Bone marrow is the spongy tissue found in the middle of some bones, and is where the body makes blood cells. Certain diseases and cancers affect the bone marrow. Cancer treatments, especially high-dose chemotherapy or radiation therapy, can also destroy the bone marrow. In these cases, healthy blood stem cells may be transplanted into your child’s bloodstream to replace the diseased or destroyed bone marrow.

Bone Marrow and Blood Stem Cells

Bone marrow is the spongy tissue found in the middle of some bones. The body’s blood cells are made in the marrow. An important type of cell found in the blood marrow and in the bloodstream are young cells called hematopoietic (hee-muh-toh-poi-ET-ik) stem cells, or blood stem cells. Blood stem cells are special because they can develop into any of the three kinds of blood cells:

• White blood cells that help the immune system fight infection. • Red blood cells that carry oxygen. • Platelets that clot blood and stop bleeding.

Bone marrow can be diseased (for example, with leukemia or destroyed (for example, by cancer treatments). In these cases healthy blood stem cells can be transplanted and restart bone marrow. When the transplant is successful, the new bone marrow will start making blood cells. This is called engraftment.

Blood Stem Cell Collection

Collecting blood stem cells is the first step (called bone marrow or stem cell harvest). Bone marrow transplants are different depending on the type of donor:

• Autologous (aw-TOL-uh-gus) bone marrow transplant means that your child is his or her own donor (self-donor). Stem cells are collected before high-dose chemotherapy or radiation therapy are given and are frozen for later use. • Allogeneic (al-oh-juh-NEE-ik) bone marrow transplant means that stem cells are donated from a genetically-matched person. This can come from a relative, an unrelated person, or from umbilical cord blood. With family, a sister or brother has the best chance of being a match. A match may also be found from an unrelated donor identified through transplant registries. Another possible source is stem cells removed from a baby’s umbilical cord after birth.

The blood stem cells will be collected from:

• The bloodstream (a process called apheresis [af-uh-REE-sis]). Several days of shots will be given to help move the stem cells from the marrow into the bloodstream. The donor’s blood is then put through a machine to separate out the stem cells. The remaining blood is returned to the donor. • Bone marrow (a process called harvesting). This involves a minor surgery done under anesthesia. The hip bones are where bone marrow is most commonly harvested. • Umbilical cord blood. This involves removing the blood stem cells from a newborn baby’s umbilical cord right after birth.

Transplanting Bone Marrow or Blood Stem Cells

After chemotherapy or radiation treatment (if needed), the transplant is the next step. Your child will receive the bone marrow or blood stem cells through an IV (intravenous line), much like a blood transfusion. The cells move through the bloodstream until they take hold in the marrow areas. Engraftment happens when they begin to produce new blood cells.