paration Before Transplant:
Your child will be given preparative treatment, called "conditioning" before the transplant. Conditioning includes high doses of chemotherapy and sometimes, radiation of the whole body. The type and purpose of conditioning depends upon your child's underlying diagnosis but may include:
Commonly used drugs include:
Once conditioning is complete, stem cells are given through a catheter. This is very similar to a blood transfusion. After traveling through the bloodstream to the bone marrow, the transplanted stem cells will begin to make red and white blood cells, and platelets.
It can take between 14 and 30 days for enough blood cells, particularly white blood cells, to be created so the body can fight infection. The identification of new blood cells and an increase in white blood cells following BMT is called engraftment. Until then, your child will be at a high risk for infection, anemia, and bleeding. Your child will remain in the hospital until he or she is well enough for discharge.
Outpatient follow-up is essential after discharge, as the risk of infection and other complications persist. Although the risk of relapse (recurrence of the cancer) is less with a transplant than chemotherapy, relapse may still occur. Most relapses occur within several years after a transplant.
The process of BMT places a tremendous amount of strain on the body during conditioning, the actual transplant, and in the days following transplant. Your child's immune system will basically be eliminated during conditioning. As a result, your child will be at high risk for infection and blood-related side effects immediately following transplant. Careful monitoring, use of medicines to treat or prevent infections, and other forms of supportive care can help your child to feel as comfortable as possible.
Infection is very common before, during, and after transplant.
Anemia (low red blood cells) and thrombocytopenia (low platelets). Transfusions of red blood cells and platelets will be needed until the new cells increase sufficiently to make these.
Mucositis (sore mouth, sore throat). IV fluids or nutrition and pain medicines are used to help with these symptoms. This problem usually improves as the new cells grow in the patient.
Loss of appetite, nausea. IV nutrition and/or nutrition with a tube into the stomach are used so that weight loss doesn't occur. Medications can be given to prevent or reduce nausea.
Infection - The patient's immune system is destroyed after a transplant, and it takes many months and sometimes years to return. The types of infections that may occur include: bacterial, fungal, and viral. Preventive antibiotics are given for some patients. Special precautions are taken to protect your child from infection, including limiting visitors and avoiding crowded areas (such as stores) after discharge.
Graft vs. host disease (GVHD) - This occurs only in an allogeneic blood or marrow transplant. Certain types of donor cells, called T cells (or T lymphocytes) react to the patient’s body and recognize it as "foreign." Medicines are given post-transplant to prevent this complication, but it may occur despite this.
Organ toxicity - Conditioning and prior cancer treatment may damage the lungs, liver, kidneys, and heart. These effects are unpredictable and not all children recover from organ toxicity.
Late Effects - There is a very good chance that there will be long-term effects following BMT that may not be identified until years after treatment. These include: