 the transplant, weight of your child, and the best tissue type match. An unrelated donor search may take several months; cord blood can be obtained within a few weeks.
Peripheral stem cells are usually collected for autologous transplant, but stem cells from the bone marrow also can be used. These are collected either before the patient has chemotherapy or following a course of chemotherapy. To collect peripheral stem cells, the patient receives medications (such as G-CSF and/or GM-CSF) to increase the number of peripheral blood stem cells available.
Cells are collected through a process called apheresis. An apheresis machine has a circuit that will collect blood, separate, and remove white blood cells containing stem cells, and then return red blood cells to the patient. This process takes about 4 hours and may need to be repeated for 2 or 3 days in a row. For certain diseases, the peripheral blood stem cells may be treated with anticancer medications to prevent tumor cells from being placed into back into the patient's body.
Before the transplant admission:
When the healthcare team decides that BMT is the best treatment option for your child, they will schedule a lengthy conversation with you to explain the procedure. They will explain the many risks associated with BMT, as well as what you can expect before, during, and after the transplant.
Your child will undergo testing to make sure he/she is healthy enough to withstand the rigors of transplant. Testing will include evaluation of the heart function with electrocardiogram (ECG) and echocardiogram, lung function (if your child is old enough), kidney and liver function, and infection status. Depending upon the disease, a bone marrow aspirate and spinal tap may be performed.
When your child is deemed healthy enough for BMT, physicians will usually insert a central line catheter that allows easy access to a large vein in the chest. The catheter will be used to deliver the new stem cells, as well as blood, antibiotics, and other medications during treatment.
Preparation 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 in