Blood and Marrow Transplant Process
Consideration of a stem cell transplant involves a several step process that our team will manage with you, your physicians and your insurer. Please begin by calling us at 215-590-2820 and we will support you throughout the entire process.
Intake and case evaluation
Our BMT Program Coordinators will be your single point of contact throughout the BMT process. Your coordinator will work with you and your referring physician to collect all the information we need and make the transition to CHOP as smooth as possible.
The BMT team will review your child’s medical history to determine whether transplantation is the recommended treatment approach. If so, the team creates a plan for transplant admission and sets up a meeting with your family to discuss BMT, the types of blood stem cell options, the drugs and/or radiation required before stem cell infusion, the risks and benefits of the conditioning and the BMT, and what to expect after BMT, including possible late effects.
Before allogeneic transplant, your child will undergo chemotherapy and/or radiation.
- This prepares the patient to accept new cells into their body by "making space" in the bone marrow for the new stem cells.
- This suppresses the immune system so the body can accept someone else's stem cells.
- If the child has cancer, a goal of the chemotherapy and radiation is also to kill the cancer cells.
Day of transplant
Stem cells from unrelated donor are collected the day before or day of the transplant. They are transported to the patients and administered like a blood transfusion.
Cord blood units are shipped to transplant center and stored before preparation for the transplant starts.
Side effects are usually the same as a blood transfusion and may include fever, chills and rash. Sometimes medication is given to prevent rash.
Most of our patients are in the hospital for three to four weeks after the transplant. A parent or another relative may stay overnight with the child.
Because pediatric blood and marrow transplant is a complex procedure, it is extremely important to have an experienced team caring for your child. Our team includes BMT physicians, nurse practitioners, nurses, social workers, nutritionists, an unrelated donor search coordinator, child life specialists, and physical and occupational therapists.
A BMT physician is on call every day and will see your child each day that he or she is in the hospital.
- Some patients experience sore mouth, sore throat or stomach pain. Pain medicine is given to relieve these symptoms.
- Hair loss is very common after transplant. This often begins 7-14 days after starting the preparation for transplant.
- Your child will have low blood counts following transplant, and it's likely that he'll need blood transfusions.
- Many patients complain of nausea, and anti-nausea medications will be given. If the nausea keeps your child from eating enough, he will be given IV nutrition.
- Children may experience fever as a result of infection. Infection is one of the the biggest concerns after transplant. Some children may be given antibiotics to prevent this side effect.
Engraftment is when the new stem cells begin growing in your child's body, and begin making new white blood cells, red blood cells and platelets. Engraftment usually begins within 14-28 days after transplant.
As engraftment occurs, the patient will likely start to feel better, and the risk of infection and bleeding decreases.
Graft-versus-host disease (GVHD) is a risk after transplant. This is when cells from the donor attack the patients cells, which they might not recognize as their own. There are two types of GVHD:
- Acute GVHD usually occurs within 100 days of transplant, affecting the skin, liver and intestinal tract.
- Chronic GVHD occurs after 100 days, but there might be symptoms before then. Chronic GVHD may involve many organs, including the skin.
Medications are used to prevent GVHD. Depending on the source of stem cells, different medications will be used.
Treatment for GVHD is often successful at controlling the disease, but the GVHD may not be completely eliminated by the treatment, and it could take months to resolve completely.
Your child will be discharged when:
- The new blood making stem cells have engrafted
- There is no active infection
- GVHD is under control with medication
- Your child is able to take food and medication by mouth
If your child has had an autologous transplant, he or she will be discharged to the referring doctor and home. If your child had an allogeneic transplant, he or she may also be be discharged to home if you live within a one-and-a-half-hour driving distance. If you live further away, you may need to stay in the Ronald McDonald House near Children's Hospital for one to three months.
Life after transplant
The first 100 days after transplant are the most critical. During this time, your child will be closely monitored for complications such as GVHD and infections.
You will need to return to the BMT clinic with your child one to two times a week for three months for follow-up. We transition most patients to their referring doctors after three to six months. Your child will need to return to the BMT clinic yearly for a comprehensive health evaluation.
After transplant, there are often restrictions of activities and crowded events (like school, church, stores and movies) which put your child at risk for infection. Be sure to listen to the doctor's recommendations about restrictions, and practice good hand-washing habits at home.
Possible late effects of transplant
Your child's transplant physician will discuss potential late effects of transplant. They may differ significantly depending on conditioning and treatment your child received before transplant. Possible late effects include:
- Endocrine problems related to:
- Dental issues
- Neuropsychologic effects