Our Treatment Process and Options
There are different types of bone marrow transplants depending on who the donor is. The different types of bone marrow transplant include:
Autologous bone marrow transplant – when the donor and recipient is the same child. Stem cells are taken from the child and then given back to the child after intensive treatment. For this procedure the term rescue is sometimes used instead of transplant.
Allogeneic bone marrow transplant – when the donor shares the same, or similar, genetic type as the recipient. This is often a brother or sister to the recipient, but could also be a matched unrelated donor (MUD). In some instances, a parent of the recipient may also be a donor. If the donation comes from an identical twin, the transplant is referred to as a Syngenic bone marrow transplant.
Umbilical cord blood transplant – this is another instance when the donor and recipient is the same child, but in this type of transplant the stem cells used were collected from the child’s umbilical cord immediately after his or her birth.
Prior to BMT, the transplant team completes an extensive evaluation of your child. The decision for your child to undergo a bone marrow transplant will be based on many factors including:
- Your child's age, overall health, and medical history
- Extent of the disease
- Availability of a donor
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Expectations for the course of the transplant
- Your opinion or preference
Once a donor and recipient are matched they will both undergo additional testing and preparations for BMT. For the donor this includes tests related to their health, exposure to viruses, and a complete genetic analysis to determine the extent of the match. For the recipient this involves a complete medical history and physical examination, including multiple tests to evaluate the child's blood and organ functions. The child will often come into the transplant center up to 10 days prior to transplant for hydration, evaluation, and other preparations. A catheter, also called a central venous line, is surgically placed in a vein in the chest area. Blood products and medications will be administered through the catheter.
BMT is done by transferring stem cells from one person to another. Those stem cells can either be collected from the circulating cells in the blood (the peripheral system) or from the bone marrow. The preparations for a bone marrow transplant vary depending on the type of transplant, the disease requiring transplant, and your child's tolerance for certain medications. Consider the following:
- Most often, high doses of chemotherapy and/or radiation are included in the preparations to effectively treat the malignancy and make room in the bone marrow. An empty marrow is needed to make room for the new stem cells to grow and establish a new production system.
- After the chemotherapy and/or radiation is administered, the transplant is given through the central venous catheter into the bloodstream. This is similar to receiving a blood transfusion and is not considered a surgical procedure. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.
- Supportive care is given to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, weighing your child daily (or twice daily), and providing a protected and clean environment.
The days before transplant are counted as minus days, the day of transplant is considered day 0, and engraftment and recovery following the transplant are counted as plus days. There are specific possible events, complications, and risks associated with each day before, during, and after transplant, so the days are numbered to help the child and family understand where they are in terms of risks and discharge planning.
During the actual infusion of the bone marrow, your child may experience any, or all, of the following symptoms:
- Chest pain
After infusion, your child may:
- Spend several weeks in the hospital
- Be very susceptible to infection
- Experience excessive bleeding
- Need blood transfusions
- Be confined to a very clean environment to minimize the chance of infection
- Take multiple antibiotics and other medications
- Be given medication to prevent graft-versus-host disease (if the transplant was allogeneic). This is when transplanted new cells (the graft) tend to attack the child's tissues (the host).
- Undergo continual laboratory testing
- Experience nausea, vomiting, diarrhea, mouth sores, and extreme weakness
- Experience temporary emotional or psychological distress
A patient’s physical and mental health are important in the success of a transplant. That is why the team of specialists at Phoenix Children’s Ottosen Family Blood and Marrow Transplant Program take every measure possible to minimize complications and promote a healthy, happy, safe environment for your child.