A bone marrow transplant (BMT) is a treatment for children with certain types of cancer or other diseases. The goal of BMT is to replace a child’s diseased bone marrow with healthy bone marrow.
Bone marrow is the spongy material in the center of the bones that makes all types of blood cells, including young blood cells called stem cells. In BMT, stem cells are filtered, and then put back into the same child. Or they are put into another sick child. These stem cells will grow and become new and healthy bone marrow. Transplanted stem cells are called the graft.
There are different types of BMT depending on how the healthy stem cells are collected.
Your child is his or her own donor. Stem cells can be collected from your child in 2 different ways:
The donor is another person who shares the same or similar genetic type as your child. This is often a brother or sister. Finding a matching donor can be a lengthy process. In some cases, a parent may be a donor. Or the donor may be a matched unrelated donor (MUD) found on a bone marrow registry. Stem cells are taken from the donor either by apheresis or bone marrow harvest.
Stem cells are taken from an umbilical cord right after a baby’s birth.
These stem cells grow into mature blood cells quicker and more effectively than stem cells from the bone marrow of another child or adult. The stem cells are tested, typed, counted, and frozen until they are needed for a transplant.
Your child’s transplant is managed by a team of specialists who care for children having BMTs. This team includes:
Other team members who may evaluate your child before and after BMT as needed include:
The goal of BMT is to cure many diseases and certain types of cancer. It can be used to:
Diseases that can be treated with BMT include:
A bone marrow transplant has risks, some of which are life-threatening. Your child’s healthcare provider and BMT team will discuss risks and benefits with you before the procedure.
Risks and complications may vary depending on:
Possible complications include:
Before the transplant:
The days before the transplant are counted as minus days. The day of transplant is considered day 0. Engraftment and recovery following the transplant are counted as plus days. For example, a child may enter the hospital on day -8 to prepare for the BMT. Days +1, +2, and so on, will follow the transplant. There are possible events, complications, and risks linked to each day before, during, and after transplant. The days are numbered to help you and your child know where you are in terms of risks and discharge planning.
Once suitable stem cells are found, your child will receive high doses of chemotherapy or radiation (sometimes both) to destroy existing bone marrow. This gives the new bone marrow cells room to grow. This may be called ablative or myeloablative therapy. It stops new blood cells from being made. The bone marrow becomes empty. An empty marrow is needed to make room for the new stem cells to grow and create a new system to make new blood cells.
Next, stem cells are given to your child through an IV in a large vein, often in the chest. This is called a central venous catheter. Getting the stem cells is like having a blood transfusion. The stem cells find their way into the bone marrow. They begin growing and making new, healthy blood cells.
During infusion of the bone marrow, your child may have:
After infusion, your child may:
Your child will get supportive care to prevent and treat infections, side effects, and complications.
During this time, your child may:
Engraftment of the stem cells happens when the donated cells make their way to the marrow and begin making new blood cells. Engraftment usually happens between day +15 and +30. This depends on the type of transplant and the disease being treated. Blood tests will be done often to count blood cells after transplant. Platelets are usually the last type of blood cells to recover.
In some cases, engraftment can be delayed. This can be due to infection, medicines, low donated stem cell count, or graft failure. The new bone marrow may start making cells in the first 30 days after the transplant. But it may take months or years for your child’s immune system to fully recover.
The healthcare team will tell you when your child is ready to go home. This depends on many things, such as:
Before you go home, you will be instructed on ways to reduce your child’s risk of infection. These include:
Your child will then need to see the transplant team often to:
Long-term success varies from child to child. Your child’s healthcare team will talk with you about your child’s prognosis, follow-up care, and future treatments.
Before you agree to the test or the procedure for your child make sure you know: