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Also known as a BMT, stem cell transplant, or hematopoietic stem cell transplant
Bone marrow is found in the center of bones and is where blood cells are made. It is found in the spongy part of the bones, especially the hips, ribs, breastbone, and spine. Bone marrow contains the youngest type of blood cells known as hematopoietic stem cells. As a hematopoietic stemcell ages, it becomes a white cell, red cell, or platelet. Hematopoietic stem cells are found in bone marrow, peripheral blood (bloodstream), and umbilical cord blood.
The first step is to locate a donor whose blood cells closely match the patient’s. This is done by tissue typing prospective donors. Tissue typing is done by a blood sample and is called HLA typing, which stands for Human Lymphocyte Antigens. These antigens are found on the surface of white blood cells. A patient’s full siblings each have a 25% chance of being a tissue type match. Less commonly, a parent may match the patient. Occasionally, a less- than-perfectly matched related donor is used.
If a related donor is not available, then a search for a compatible, unrelated donor is performed through the National Marrow Donor Program. Unrelated donor cells can come from a living donor or frozen cord blood. Your physician will decide what the best source for donor cells is for your child. This is based upon urgency of 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.
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:
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.
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.