Childhood Cancer

Childhood Cancer

The transplant

Prior to the stem cell transplant, the child’s bone marrow is suppressed using high-dose chemotherapy (radiation is generally not used for to prepare a child with a solid tumor for a PBSCT). This portion of treatment, called conditioning, kills tumor cells and makes room in the bone marrow for new stem cells.

Tanner was 17 months old when he had a single transplant to treat his stage 4 neuroblastoma. My husband and I split time with him at the hospital. I was there the first part of the week, and he took off Fridays and came to the hospital so I could go home. When you have a little one and he’s connected to all those IVs, it’s so hard. I learned to block off a space in the hospital room so he had an area he could move around in, but keep the IV safe. Because we were worried about germs, neither of his brothers could visit. Video chat made a big difference. People from child life would come and play with him so I could get out, walk to a nearby park, and clear my head. Child life was awesome. Tanner came home on day 23, but he was still on TPN [total parenteral nutrition] and oral pain meds. He was on the TPN for about 3 weeks after he came home. Even after his mouth sores were gone, he just didn’t seem to feel like eating. He is doing very well now and is an energetic and happy little boy!

Conditioning regimens vary according to institution and protocol; they also depend on the medical condition and history of the child. For tandem transplants, the chemotherapy is given for 2 to 6 days. Sometimes all or part of the therapy is given in an outpatient setting.

If your child receives conditioning chemotherapy as an outpatient, he will need to go to the transplant unit no later than the evening before the procedure for hydration. Your child also may need IV fluids at night to provide hydration.

Leah was feeling very good and very healthy when she went in for her transplant. We lived near the transplant center, and she had a least 20 visitors a day. I think the visits and the nonstop telephone conversations really kept her spirits up.

The transplant itself consists of infusing the stem cells through a central venous catheter into the child, just like a blood transfusion. The stem cells travel through the blood vessels, eventually settling in the bone marrow.

I cannot say enough good things about the transplant center. They were very family-oriented, allowed us in the room 24 hours a day. I was allowed to sleep in bed with her (I just told the nurses to make sure to poke her and not me). The nurses were wonderful, and I still think of them as family.

A transplant doctor will monitor your child during the infusion of stem cells. A variety of minor to major complications might occur, including:

•  Abdominal cramps

•  Difficulty breathing

•  Slow heartbeat

•  Tightness in the chest

•  Chills

•  Cough

•  Diarrhea

•  Skin rash

•  Fever

•  Flushing

•  Headache

•  Changes in blood pressure

•  Nausea and vomiting

•  Unpleasant taste in the mouth

•  Kidney failure

The complications that occur are typically due to the DMSO used to keep the stem cells alive during the storage process. Washing the stem cells prior to infusion minimizes the risk of these complications, but is not standard practice for all transplant centers.