Childhood Cancer

Childhood Leukemia

The Transplant

Prior to the SCT, the child’s bone marrow is suppressed using high-dose chemotherapy and sometimes total body irradiation (TBI). This portion of treatment, called conditioning, kills cancer cells and makes room in the bone marrow for the new stem cells.

Tanner was 17 months old when he had his transplant. 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 three weeks after he came home. 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. 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 transplant for hydration.

Conditioning was four days of chemotherapy and three days of TBI delivered twice a day in fractions. Our 4-year-old son was sedated each time for the TBI. The transplant took six hours because they got so many stem cells from the donor’s bone marrow. Even though it was his new birthday, it wasn’t so joyous because the IV Benadryl® they gave him upset him so he screamed most of the six hours it took to transfuse the liter of cells. The mucositis started after four days, so he couldn’t eat or drink. He got continuous intravenous pain meds, and I was stringent about the oral care. He was on TPN through the PICC line. He needed lots of platelets, but never needed a red blood cell transfusion because the donated marrow had such a high red cell count. He had no complications or infections and we were home four weeks after the transplant (close to the record for that facility).

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 stem cell infusion. The infusion of donor stem cells is typically uneventful. However, a variety of minor to major complications might occur, especially if the stem cells have previously been frozen, 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

Some of the complications that occur are caused by the substance (dimethyl sulfoxide) used to keep the stem cells alive while frozen. Washing the stem cells prior to infusion minimizes the risk of these complications, but is not standard practice at all transplant centers. However, most stem cells used in allogeneic transplants are fresh, not frozen.