What can I expect if my child has to undergo bone marrow transplantation?

Bone marrow is the tissue that is inside the bones, it contains stem cells that produce body’s blood cells. A bone marrow transplantation is also called a stem cell transplantation. Stem cell transplantation in children is mainly performed to treat acute leukemia when the first treatment did not succeed and uses stem cells from a donor.

In order for a bone marrow transplantation to succeed, myeloablation is performed. This has two goals. Firstly, it will kill leukemia cells, secondly it will break down the patient’s immune system. This is necessary because, otherwise, the immune system will reject the new cells. Myeloablation is done with extensive chemotherapy or radiotherapy. Extensive radiotherapy or chemotherapy will weaken the patient. Many side effects can occur, such as hair loss, loss of appetite, diarrhea, fever, muscle cramps.

Because the patient’s immune system will be temporarily suppressed, he will be more prone to infection. Therefore, he or she is mostly placed in isolation for a few weeks until the new stem cells have started to produce white blood cells which can protect the body from infections.

The new cells are given intravenously to the patient. Side effects similar to an allergic reaction can occur while the cells are administered, such as itching, hives, or difficult breathing. These side effects can be treated with medicines. After the infusion, other side effects can arise. Often, the patient will suffer from gastrointestinal complaints such as nausea, diarrhea or difficulty swallowing due to mucositis. Sometimes a feeding tube or total parenteral nutrition, i.e. nutrition given directly into a vein, can be necessary.

It takes at least two to three weeks before the donated stem cells will start to produce new cells, so for this time, the patient remains in isolation and will be closely observed. Waiting for the new cells in isolation can be quite challenging, because the patient cannot receive many visitors and, consequently, might start to feel locked up.

It must be said that stem cell transplantation is a very complicated procedure. The risk of complications is extremely high – directly due to the myeloablation targeting both leukemia cells and the patient’s immune system, or indirectly due to infections. Since an adequate infrastructure is needed, stem cell transplantations are only performed in specialized treatment centers.