The bone marrow also called stem cells is a soft, spongy tissue found inside the bones and is responsible for the development and storage of most of the body's blood cells mainly Red blood cells (RBC), White Blood cells (WBC) and platelets. Sometimes, a child’s bone marrow does not make the correct amount of blood cells. A bone marrow or stem cell transplant can replace your child’s bone marrow with donor stem cells to make it healthy again. The goal of a bone marrow transplant is to cure many diseases and certain types of cancer. When a child's bone marrow has been damaged or destroyed due to a disease or intense treatments of radiation or chemotherapy for cancer, a bone marrow transplant may be needed.
Bone Marrow Transplant is of three types: Autologous in which stem cells from the body of the patient itself is used to replace unhealthy cells; Allogenic in which the donor shares the same genetic type as the child for e.g. parents and Umbilical Cord blood transplant in which stem cells taken from an umbilical cord immediately after delivery of an infant is used. A medication may be given to the donor for about one week prior to stem cell collection that will stimulate the bone marrow to increase production of new stem cells.
PREPARING FOR THE TRANSPLANT
Both donor and the recipient has to be prepared accordingly. Donor sources available include self, sibling, parent or relative, nonrelated person, or umbilical cord blood from a related or nonrelated person. The potential donor will have to undergo additional tests related to their health, exposure to viruses, and complete genetic analysis will be done to determine the extent of the match. Once a match for a child needing a bone marrow transplant is found, then stem cells will be collected either by a bone marrow harvest or peripheral blood stem cell collection.
For the Child receiving the transplant, a complete medical history and physical examination is performed, including multiple tests to evaluate the child’s blood and organ functions. Prior to the transplant the child has to visit the hospital for pre-transplant evaluation and preparations.
ON THE DAY OF THE TRANSPLANT
Before transplant donor stem cells are collected. There are various ways to collect stem cells such as Peripheral blood stem cells are collected through a process in which the donor is connected to a special cell separation machine via a needle inserted in the vein. Bone marrow harvesting involves collecting stem cells with a needle placed into the soft centre of the bone, the marrow. For umbilical cord blood transplants, blood has been collected at the time of a birth and stored.
After the stem cell has been collected, high dose chemotherapy is done to effectively treat the malignancy and make room in the bone marrow for the new cells to grow. After the chemotherapy and/or radiation is administered, the transplant, either from bone marrow, cord, or from peripherally collected stem cells, is given through the central venous catheter into the bloodstream. It is not a surgical procedure to place the marrow into the bone, but is similar to receiving a blood transfusion. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.
After the transplant, Supportive care is given to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, weighing your child daily (or twice daily), and providing a protected and clean environment. During actual infusion of the bone marrow, your child may experience: Pain, Chills, Fever, Hives or Chest pain. Your child need to spend several weeks in the hospital post-transplant, may experience excessive bleeding and require blood transfusion and experience temporary emotional or psychological distress
Your child’s physical and mental health are important in the success of a transplant. Every measure should be taken to minimize complications and promote a healthy, happy, safe environment for your child. Follow post-transplant instructions extensively to ensure comfort of the child. There are high chances of infections so special care and hygiene should be maintained for better recovery. As with any procedure, such as bone marrow transplant, prognosis, and long-term survival can vary greatly from child to child.
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Q: What diseases can be treated by Bone marrow transplant?
A: High-risk malignancies: relapsed leukaemia’s and lymphomas, Immune deficiency diseases and other disease that can be treated by blood stream transplant.
Q: How long it will take for my child to get back to normal life?
A: Generally it takes about three months for children to get back to normal life and join school, in some cases it may take up to six months.
Q: Who can be a donor for an Allogeneic Bone Marrow transplant?
A: Donor can be anyone with same genetic background or unrelated donors can be used after blood type and HLA matching.
Q: What are the survival rates for the patients undergoing bone marrow transplant?
A: It varies in different individuals. However, outcomes for children undergoing autologous or allogeneic bone marrow transplant have improved during the past several decades. However, outcomes vary according to the patient’s underlying disease and the patient’s disease status at the time of transplantation.
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