Procedure for Pediatric Bone Marrow Transplant

Paediatric Bone Marrow Transplant

Bone marrow is the flexible and spongy tissue that is present in the central part of bones like spine, hips, breast-bone and ribs. The blood cells are formed in the bone marrow and it contains the newest blood cells that are called hematopoietic stem cells.

A bone marrow transplant (BMT), also called as stem cell transplant is a complex procedure that involves replacing of diseased stem cells with healthy stem cells that can form new cells that are also healthy. BMT is often considered in cases of bone marrow cancer and is an important part of leukaemia treatment in cases, where chemotherapy alone could not completely cure the disease. Children with cancer, blood disorders and other conditions may also require BMT.

Types of Bone Marrow Transplant (BMT)
BMT is of following two types and the choice of procedure is based upon the diagnosis of the disorder:

• Allogeneic:
• In cases where the patient gets bone marrow from a donor, the transplant is known as allogenic bone marrow transplant. This is generally done in leukemia patients and in patients with some forms of lymphomas.

• Autologous:

When the bone marrow transplant is done using patient’s bone marrow, the transplant is known as autologous bone marrow transplant. This is generally done in solid tumors like neuroblastoma, brain tumor and Hodgkin disease.

Indications for Paediatric Bone Marrow Transplant

A bone marrow transplant is needed in following conditions:

• Acute Lymphoblastic Leukemia (ALL)
• Acute Myelogenous Leukemia (AML)
• Aplastic Anemia
• Beta Thalassemia (Cooley's Anemia)
• Diamond-Blackfan Anemia
• Hemophagocytic Lymphohistiocytosis (HLH)
• Hodgkin Lymphoma
• Neuroblastoma
• Non-Hodgkin Lymphoma in Children
• Pediatric Brain Tumors
• Sickle Cell Disease
• Myelodysplastic syndrome
• Inborn errors of metabolism
• Bone marrow failure syndromes
• Immuno-deficiencies and immune dysregulation diseases
• Sarcomas
• Brain tumors

Pre-Procedure Care

Before deciding to undergo the transplant, the child’s parents are thoroughly explained about the procedure and its associated risks. The patient needs to undergo a complete physical examination along with some blood tests and imaging studies to confirm the healthy status for transplant.

An informed consent is also signed before the procedure.
Conditioning before transplant: The patient receives chemotherapy drugs in high doses along with radiation (if required) therapy for conditioning before the transplant.

Bone Marrow Transplant Procedure

After conditioning, the stem cells are infused through the child's central venous line or catheter. This procedure is quite similar to a blood transfusion. The transplanted stem cells travel through the bloodstream and reach bone marrow. Here, the transplanted stem cells start making RBCs, WBCs, and platelets. After almost 14 to 30 days, sufficient WBCs are formed that can fight with disease or infection. This is called engraftment.

What is the average length of stay for this surgery?
A child is generally discharged after engraftment if he/she is medically stable and able to take the required medications.

Risks & Complications of Bone Marrow Transplant

BMT is a complex surgery and requires high level of care. The child needs constant monitoring in hospital. Some of the risks and complications associated with BMT are:

• High risk for bleeding, infection andanaemia
• Low platelets and low red blood cells
• Pain due to mouth sores and gastrointestinal (GI) irritation
• Diarrhoea, nausea, and vomiting due to chemo and radiotherapy
• Fluid overload that can lead to pneumonia, liver damage, and high blood pressure
• Respiratory distress
• Organ damage
• Graft failure
• Graft-versus-host disease

Post-Procedure Care

The child and the family need to be very careful after the transplant and should religiously follow all the instructions provided by the surgeon including:

• Take all the medication as prescribed by the surgeon
• No visit to any public place for six months after autologous (self) transplant
• No visit to any public place for nine to twelve months after allogeneic (related and unrelated donor) transplant
• Regular follow-up is essential after discharge to avoid any risk or complication of the transplant
• Follow low bacteria diet as advised
• Adopt good hygiene and keep the child and the surroundings infection free.