Hematopoietic (blood-making) stem cells are immature cells found in the bone marrow (the inside of the body’s bones). This is why stem cells are also called bone marrow cells. Bone marrow produces:
- Red blood cells (which carry oxygen)
- Platelets (which help the blood clot)
- White blood cells (which are the main cells of the immune system)
A bone marrow transplant replaces damaged or destroyed bone marrow cells with healthy ones. The main source of bone marrow cells has usually been from the bone marrow. Because of this, "bone marrow transplant" is the term most often used, but a transplant can also use stem cells taken from other blood sources like circulating blood (called peripheral blood) or the umbilical cord.
Should my child receive an autologous or allogeneic transplant?
In autologous transplants, patients receive their own bone marrow cells which were previously taken from the patient and stored for later use. This process is called harvesting. Autologous transplants are often used for patients who have solid tumors or lymphomas that are at high risk of treatment failure.
In allogeneic transplants, patients receive bone marrow cells from another person. Allogeneic transplants are often used to treat high-risk leukemias or lymphomas, immunodeficiencies, bone marrow failure diseases and sickle cell disease.
St. Jude performs both types of bone marrow transplants. We also have clinical trials for patients with high-risk hematologic malignancies who have bone marrow cells donated by a parent who is a partial match. This is called a haploidentical transplant.
Before the bone marrow transplant
Your child must have a central line placed before transplant. This allows your child to easily give blood samples and receive medicines through the vein. Patients undergo extensive testing before the transplant. This pre-transplant appointment includes blood work, tests to check the health of major organs and meetings with members of our multidisciplinary/support teams.
During the bone marrow transplant
Your child will be admitted to the Transplant Unit at St. Jude the day before the conditioning regimen begins. The conditioning process, also known as the preparative regimen, will prepare your child’s body to receive the donor cells. This may consist of chemotherapy alone or may be combined with radiation. The process lasts 5 to 14 days. On the day of transplant, the bone marrow cells are given in your child’s room. Depending of the type of transplant the bone marrow cells are either harvested locally or shipped to St Jude, and processed in our state-of-the-art Human Applications Laboratory. Your child may also receive medicine to prevent allergic reactions before they receive the new cells. The new cells will take several weeks to grow. Your child will remain in the hospital until they have recovered from the transplant process, which often takes at least four to six weeks.
If complications occur, the hospital stay may be longer. Patients who receive transplants typically stay at St. Jude for at least 100 days. During that time, we provide housing for families who do not live in Memphis.
What are the side effects of a bone marrow transplant?
Sometimes a bone marrow transplant may not be successful because the disease returns or because of severe treatment-related side effects. Some side effects that may occur include:
After the bone marrow transplant
A group of specialists across many departments make up your child’s discharge team. They will meet with you to plan your child’s discharge needs and to educate you about outpatient care. When your child is first discharged, you will need to remain locally for several months for continued monitoring and care after their transplant.
Once your child is safe to return home, the St. Jude physician will send a letter to your child’s referring physician. This letter will outline the treatment you child received.
Follow-up visits after returning home:
- After an autologous transplant, your child will return to meet with members of the St. Jude Transplant team only for tests required by the clinical trial.
- If your child had an allogeneic transplant, your child will return every one to two months during the first year.
- During the second year, patients return to the hospital every three to six months.
- After that, patients are seen once a year until they are 18 years old or until 10 years after the transplant has passed, whichever is longer. At that time, patients are discharged permanently from the hospital and are given a summary of their entire treatment.
- At five years, patients without active transplant issues are transferred to the After Completion of Therapy team for long-term follow-up.