Prior to the bone marrow transplant, your child will receive high dose chemotherapy with or without radiation. The purpose of this treatment is to rid the body of the disease and make room for the new marrow to grow.

Sources of Stem Cells
Bone marrow is rich in stem cells. Stem cells are a type of blood cells which ultimately produces red blood cells, white blood cells and platelets. Stem cells are also found in circulating blood and umbilical cord blood.

An allogeneic BMT uses the stem cells collected from the bone marrow of another person. This donor may be HLA matched or mismatched, and may be related or unrelated. (See "Selecting a Donor").

Autologous bone marrow transplant involves the withdrawal of the child's own marrow, which is then frozen. It is given back to the child after chemotherapy and radiation have been administered. If the marrow is involved in the disease process, it must be treated to remove the malignant cells before giving it back to the child.

Stem cells may be collected from the circulating blood. Generally, this collection process takes 3-6 hours each day for three days and may require placement of another catheter. Occasionally, this process may need to be repeated until enough stem cells are collected. A medication may be given to stimulate the bone marrow to produce stem cells. Once enough stem cells are collected, they are frozen. The child then receives chemotherapy/radiation therapy, and is given back the stem cells to re-populate the bone marrow.

Stem cells from umbilical cord blood may be used for transplantation. A number of centers collect and store umbilical cord blood for BMT and there is a large registry which keeps records of these. If a child needs a BMT, this registry can be examined to see if there is a cord blood that is matched and could be used following chemotherapy/radiation therapy. Additionally, a sibling's umbilical cord stem cells may be collected at the time of delivery if the sibling is being considered as a donor.

Collection of Peripheral Blood Stem Cells
After your child finishes the course of chemotherapy and his/her counts begin to recover, with the use of G-CSF, the peripheral stem cell collection can begin. The collection will take place on 3 JCW, the bone marrow transplant unit or the blood donor center, depending on the age/size of your child. Small children usually need to have a separate catheter placed for the collection. The new catheter (called a hemodialysis catheter) may be inserted in the operating room or in the radiology suite. If your child does not have a special catheter placed for stem cell collection, an IV (intravenous) line may need to be started in the arm each day. EMLA cream may be applied to help decrease the pain with insertion of the IV.

Process:

When your child's white count rises, the number of stem cells will be counted, and if adequate, they will be collected and stored for later use. This is done by a special machine called an apheresis machine. To get the stem cells out, your child's blood will go through the apheresis machine, the stem cells will be separated out, and the rest will be returned through the hemodialysis catheter, the central line or the IV. The process will take about 3-6 hours each day for about three days. A nurse will be there during the collection and will check vital signs frequently. Older children may need to eat Tums every 15-30 minutes during the procedure to keep the calcium level normal. If your child feels tingling or has chills during the collection, the nurse should be informed. Personnel in the blood bank calculate the dose of stem cells collected. If not enough are collected during the first three days, the process may be repeated. The stem cells will be frozen until the child is ready to receive them.

Infusion of Stem Cells
After your child receives pre-transplant chemotherapy, the stem cells can be reinfused through the central line. The stem cells are thawed right before they are infused. Before the infusion, your child will receive tylenol or benadryl and possibly other medications. These are given to prevent a reaction to the stem cells and the fluid they were frozen in. Vital signs will be checked every 15 minutes during the stem cell infusion. A nurse and a physician assistant will be in the room during the infusion.

After the stem cells are given, your child will receive extra IV fluids through the central line to ensure the kidneys are not damaged. Your child's urine may turn red after the stem cell infusion.

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