Paediatric Bone Marrow Transplant

Published with the inputs from Dr Eby P Baby,  Associate Consultant, Paediatric Oncology, Baby Memorial Hospitals- Kozhikode

Paediatric bone marrow transplant, also known as hematopoietic stem cell transplantation (HSCT), is a treatment used for children with certain blood disorders, bone marrow disorders, immune system disorders, and selected cancers. The treatment involves replacing damaged or diseased blood-forming cells with healthy blood-forming stem cells.

Depending on the child's condition and the source of the stem cells, a bone marrow transplant may use the child's own stem cells (autologous transplant) or stem cells from a suitable donor (allogeneic transplant). The transplant process is carefully planned by a specialised paediatric bone marrow transplant team based on the child's diagnosis, overall health, disease status, and donor availability.

What is a paediatric bone marrow transplant?

A paediatric bone marrow transplant is a procedure in which healthy blood-forming stem cells are given to a child to replace damaged or diseased bone marrow.

Bone marrow is responsible for producing important blood cells, including red blood cells, white blood cells, and platelets. A transplant can help restore normal blood-forming function when the child's bone marrow is affected by certain diseases or treatments.

What is another name for a bone marrow transplant?

Bone marrow transplantation is also referred to as hematopoietic stem cell transplantation (HSCT) or stem cell transplantation. The term "bone marrow transplant" is commonly used even when the stem cells are collected from sources other than bone marrow.

Which children may need a bone marrow transplant?

A paediatric bone marrow transplant may be considered for children with certain:

• Blood cancers, including selected leukemias and lymphomas
• Bone marrow failure syndromes
• Inherited blood disorders
• Immune system disorders
• Metabolic disorders

Other conditions in which stem cell transplantation is considered an appropriate treatment- like high risk neuroblastoma, ewing sarcoma. The decision to proceed with transplantation depends on the child's specific diagnosis and clinical condition.

What are the different types of paediatric bone marrow transplant?

There are two main types of stem cell transplantation:

Autologous Transplant

In an autologous transplant, the child's own stem cells are collected and stored before treatment and subsequently returned to the child after chemotherapy to treat the disease.

Allogeneic Transplant

In an allogeneic transplant, stem cells are obtained from another person who is a suitable donor. The donor may be a family member or an unrelated donor, depending on the child's requirements and donor matching.

Where do the stem cells for a transplant come from?

Stem cells used for transplantation can be collected from:

• Bone marrow
• Peripheral blood

The appropriate source depends on the child's condition and the transplant plan.

How is a paediatric bone marrow transplant performed?

The transplant process generally involves several stages.

First, the child undergoes a detailed evaluation to determine whether transplantation is appropriate. HLA matching with donor to look for compatibility is also assessed.

Before the stem cells are given, the child receive conditioning chemotherapy. This include chemotherapy, serotherapy and in selected cases -Radiotherapy to prepare the body for transplantation, and to clear the diseased bone marrow.

The stem cells are then administered through an intravenous line, similar to a blood transfusion. The transplanted stem cells travel to the bone marrow and begin producing new blood cells over 2-3 week.

What is conditioning before a bone marrow transplant?

Conditioning is the treatment given before stem cell transplantation to prepare the child's body for the transplant, to eliminate the diseased marrow and to make the body ready to receive new stem cells.

It may involve chemotherapy, serotherapy and radiation, depending on the disease and transplant plan, The specific conditioning regimen varies according to the child's diagnosis, type of transplant, and clinical circumstances.

How long does a paediatric bone marrow transplant take?

The transplantation of stem cells itself is generally not a surgical procedure and may take a relatively short period. However, the overall transplant journey extends over a much longer period because the child requires preparation before transplantation( 1 week) and close monitoring afterward till the blood count recovery(2-3 week).

The duration of hospitalisation and recovery varies depending on the child's condition, type of transplant, complications, and response to treatment.

What happens after a bone marrow transplant?

After transplantation, the child is closely monitored by the transplant team while the transplanted stem cells establish themselves and begin producing blood cells.

During this period, the child may require monitoring of blood counts, infections, organ function, and other aspects of recovery. Supportive treatment may also be required during the transplant and recovery period.

What are the possible complications of paediatric bone marrow transplantation?

Bone marrow transplantation can be associated with complications. These may vary depending on the type of transplant, the child's underlying condition, conditioning treatment, and other factors.

Possible complications can include:

• Infections
• Low blood cell counts
• Bleeding
• Organ-related complications
• Graft-versus-host disease (GVHD) following an allogeneic transplant
• Other transplant-related complications

The transplant team monitors children closely to identify and manage complications as early as possible.

What is graft-versus-host disease?

Graft-versus-host disease, or GVHD, is a potential complication of an allogeneic stem cell transplant.

It occurs when immune cells from the donor recognise the recipient's tissues as foreign and mount an immune response against them. GVHD can affect different organs and requires careful monitoring and treatment.

How is a suitable donor identified for a child?

For an allogeneic transplant, the donor and child undergo compatibility testing, including human leukocyte antigen (HLA) typing.

A suitable donor may be a sibling, another family member, or an unrelated donor, depending on the child's requirements and available donor options.

Can a child receive a bone marrow transplant from a parent?

In situations where full match donor is not available, then we can take parent as donor for Half match transplant.

How important is infection prevention after a transplant?

Children undergoing bone marrow transplantation have periods of increased vulnerability to infections, particularly while their immune system is recovering.

The transplant team provides specific instructions regarding infection prevention, hygiene, food, visitors, medications, and other precautions according to the child's individual condition.

When can a child return to normal activities after a bone marrow transplant?

The recovery period varies from child to child, usually by 6-12 moth post transplant. The timing of returning to school, physical activities, social activities, and other routines depends on blood count recovery, immune recovery, the child's overall health, and the transplant team's assessment.

The transplant team provides individual guidance regarding the child's activities during recovery.

How long does follow-up continue after a paediatric bone marrow transplant?

Close follow-up is required for initial 3 month to 6 month, then long term follow-up. Long-term follow-up is an important part of paediatric stem cell transplantation. Children may require regular monitoring after transplantation to assess blood counts, immune recovery, organ function, disease status, growth and development, and other aspects of health.

The duration and frequency of follow-up depend on the child's diagnosis and transplant course.

Connect with Our Experts Today

If your child has been diagnosed with a blood disorder, bone marrow disorder, immune system disorder, or another condition for which stem cell transplantation may be considered, consult the Paediatric Haematology and Oncology specialists at Baby Memorial Hospital (BMH).

Our specialists can evaluate your child's condition and advise whether pediatric bone marrow transplantation may be an appropriate treatment option.

👉 Book an Appointment Online or visit Baby Memorial Hospital (BMH) to speak with our specialists and receive guidance tailored to your child's healthcare needs