Blood and Marrow Transplantation (BMT) is a special therapy for patients with cancer or other diseases involving the bone marrow. With this therapy, the child first receives high-dose chemotherapy and/or radiation to eradicate his or her own diseased or malfunctioning bone marrow. Then the patient receives an infusion of stem cells to establish normal bone marrow function.
Your child will receive a thorough evaluation prior to the transplant in order to assess disease status and organ function. The evaluation will allow your child's doctor to make sure that he or she is healthy enough to undergo the transplant procedure and to tailor a specific plan of therapy to your child's health needs. This may include a complete physical examination, blood tests, a bone marrow biopsy and, possibly, imaging studies such as CT scans, MRI studies or X-rays. The heart, lungs, kidney and liver are evaluated so that the doctors can take into consideration what medications it may be important to add or to avoid.
A child will often come to the hospital up to 10 days prior to transplant for hydration, evaluation, placement of the central venous line and other preparations. The central venous line–or catheter–is surgically placed in a vein in the chest area. Blood products and medications will be administered through the catheter.
Most often, high doses of chemotherapy and/or radiation are included in the preparation regimen. Such intense therapy is required to treat the malignancy and to suppress the child's immune system so that it does not reject the new stem cells. This therapy is often called ablative, or myeloablative, because of the severe effect on the bone marrow.
Following the conditioning therapy, stem cells, either from bone marrow, cord blood or peripheral blood, are given through the central venous catheter into the bloodstream. This is called an infusion. 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 new, healthy blood cells.
During your child's hospital stay, 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, input and output, weight and physical findings, and strict infection control precautions.
A caring team of social workers, child psychologists and child life specialists are available to help your child through any temporary emotional or psychological distress that he or she may experience.
Prognosis
As with any procedure, the prognosis and long-term survival of blood and marrow transplantation can vary greatly from child to child. Prognosis depends on a number of factors which include:
- Type of marrow transplant
- Type and extent of the disease being treated
- Age and overall health of the child and his or her tolerance of specific medications, procedures or therapies
- Severity of complications
Your child's transplant physician will provide you with specific details about your child's expected outcome from the procedure.
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