The Transplant Process – 7 Steps

The process of transplant can be divided into seven steps. Each step has its own purpose and challenges. These steps are outlined below, but if your child is a transplant patient, you’ll receive in-depth information about their transplant and the process from your doctor.

Step 1: Planning Ahead
After you’ve decided that a transplant is right for your child, you’ll want to make a few plans to ease the process.

• Assess your financial coverage and other financial resources. You may even consider fundraising. More information is available at SCCA to assist you.
• Select their caregiver -- most often this is one or both of the parents.
• Make decisions about child care and/or schooling for siblings.
• Plan your family's stay in Seattle if you don’t live locally.

Step 2: Preparation
This step includes your First Visit and Arrival Conference where you will meet the members of your child's medical team and your child will have a medical evaluation. During these appointments you'll read and sign consent forms and protocols, ask questions, and learn how you will help your child cope with the transplant. There are classes for caregivers to help. Your child's central venous catheter will be inserted at Seattle Children's. This is a surgical procedure and sedation will be provided first. You will receive instructions about preparing for this procedure. For autologous transplant patients, the collection and storage of your child's marrow or peripheral blood stem cells will also take place.

Step 3: Conditioning
The conditioning stage prepares your child for transplant. It may be done on an outpatient basis at SCCA or as an inpatient at Seattle Children's. Conditioning removes cancer cells and the remaining immune system from your child's body so that new marrow has room to grow. Traditionally, this is performed with either high-dose chemotherapy and/or radiation therapy. In a mini transplant, moderate medications and radiation are used.

Side Effects of Conditioning
Side effects of the conditioning therapy may include nausea, vomiting, diarrhea, dry mouth, fatigue, and skin changes. These can typically be managed with medications. Frequent mouth rinses are helpful, too.

Some of the side effects of chemotherapy happen right away. Detailed information regarding the specific chemotherapy drugs and their side effects will be discussed with you by your child's health-care team.

Radiation therapy is given to the entire body, two times a day in small fractions over a number of days. There is no pain involved. Detailed information regarding radiation and the treatment of its side effects will also be discussed with you by your health-care team.

Step 4: Transplant
The transplant takes place a day or two after chemotherapy and/or radiation is completed. The goal is to infuse the stem cells from which all type of blood cells will grow. These cells can be collected from bone marrow, from circulating blood, or from saved umbilical cord blood after a baby’s birth. The stem cells are infused through the central venous line in much the same way that any blood transfusion is given.

Many families choose to celebrate the transplant day as a special occasion.

The Bone Marrow Donor

Donors will receive their own education materials when they arrive at SCCA. The bone-marrow donor is the person who makes an allogeneic transplant procedure possible. The donor is the person who most closely matches the geneic type of your child. The donor may be an immediate family member, often a brother or sister. In some cases, the donor and patient are not related at all but are still closely matched in tissue type.

Read more about When Your Child is the Donor.

Most families arrive at SCCA knowing who the donor will be. Even with a known donor, it is still important that some typing be repeated. This information assures the medical team that the best possible donor has been selected. There are no age restrictions for donors.

Marrow Harvesting

The actual harvesting of the marrow is performed in surgery where marrow is taken from the hip bones. Marrow is obtained through needles inserted through the skin into the hipbones. Most donors go home from the hospital after marrow harvest unless an overnight stay is medically necessary. Stem cells are produced in the bone marrow and circulate in the bloodstream (called peripheral blood stem cells or PBSCs). Normally, small numbers of stem cells circulate in the bloodstream, but it is possible to obtain stem cells this way, but before that can be done the it is necessary to stimulate the movement of stem cells into the bloodstream. This is called mobilization and the donor receives special proteins called growth factors for a few days before collection can begin.

Stem cells are collected in the Apheresis Unit at SCCA.

More Information for Donors.


Step 5: Waiting for Engraftment
Engraftment means that the bone marrow or stem cells you received during the transplant are growing and beginning to produce new blood cells. Signs of engraftment usually are seen about 10 to 28 days after the transplant.

Often the first sign is a rising white blood cell count. Your child's blood cell counts will be monitored to watch for this. During this time:

• Your child will be very susceptible to infections because of the lack of white blood cells.
• Your child will receive transfusions of blood cells or platelets if needed to boost cell counts.
• Your child will also will be monitored closely for any side effects or complications of the treatment.

Possible complications include viral, bacterial, and fungal infections; pneumonia; veno-occlusive disease (VOD), also called sinusoidal obstruction syndrome (SOS), of the liver and other organ failure. The risk of organ failure may be greater in patients who already have had intensive chemotherapy or radiation therapy or both before coming for a transplant.

During this time, you may want to take advantage of the Support Services available to you and your family, including social workers. Most patients, and parents of patients, experience the uncertainty of waiting for engraftment as stressful. Associated with the daily monitoring, medical procedures, and treatments is feeling a loss of control. Coping can be a challenge, which may vary depending on your child's age or developmental stage. Children benefit from age-appropriate preparation for new treatments and experiences. Reasonable limit-setting and maintaining as normal a schedule as possible often helps children feel safe and they cope better with the hospital experience. Playing games, painting, doing crafts, or listening to books read aloud can be helpful.

For a standard transplant, your child will be hospitalized while waiting for engraftment. This is not the case for a mini transplant.

Step 6: Recovery after Engraftment
As your child's new immune system is developing, the goal is to support recovery and to manage any complications that may arise during this phase. The immune system is immature, and your child is still vulnerable to infections. Infustions of red blood cells or platelets, as well as fluids and nutritional support, may be necessary.

Your child will feel tired during this phase, as well as later in recovery. Try to keep your child as active as possible because this helps prevent some complications. Many adults and children feel depressed at times during recovery as well. This is a normal reaction to the changes and intense experiences of the transplant. SCCA and Seattle Children's medical team and support staff will provide information on ways to help alleviate depression and other emotions you and your child may experience during this time.

Toward the end of the recovery period, you will meet with staff from the Long-Term Follow-Up team.

Step 7: Long-term recovery
Long-term recovery may take a year or longer. Once you leave SCCA and return home, you will be under the care of your referring doctor. You should report any new symptoms to your doctor promptly and contact the Long-Term Follow-Up staff if you have any questions. Allogenic transplant patients return to SCCA one year after their transplant for an evaluation.

* The information on this page only summarizes the Transplant Process. As a patient at SCCA and Seattle Children's you will receive more complete, in-depth information.