The Transplant Process
If your child will have a bone marrow or stem cell transplant at Seattle Cancer Care Alliance (SCCA), consider the information below a brief introduction to the steps involved in receiving a transplant. Read the bone marrow transplant facts section, too.
All transplant patients will receive their own copy of our “Patient & Caregiver Resource Manual” that includes details about navigating the SCCA clinic, treatment in the SCCA Inpatient Unit at Seattle Children’s, the steps in the transplantation process, caring for your child at home, long-term recovery and more. It also includes a guide to Seattle, which is helpful for our out-of-town patients.
Step 2: First visit. This includes meeting the members of your child’s medical team; having an arrival conference, a medical evaluation for transplant and a data-review conference; and settling in to your temporary home in Seattle, if you are from out of town.
Step 3: Conditioning. During this stage, your child will receive conditioning therapy to prepare for the transplant. Conditioning is a treatment—high-dose chemotherapy alone or in combination with radiation therapy—given before the actual transplant to prepare your child’s bone marrow to receive the transplant.
Your child will be given medication to prevent and relieve symptoms caused by the conditioning therapy. These symptoms may include a sore mouth (oral mucositis), hair loss, nausea, vomiting, diarrhea and fever. Having your child rinse his or her mouth frequently will help relieve the discomfort of the sore mouth. Ask your doctor about ways to relieve some of the other side effects.
You will want to make sure that your child balances rest and activity.
Young children are always hospitalized during the conditioning stage. An older child may receive radiation therapy (total body irradiation) as an outpatient before being admitted to the hospital for chemotherapy.
Step 4: Transplant. Your child will receive an infusion of bone marrow or stem cells though a central line. This infusion is usually a brief and uncomplicated procedure, but it is a significant event. Many families choose to celebrate their child’s transplant day as a special occasion. The transplant takes place at SCCA or as an inpatient at Seattle Children’s. Read about finding a donor and what happens when your child’s sibling is the donor.
Step 5: Engraftment. This means that the bone marrow or stem cells your child received during the transplant are growing and beginning to produce new blood cells. Signs of engraftment are seen usually about 10 to 28 days after the transplant. Often the first sign is a rising white blood cell count, and your child’s counts will be monitored to watch for this.
Your child is very susceptible to infections during this time because of the lack of white blood cells. Your child will receive transfusions of blood cells or platelets if necessary.
Your child 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 (VOC); and 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, child life specialists and volunteers.
Your child will be hospitalized while waiting for engraftment.
Step 6: Recovery. After engraftment, your child will remain in the hospital for part of the recovery stage and then will continue to recover as an outpatient. You and your child will need to live within 30 minutes driving distance of either the SCCA clinic or Seattle Children’s during this time.
You will be caring for your child once he or she is released from the hospital. We have classes to teach you the skills you will need, and you will have detailed instructions in the “Patient & Caregiver Resource Manual” as well. Your child’s doctor or nurse is only a phone call away if you have questions.
Step 7: Long-term follow-up. Once you leave SCCA and return home, your child will be under the care of his or her primary care doctor. You should report any new symptoms to your child’s doctor promptly and contact the Long-Term Follow-Up staff if you have any questions. All children return to SCCA one year after their transplant for a one-year evaluation. Many children return annually thereafter for evaluations of engraftment, growth and development, and other long-term follow-up issues unique to growing children.