Preparing for treatment - Bone Marrow Transplant

Some children with leukaemia, certain other forms of cancer, diseases of the bone marrow that are not truly cancerous and some genetic diseases, require a bone marrow transplant (BMT) as part of their treatment. This treatment option is only given to patients for whom BMT offers the best or the only chance of cure, since it is a far more intensive form of treatment than chemotherapy. BMT is the transplanting of stem cells from the bone marrow of a healthy donor to the patient. The patient's unhealthy bone marrow cells are destroyed, and then healthy bone marrow cells are infused into the patient, almost like a blood transfusion. There are different kinds of BMT and there are many factors to consider when deciding which type of transplant should be used for a particular patient. Your doctor will discuss all of these options with you.

 Types of bone marrow transplant include:

1) autologus transplant: The child's own bone marrow is used. Bone marrow is taken from the patient, provided he/she is in remission or after initial treatment cycles have successfully reduced the disease and stored in a special freezer and given back to the patient at a later stage.

2) allogenic transplant: A family member or an unrelated, genetically matched person donates bone marrow to the child.

3) syngenic transplant: The child's identical twin or triplet is the donor.

3) stem cell transplant: Stem cells from the circulating blood in the body or from a placenta (after birth) can be used instead of bone marrow.

4) haematopoietic stem cell transplant (HSCT): Is the more modern, more encompassing term for BMT as stem cells are collected from the peripheral blood (not the bone marrow), by  a process called apheresis (the donor/patient blood is passed through a machine that separates blood components and maintains the stem cells. The remaining blood is returned to the donor/patient). Stem cells from the circulating blood in the body or from the umbilical cord and a placenta (after birth) can be used, can be used  provided there is a human lymphoid antigen (HLA) tissue match to the patient. 

5) autologous haematopoietic stem cell transplant (aHSCT): If the patient is to have an aHSCT, the stem cells would have been collected while the patient was in remission and given back to the patient, after the high dose chemotherapy or radiation.

The first step in preparing for BMT/HSCT is to destroy the patient's unhealthy bone marrow. This is done by giving the patient high-dose chemotherapy and sometimes a form of radiation therapy called Total Body Irradiation. The purpose of this is to eliminate all the cancer cells in the body and the abnormal parts of the bone marrow. However, this treatment also destroys the white blood cells that protect the body against infections, making the patient very susceptible to all kinds of infection. It can take 6 to 12 months after the transplant before the patient's immune system recovers. 

BMT/HSCT is really intensive and tough on the patient's body and requires a stay in hospital for 6 weeks or longer.

Tips for parents and caregivers:

Understand the process and keep a diary to monitor progress and concerns and a file with all the relevant documents.

Understanding them helps you make informed decisions.

Follow infection-control rules - hand hygiene is non-negotiable. 

Adhere to the hospital’s requirements when it comes to visitors.

Adhere to the child’s diet as advised by the dietician.

Give the child a sense of independence by allowing them to choose small things like what clothes they wear, which book to read, or which movie to watch.

Open, honest, gentle and clear communication to the child and family is paramount. Explain what’s happening at their level of understanding.

Make the hospital room child-friendly. Bring favourite things from home provided they have been washed and wiped with hospital-approved disinfectant or check your hospital’s BMT protocols. Keep your daily routine and bring fun and entertainment to the room.

Mouth sores are common — follow the mouthrinse / care protocol exactly.

Keep skin moisturised, after checking with your transplant team which product is best to use and watch for rashes — these could be early signs of graft-versus-host disease (a complication of donated stem cell transplants).

Take care of yourself. Allow other caregivers to give you off-time and allow your community to support your family at home.

Connect with a parent support group and reach out to allied medical professionals for help and guidance. 

Post-transplant precautions can last 6–12 months: avoiding crowds, wearing masks, limiting school attendance until immune function recovers.

Ask the medical team for advice about vaccinations. 

Monitor for late effects: Growth, hormone function, learning, and emotional wellbeing may need ongoing assessment.

Below are some resources you might find useful:

1) City Of Hope. 2025. Pediatric Bone Marrow Transplant Facts.

2) NHS Foundation Trust. Manchester University. n.d. Haematopoietic Stem Cell Transplantation (HSCT).