Within hours of the transplant, the new bone marrow stem cells will find their way to the marrow space in your child's bones where they will grow and start making red cells, white cells and platelets. It will take the new bone marrow about two to four weeks to grow, or engraft, in the bones.
While waiting for the new marrow to engraft, the patient will continue to be at a very high risk for developing infections, including pneumonia, and must remain in isolation. During this time, especially if mouth sores, called mucositis, develop, it is likely your child will have fevers and will need additional antibiotics.
In addition, multiple transfusions will be needed to support platelet and red blood cell counts. All blood products are tested as carefully and completely as possible by the Blood Bank to minimize transfusion reactions and infection.
While it is not necessary, if you wish to arrange for donor-designated blood to be given to your child during transplant, our clinical nurse specialist or nurse coordinator can provide you with information as to how to create such a program.
The need for transfusions will decrease as the new marrow stem cells begin working. Daily complete blood counts (CBC) and platelet counts will help the doctors keep track of how well the new marrow is growing.
The absolute neutrophil count (ANC) which is the total number of special white cells or neutrophils that fight bacterial and fungal infections must be greater than 500 for three consecutive days before the attending physician will discontinue strict isolation.
Side Effects and Complications
Infection, anemia and bleeding are all potential problems after the transplant. These are expected side effects of the conditioning regimen. Other side effects that can be expected during this post-transplant period include:
- Mouth sores
- Sore throat
- Dry mouth
- Swollen glands
- Hair loss
- Darkening and dryness of the skin
Some or all of these side effects may develop. The lungs, liver and kidneys also may show the cumulative effects of chemotherapy, radiation and other drugs used post-transplant. Complications due to organ damage, such as veno-occlusive disease (VOD) of the liver, may be mild and transient or severe and fatal.
The pre-transplant evaluations as well as careful monitoring while in the BMT Unit are intended to minimize serious complications. However, five percent to 20 percent of all children receiving a BMT will die of a complication such as an infection, bleeding, organ failure, graft failure or graft-versus-host disease, generally within the first three months following the transplant. The likelihood of a fatal complication varies depending upon the underlying disease, age of the patient, conditioning regimen and type of transplant.
Most patients experience some nausea and vomiting during the conditioning regimen, which often continues into the post-transplant period. The amount of nausea and vomiting varies among children and is dependent upon the type of chemotherapy and radiation therapy received. To control the nausea and vomiting there are anti-nausea medications that can be given through the IV. There are several types of drugs that can be used alone or in combination, including Granisetron (Kytril), Ondansatron (Zofran), Decadron, Ativan, Reglan, Benadryl and a Scopalamine patch. If there is a specific medication that has worked in the past for you or your child please let us know.
Your child's appetite will probably be very poor during the transplant period. Therefore, nutritional support will be provided using special IV fluids called total parenteral nutrition (TPN).
Mouth sores and skin breakdown may be a painful side effect chemotherapy and radiation. To relieve the pain, intravenous pain medications such as Morphine or Dilaudid can be administered at intervals or as a continuous infusion.