Stem cells are found in bone marrow, blood and, at birth, in the umbilical cord blood. Stem cells from bone marrow and umbilical cord blood are mainly used for children. During a stem cell transplantation, healthy stem cells enter the child's bloodstream via an IV drip. No operation, therefore, is required.
We remove these stem cells in advance from the child or from a donor. The donor may be a sibling, for example, or someone selected from a global donor pool. It is also possible to use frozen umbilical cord blood. The stem cells travel through the blood into the bone marrow cavity, where they make new healthy blood cells. To make room for the donor's stem cells, it is usually necessary to first 'deactivate' the child's bone marrow. This is accomplished with chemotherapy, sometimes in combination with total body irradiation.
Stem cell transplantation is an invasive, risky treatment. The treatment can even damage the body of the child. We keep a close eye on this both during and after the treatment.
When is a stem cell transplant performed?
Stem cell transplants are only performed in children with serious conditions. For example, a child with leukemia who does not respond well to chemotherapy or a child with a metabolic disorder that leads to severe neurological damage. Sometimes, stem cell transplants are one of the last options for children with congenital diseases who have a weak immune system or whose bone marrow is not functioning sufficiently.
The following examinations are generally required to prepare for the stem cell transplant:
- a test to determine the composition of the blood
- an ECG and a cardiac ultrasound
- an oral examination by a dentist to find infections in the mouth
- growth, development and hormonal balance
- lung function test (breath test and X-ray examination)
- eye examination
- X-ray examination (CT scan and abdominal ultrasound)
- lung examination (bronchus alveolaire lavage)
During and after the transplant, your child will receive medication in his/her bloodstream. That is why a central venous catheter will be inserted into your child's blood vessel. This 'Hickman catheter' is inserted in the operating room under anesthesia. The operation will last for between one to one-and-a-half hours. We insert a PICC line for children aged 8 and over. This catheter is inserted via the arm. A PICC line does not require anesthesia.
Chemotherapy is required before the stem cell transplant can be performed. Chemotherapy is administered in order to kill your child's own bone marrow cells. This is how we make room for the new bone marrow. In addition, chemotherapy suppresses your child's immune system. This is important measure to prevent your child's body from rejecting the donor bone marrow after the transplant.
Due to the transplant, initially the number of white blood cells in your child's body will substantially decrease. This means that your child will be more susceptible to bacteria, viruses and fungi. We want to limit any chance of infection as much as possible. And this is possible with the administration of immunotherapy.
The transplantation of the stem cells is a stressful yet exciting moment. The parents may be present for this. If a younger brother, sister or one of the parents is the donor, the transplant will generally take place on the same day that the bone marrow was taken from the donor. A lab technician brings the stem cells to the department in an infusion bag. The stem cells are then administered via the central line. This process is very similar to a blood transfusion. So, surgery is not necessary for the transplant itself.
If the new stem cells begin growing and the blood contains new white blood cells, your child may leave the isolation room after a while to go outside. At our center, the rules governing the isolation remain the same until your child is able to go home.
Before your child goes home, the Hickman catheter or PICC line will be removed. Will your child have to be admitted to the hospital within six months of his/her stem cell transplant? Due to, for example, an infection or a transplant illness? Then the strict insulation rules will once more apply. That means that your child will only be allowed to leave the room to go outside.
Check-ups at the Outpatient Clinic
At the outpatient clinic, we assess whether your child's immune system is recovering adequately. If this is the case, your child will receive the vaccinations again (DTP, MMR and so forth). These are the same vaccinations that children are given at a young age. Your child must have these vaccinations again.
What are the potential side effects of a stem cell transplant?
Because of the medication that your child received to prevent the rejection of the donor transplant, his/her taste can change significantly. This is only temporary. If your child develops a transplant disease, he/she will usually receive prednisone. Behavioral changes are a side effect of this drug.
Post Transplant Regimen
After the stem cell transplant, your child will have a weakened immune system for several months. Your child will also need plenty of rest and will easily tire. The most important regimen rule for the initial period after being discharged from the hospital:
- Avoid confined spaces where many people gather (stores, the cinema, buses and trains, receptions and church).
- Do not let your child go to school until you have consulted with the attending physician.
- Avoid busy public areas and poorly ventilated spaces.
- Your child may not swim with the Hickman catheter inserted.
- Try to maintain your child's normal diet as much as possible
You can receive visitors at home, but limit this to no more than four people at the same time. Pay attention that visitors do not suffer from the following symptoms:
- the common cold
- the flu
- a stomach pain (diarrhea)
- childhood diseases such as chickenpox, measles, etc.
- a cold sore or shingles