Stem cell transplantation for children and teens

What are stem cells?

Blood stem cells are produced in the marrow of the bones and can become any kind of blood cell the body needs. Stem cells are constantly dividing and maturing into different types of blood cells, replacing older and worn-out blood cells in the body. They produce billions of new blood cells every day. If the stem cells cannot make enough new blood cells, many serious health problems can occur. These problems may include infections, anemia or bleeding.

Healthy stem cells are needed to live. When cancer or cancer treatments destroy the stem cells, stem cell transplantation (SCT) may be the best treatment option.

What is a stem cell transplantation (SCT)?

Stem cell transplantation (SCT), sometimes referred to as bone marrow transplant (BMT), is a procedure in which a patient receives healthy stem cells to replace damaged stem cells.

Before SCT, the patient receives high doses of chemotherapy, and sometimes radiation therapy, to prepare the body for transplantation. This is called "conditioning treatment." The conditioning treatment can be very hard on a patient’s body and can lead to severe side effects and complications. Therefore, it is important for patients to discuss all the risks and benefits of SCT with their doctors. The doctor should also discuss other possible treatment options, including taking part in a clinical trial.

After the stem cells are infused, they will travel in the bloodstream to the bone marrow. These stem cells begin to divide and make new blood cells in the bone marrow, a process called "engraftment." Engraftment usually happens within the first 30 days after transplantation, but sometimes it can take longer. The doctor will check the patient’s blood counts every day to see if the patient’s bone marrow has begun producing new blood cells. As engraftment occurs, the numbers of white blood cells, red blood cells and platelets begin to increase in the patient.

Types of stem cell transplantation

The main types of SCT are:

• Autologous transplantation uses the patient’s own stem cells. These cells are removed, treated and returned to his or her own body after a conditioning regimen.
• Allogeneic transplantation uses stem cells from a donor. A donor may be a family member or someone who is not related to the patient. Reduced-intensity allogeneic stem cell transplantation includes conditioning treatment that contains lower, less toxic doses of chemotherapy and radiation.

Are you a candidate for stem cell transplantation?

In order to find out if a patient is a good candidate for SCT, the patient’s doctor will consider:

• The patient’s general health
• Results of the physical checkup and medical tests
• The type and stage of cancer or other diseases
• Previous medical treatments
• The likelihood that the disease will respond to the transplant
• The ability to use the patient’s own stem cells, or the availability of a suitable donor

Some patients may not be eligible for standard SCT due to advanced age or other major health problems, such as heart, lung or kidney disease. For some of these patients, a reduced intensity allogeneic SCT may be a treatment option.

Preparing for transplantation

Medical tests: Stem cell transplantation (SCT) is a demanding medical procedure. Doctors will order medical tests to make sure that patients are healthy enough for this treatment.

Caregiver: Patients who undergo SCT will need an adult caregiver to provide support and care throughout the process. Sometimes, a caregiver is one person, but often several people help at different times. A caregiver can be a spouse, partner, sibling, parent, adult child or a close friend. A caregiver should be with the patient at all times after the patient is discharged from the hospital in case unexpected complications arise and help is needed. Members of the patient’s healthcare team will teach the caregiver(s) the necessary skills to care for the patient.

Cost of transplantation: Stem cell transplantation is a very expensive procedure. As soon as a stem cell transplant is being considered as a treatment option, patients should discuss financial issues with their treatment team. Transplant centers have staff members who can help patients to get answers for financial questions concerning health insurance and financial assistance.

Most insurance plans cover some of the costs of transplantation for certain cancers or diseases. Before undergoing transplantation, patients should contact their medical insurance providers and determine which costs the insurance provider will cover. If their insurance company denies coverage for a recommended treatment, procedure, or prescription medication, patients may be able to get the decision overturned by filing an appeal with their insurance company. 

Learn more about paying for your child's blood cancer treatment or contact a Blood Cancer United Information Specialist for additional financial resources.

Fertility: High doses of chemotherapy and radiation can damage eggs, sperm and other parts of the reproductive system, affecting the ability to become pregnant or contribute to a pregnancy. Recovery from stem cell transplantation may take months to years, and patients of childbearing age may not be physically or psychologically ready to think about parenthood for several years after transplantation. Patients who may want to have children in the future should discuss options to preserve fertility before transplantation.

Learn more about the impact of SCT on a child's fertility and reproductive health.

Insertion of a central venous catheter: Before the transplantation, the patient will have a central line (central venous catheter) inserted if they do not have one already to make infusions and blood draws easier and less painful. 

See Methods to administer drugs for more information.