Understanding the Stem Cell Transplant Process

You will meet with a care team designed specifically for your child’s condition and needs. The team consists of a transplant physician, transplant nurse practitioner, social worker, child life specialists and a chaplain. Physicians in other specialties are consulted as warranted.

Pre-transplant testing includes laboratory work and other diagnostic tests tailored to each child’s disease, specific condition and diagnosis. These tests might include a bone marrow aspirate, spinal tap, echocardiogram (EKG), pulmonary function test, CT scan and/or MRI scan.

Your care team will identify the type of transplant that is appropriate for your child’s situation.

Stem cell donors are identified by "HLA typing" — a test to determine if another person shares some of the same HLA as your child. (HLA — an acronym for "human leukocyte antigen" — is a marker your immune system uses to recognize which cells belong in your body and which are "foreign" to your system). Patients have a 25 percent chance of having an HLA match with a sibling. If your child does not have a sibling or other family member who is a good match, we look for an unrelated donor through the National Marrow Donor Registry. If there is not a suitable donor, we will speak to you about other strategies including parental blood stem cell grafts and cord blood grafts.

If the patient’s own stem cells are being used, or if the donor is a family member, the stem cell procurement process takes place at Comer Children’s. Unrelated donors are found through the National Marrow Donor Program (NMDP) registry. Their stem cells are brought to the hospital on the day of your child’s transplant. Unrelated umbilical cord stem cells are shipped to our hospital in advance of your child’s conditioning treatment.

Conditioning therapy involves the administration of chemotherapy and/or radiation therapy to the patient before the actual transplant to prepare your child’s bone marrow to receive treatment.

During transplantation, healthy stem cells are infused through the patient's central venous line. The procedure is simple, quick and painless.

Engraftment is when transplanted cells begin to grow and reproduce healthy blood cells. Engraftment signs are usually seen between 10 and 28 days after transplant. The first sign is often an improved white blood cell count. Children are hospitalized and monitored closely for side effects or complications while waiting for engraftment.

Your child remains in the hospital for part of the recovery period and then may continue to recover as an outpatient. The first 100 days post-transplant are a critical time for increased risk of complications. We apply stringent guidelines related to eating, activity outside the home and exposure to visitors.

Depending on how far away you live from Comer Children’s, you and your child may be encouraged to spend part of your recovery time at the Ronald McDonald House, just a few blocks from the hospital. This is especially convenient for allogeneic transplant patients who need to be seen on a daily basis for several weeks after transplant.

You and your primary care doctor will care for your child after recovery. Unless there are new symptoms or complications, your child returns to Comer Children’s one year after transplant for evaluation. Our Childhood Cancer Survivors Center is available to address any concerns or long-term health issues related to childhood cancer and treatment.