Our Health Topics

Pediatric Stem Cell Transplantation

  • Overview

    Stem cell transplantation (also called a bone marrow transplant) is a therapy for children with cancer or other diseases that affect their bone marrow. Bone marrow is a specialized tissue inside the bones that produces all of the body’s blood cells. The goal of a stem cell transplant is to transfuse healthy bone marrow cells into your child after unhealthy bone marrow has been destroyed.

    • Stem cell transplant is the treatment of choice for a large number of diseases of the immune and blood forming systems, including acute and chronic leukemia, lymphomas; immunologic and hematologic disorders, like severe combined immunodeficiency syndrome; and bone marrow failure syndromes, such as severe aplastic anemia.
    • It has also been used to successfully treat a variety of childhood solid tumors, including neuroblastoma, Wilms' tumors, and certain testicular and ovarian malignancies.
    • Following a successful transplant, your child will require specialized care and precautions as her immune system recovers.

    How Boston Children's Hospital approaches stem cell transplants

    Patients needing a stem cell transplant are treated through the Pediatric Stem Cell Transplantation Program at Dana-Farber/Boston Children's Cancer and Blood Disorders Center. Our stem cell transplant program is one of the most experienced and largest pediatric transplant centers in the nation.

    Dana-Farber/Children’s Hospital Cancer Center, an integrated pediatric oncology program through Dana-Farber Cancer Institute and Children’s Hospital Boston that provides—in one specialized program—all the services of both a leading cancer center and a pediatric hospital. - See more at: http://www.childrenshospital.org/health-topics/conditions/b/brain-tumors#sthash.TgwjHDuS.dpuf
     

    Multidisciplinary care

    Our multidisciplinary pediatric stem cell transplant team integrates the expertise of:

    • pediatric specialists from all medical areas, such as hematology, gastroenterology, cardiology, nutrition, endocrinology and infectious disease
       
    • senior attending physicians, nurse practitioners, pharmacists, physician assistants, registered nurses and pediatric hematology-oncology fellows with expertise in stem cell transplant
       
    • physicians specializing in nutrition and pain management, who see your child daily
       
    • Child Life specialists, psychologists, social workers and resource specialists who provide your child with supportive care before, during and after the transplant

    What we offer

    Personalized, patient- and family-centered care is a hallmark of our practice. Our comprehensive services include:

    • evaluation and pre-transplant care of your child by a senior transplant attending
       
    • donor identification, including family HLA typing (checking a collection of genes) and, if necessary, the coordination of unrelated donor services with our on-site National Marrow Donor Program office
       
    • round-the-clock access to a member of our transplant team
       
    • weekly patient satisfaction rounds with nursing and physician leadership
       

    When we say 'stem cell transplant,' we mean the conditioning chemotherapy followed by the infusion of the stem cells. Ironically, the infusion of stem cells is sometimes the least important part. When we're talking about transplant, we're talking about that package.

    Leslie Lehmann, MD, Director, Boston Children's Hospital Stem Cell Transplantation Program

  • In-Depth

    We understand how overwhelming it can be to learn that your child needs a stem cell transplant. Right now, you probably have a lot of questions. What is it? What do we do next?

    We’ve tried to provide some answers to those questions in the following pages, and our experts can explain your child’s options fully when you meet with us.

    What is bone marrow?

    Bone marrow is a soft, spongy tissue found inside the bones. The bone marrow in the hips, breastbone, spine, ribs, and skull contain cells that produce about 95 percent of the body's blood cells.

    The three main types of blood cells produced in the bone marrow are:

    • red blood cells (erythrocytes), which carry oxygen throughout the body
       
    • white blood cells (leukocytes), which help to fight infections
       
    • platelets, which help blood to clot

    What are stem cells?

    Stem cells are immature cells that are able to produce other blood cells that mature and function as needed. Every type of blood cell in the bone marrow begins as a stem cell.

    Stem cells are the most important cells in a bone marrow transplant. Once transplanted, they move into your child’s bones and begin to produce the blood cells that are needed by her body.

    Hematopoietic stem cells can form any type of blood cell including red blood cells, white blood cells and platelets. They are different from pluripotent stem cells, which can form any type of cell. Stem cell, or bone marrow, transplantation uses hematopoietic stem cells to treat cancers and certain genetic disorders.

    For more information on stem cell research, visit our stem cell website.

    What is a stem cell transplant?

    A stem cell transplant is an infusion of healthy hematopoietic stem cells by IV (through a needle into a vein) in order to treat certain types of cancer, blood disorders and other conditions. Hematopoietic stem cells are a special type of cell found in the bone marrow that can form any type of blood cell: red blood cells, white blood cells and platelets. This is different from pluripotent or embryonic stem cells, which can form any type of cell in the body.

    The cells for a stem cell transplant, also called a bone marrow transplant, can come from a related donor—usually a sibling, unrelated donor or the patient himself. The stem cells are infused into your child’s bloodstream and travel to the bone marrow where they begin to make new blood cells.

    Why would a stem cell transplant be needed?

    The goal of a stem cell transplant is to cure many diseases, including some types of cancer.

    A stem cell transplant can be used to:

    • replace diseased, non-functional bone marrow with healthy functioning bone marrow (for conditions such aplastic anemia and sickle cell disease)
       
    • replace bone marrow and restore its normal function after high doses of chemotherapy or radiation (for diseases such as lymphoma and neuroblastoma)
       
    • replace bone marrow with healthy functioning bone marrow to prevent further damage from a genetic disease process (such as Hurler's syndrome and adrenoleukodystrophy)

    Stem cell transplantation has risks involved, some of which are life threatening. The risks and benefits must be weighed in a thorough discussion with your child’s stem cell transplant team prior to the procedure.

    What diseases can be treated with stem cell transplantation?

    Some of the most common conditions that bone marrow transplants are used to treat include:

    • leukemia
    • lymphomas
    • some solid tumors (i.e., neuroblastoma)
    • aplastic anemia
    • congenital bone marrow failure syndromes
    • immune deficiencies (severe combined immunodeficiency disorder, Wiskott-Aldrich Syndrome)
    • sickle cell disease
    • thalassemia
    • metabolic/storage diseases (e.g., Hurler's syndrome, adrenoleukodystrophy disorder)

    A stem cell transplant may not be appropriate for your child even if she suffers from one of these diseases. Your child’s physician will determine whether a stem cell transplant is appropriate.

    What are the different types of stem cell transplants?

    There are three different types of bone marrow transplant:

    • autologous stem cell transplant: Your child acts as her own donor. Stem cells are collected by apheresis (a process of collecting stem cells in the blood) and then replaced after intensive treatment. In this situation, the term “stem cell rescue” is often used instead of “transplant.”
       
    • allogeneic stem cell transplant: In this type of transplant, stem cells are taken either by bone marrow harvest or apheresis from a genetically-compatible donor, usually a brother or sister. Other donors for allogeneic bone marrow transplants include:
      • A parent — When the donor is a parent and the genetic match is at least half identical to the recipient, the match is called a “haploid-identical match.”
         
      • An identical twin  — Identical twins are considered a complete genetic match for a stem cell transplant. This kind of transplant is called a “syngeneic” transplant. Syngeneic transplants are very rare because the child must have an identical twin.
         
      • An unrelated donor (UBMT or MUD for “matched unrelated donor”) — The genetically matched marrow or stem cells are provided by an unrelated donor. These donors are generally found through national bone marrow registries.
         
    • umbilical cord blood transplant: Stem cells are sometimes taken from an umbilical cord immediately after a baby is born. These stem cells can reproduce into mature, functioning blood cells. These cells are tested, typed, counted and frozen until they are ready to be transplanted. The T-lymphocytes, a type of immune cell that can cause transplant complications, are immature, so recipients may have a decreased risk of problems related to transplant. However, because of the limited number of stem cells in the umbilical cord, this type of transplant is generally limited to younger and smaller patients.

    How is it decided if my child will have a stem cell transplant?

    The decision for your child to undergo a stem cell transplant will be based on many factors including:

    • her age, overall health and medical history
    • disease status
    • availability of a donor
    • his tolerance for specific medications, procedures or therapies
    • expectations for the course of the disease
    • expectations for the course of the transplant

    Our stem cell transplant experts will determine whether a stem cell transplant is appropriate for your child and will discuss your child’s treatment options with you and your family

    FAQ

    Q: What is a stem cell transplant?

    A:
    A stem cell transplant is an infusion of healthy hematopoietic stem cells that’s done to treat certain types of cancer, blood disorders and other conditions. Hematopoietic stem cells are a special type of cell found in the bone marrow that can form any type of blood cell: red blood cells, white blood cells and platelets. This is different from pluripotent or embryonic stem cells, which can form any type of cell in the body.

    The cells for a stem cell transplant, also called a bone marrow transplant, can come from a related donor such as a sibling, an unrelated donor or from the patient herself. The stem cells are injected into your child’s bloodstream and travel to the bone marrow where they begin to make new blood cells.

    Q: How do I find a matched donor for my child?

    A:
    If your child needs stem cells from someone else, we will determine the best donor possible using HLA-typing, a process that is used to detect your child’s transplant antigens. Antigens are "fingerprints" on the surface of almost all cells of the body.

    It’s best to find a donor whose HLA-type is as similar as possible to your child’s. We begin by testing your child and immediate family members.

    • Matched or closely matched family donor: About 25 percent of patients have a family member who is a match at the six major sites tested. If a member of your family matches in five or six of the areas, she may be selected as a donor.
       
    • Unrelated donor: If no acceptable match is found within your family, the transplant team may conduct a preliminary search for an unrelated donor through the National Marrow Donor Program (NMDP) and more than 46 international and cord bank computerized database registries. The preliminary search of the donor database is free. The transplant team will then ask registries to contact potential matched donors for further testing, which requires insurance coverage or a financial down-payment. The transplant team meets at least weekly to review the status of the donor search, and the Stem Cell Transplant Patient Coordinator will update you and your family on a regular basis.
       
    • Mismatched family and haploidentical transplant: Some patients will not have an acceptable donor in the registries. Researchers are currently investigating the possibility of using family members as donors even if they aren’t a close enough match for a traditional transplant. This type of transplant is called a haploidentical transplant. Any family member between the ages of 17 and 60 who has been HLA tested at Dana-Farber Cancer Institute may enroll in the NMDP by contacting the NMDP Donor Center at 617-632-2561.

    Q: How does a stem cell transplant work?

    A:
    Stem cells are injected via IV into your child’s blood stream. They make their way into her bone marrow and replace the cells that used to be there. Eventually, these stem cells begin to make new, healthy blood cells. The transplant replaces stem cells that were damaged or defective and, as a result, it can cure certain cancers, blood disorders and genetic defects.

    Q: How long does it take to find an unrelated donor? 

    A: Identifying a donor involves many factors, so the length of a donor search varies. How many possible matches exist, how long it takes to receive samples to confirm typing, and donor availability can all affect the length of a donor search. Our Stem Cell Transplant Patient Coordinator will keep you and your family updated on the status of the search.

    Q: What is the cost of typing for donors? 

    A: Through Dana-Farber/Boston Children's Cancer and Blood Disorders Center, donor typing is free for immediate family members at Dana-Farber Cancer Institute's blood center. Extended family members and friends interested in becoming a marrow donor should contact the National Marrow Donor Program (NMDP), which will provide typing services for a cost of $60. This fee may be covered by the donor's health care insurance plan.

    Q: What is the donor process?

    A: A bone marrow donor process begins with a physical evaluation, which includes basic blood tests and screening for infectious disease. If the donor is approved, she will have to attend a pre-operative appointment before the bone marrow harvest, a surgical operation to collect the bone marrow.

    Q: How long do donors have to stay in the hospital after the bone marrow harvest? 

    A: Bone marrow donors stay one night for observation after the bone marrow harvest. If the donor is a child, she will be admitted to the transplantation unit if a bed is available. If the donor is an adult, the harvest and overnight stay occur at Brigham and Women's Hospital.

    Q: Can I contact my child's unrelated bone marrow donor? 

    A: For the first year after your child's transplant you can have anonymous contact with the donor. Communication is usually facilitated through the National Marrow Donor Program. You may send written correspondence, but no personal information, names or geographical references are allowed. After one year, if both parties agree, you may directly contact the donor. In some cases, this waiting period may be longer due to international regulations.

    For more information on stem cell transplantation, visit our research site.

    Q: How long will my child have to stay in the hospital?

    A:
    Your child’s length of stay will depend on many factors, including:

    • the success of engraftment
    • the presence of complications
    • your child’s overall health
    • your distance from Children’s

    Your child’s length of stay can vary significantly depending on these factors. On average, however, children stay in the hospital for about 30 to 40 days.

    Useful terms

    Here are some important terms to know:

    Allogeneic stem cell transplant (Allo): This is the infusion of another person’s bone marrow or stem cells after high dose chemotherapy and/or radiation.

    Autologous stem cell transplant (Auto): This is the infusion of a patient’s own bone marrow or stem cells after receiving high dose chemotherapy and/or radiation.

    Graft-versus-host disease (GVHD): This is a rejection process, in which the transplanted bone marrow (the graft) attacks tissues in the recipient (the host). The organs usually affected are the skin, gastrointestinal tract and liver.

    HLA typing: This is the process of identifying the genetic structure of circulating white blood cells. HLA typing, also known as tissue-typing, is performed to determine whether a donor can be found for a bone marrow transplant. Blood is removed from a vein for this test.

    Peripheral-blood stem cell transplant (PBSCT): This is a type of transplant in which circulating stem cells are collected and later infused back into a given patient after very high doses of chemotherapy or radiation therapy have been given.

    Stem cell: This is the building block of bone marrow and blood formation. Stem cells form white blood cells, red blood cells and platelets. Hematopoietic stem cells are used in stem cell transplants.

    Questions to ask your child’s doctor

    After you learn that your child may need a stem cell transplant, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you.

    Lots of parents find it helpful to jot down questions as they arise – that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed.

    If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

    Some of the questions you may want to ask include:

    • How much experience has this hospital/my child’s doctor had with stem cell transplants?
       
    • What are the possible short and long-term complications?
       
    • How will they be addressed?
       
    • What is the likelihood of cure?
       
    • Is it possible that my child could need another transplant?
       
    • What services are available to help my child and my family cope?
       
    Care Pages

    Keep family and friends up to date during your child’s treatment by creating a free Children’s CarePage.

  • At Boston Children's Hospital, we know how difficult it can be to go through a stem cell transplant, both for your child and for your whole family. That's why our physicians are focused on family-centered care: From your first visit, you'll work with a team of professionals who are committed to supporting all of your family's physical and psychosocial needs.

    Preparation for your child

    Before your child receives the transplant, the following things happen:

    • Your child's bone marrow transplant team will complete an extensive evaluation. All other treatment options are discussed and evaluated for risk versus benefit.
       
    • A suitable (tissue typed and matched) donor must be available. This can be a challenging and lengthy process. Voluntary marrow donors are registered in several national and international registries. A bone marrow search involves searching these registries for donors whose blood most closely resembles or matches your child's blood.
       
    • A complete medical history and physical examination of your child will be performed, including multiple tests to evaluate his blood and organ functions (such as the heart, kidney, liver and lungs).
       
    • Your child will often come into the transplant center up to 10 days before transplant for hydration, evaluation, placement of the central venous line and other preparations. A catheter, also called a central venous line, is surgically placed in a vein in the chest area. Blood products and medications will be administered through the catheter.

    How are a donor and recipient matched?

    Matching involves looking at the donor and child's HLA (human leukocyte antigen) tissue. There many HLA antigens—at least 100—but it is believed that there are a few major ones that determine whether it will be a good match. The others are considered “minor” and their effect on a successful transplant is not as well defined.

    Medical research is still investigating the role all antigens play in the process of a stem cell transplant. The more antigens match, the better the transplant's chance of success.

    Once a potential donor is notified that she may be a match for your child, the donor will undergo additional tests related to their health, exposure to viruses, and complete genetic analysis to determine the extent of the match. The donor will be given instructions on how a bone marrow donation will be made.

    Relatives may or may not elect to have their type registered for use with other recipients.

    How are the stem cells collected?

    Stem cells can either be collected from the bone marrow or the blood:

    1. Peripheral blood stem cells (PBSCs)

    Peripheral blood stem cells are collected by apheresis, a process in which blood is taken from a vein using a needle and circulated though a special cell separation machine. The machine removes the stem cells, and returns the remaining blood and plasma back to the donor through another needle inserted into the opposite arm.

    • Several sessions may be required to collect enough stem cells to assure a chance of successful transplant for your child.
       
    • The donor may take medication for about one week before the procedure that will make the bone marrow produce increased numbers of new stem cells that are released from the marrow into the blood.

    2. Bone marrow harvest

    Bone marrow harvesting involves collecting stem cells with a needle placed into the soft center of the bone, the marrow.

    • Bone marrow is most often collected from the hipbones and the sternum. This procedure takes place in the operating room.
    • The donor will be anesthetized during the procedure.
    • In recovery, the donor may experience some pain in the areas where the needle was inserted.

    3. Umbilical cord blood collection

    Cord blood is collected after delivery, when the placenta and umbilical cord are separated from the infant.

    • The blood that is contained in the cord is collected in a sterile container.
    • The blood is then tested for type and the presence of viruses or disease, and the stem cells are counted.
    • The cord blood is then stored in special freezers and is registered in a national registry for potential recipient matches.

    The stem cell transplant procedure

    Preparation for a bone marrow transplant varies depending on the type of transplant, the disease requiring transplant and your child's tolerance for certain medications. Here are some things to keep in mind:

    • High doses of chemotherapy and/or radiation are usually part of preparation. This is necessary to make room in the bone marrow for the new cells to grow. This therapy is often called ablative, or myeloablative, because it prevents the production of cells, which essentially empties out the bone marrow. An empty marrow is needed to make room for the new stem cells to grow and establish a new production system.
    • Children with bone marrow failure syndromes, such as Fanconi anemia and dyskeratosis congenita, may receive lower doses of chemotherapy or radiation in order to avoid complications. This is called reduced-intensity conditioning therapy.
       
    • After chemotherapy and/or radiation, the stem cell transplant is given through a special catheter inserted into a large vein (called a central venous catheter). It is not a surgical procedure to place the marrow into the bone, and is similar to receiving a blood transfusion. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells (engraftment).
       
    • We give supportive care to your child to prevent and treat infections, side effects and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, frequent weighing and providing a protected, sterile environment.

    Counting the days

    It's helpful to understand how days are counted around your child's transplant. The days are numbered to help the child and family understand where they are in terms of risks and discharge planning.

    • The days before transplant are counted as “minus” days (e.g. -8).
    • The day of transplant is considered day zero (0).
    • Engraftment and recovery following the transplant are counted as plus days (e.g. +1, +2, etc.).

    For example, a child may enter the hospital on day -8 to begin preparation for the transplant. The day of transplant is usually numbered as day 0. Days +1, +2 (etc.) will follow. There are specific events, complications, and risks associated with each day before, during and after transplant.

    During and after the transplant

    A transplant is a serious procedure. During infusion of bone marrow, your child may experience any or all of the following symptoms:

    • pain
    • chills
    • fever
    • hives
    • chest pain

    After infusion, your child may:

    • spend several weeks in the hospital
       
    • experience excessive bleeding
       
    • have blood transfusions
       
    • experience nausea, vomiting, diarrhea, mouth sores and extreme weakness
       
    • experience temporary emotional or psychological distress
       
    • be very susceptible to infection
       
    • take multiple antibiotics and other medications
       
    • be confined to a sterile environment
       
    • be given medication to prevent graft-versus-host disease (if the transplant came from a donor). The transplanted new cells (graft) tend to attack your child's tissues (the host), even if the donor is a relative.
       
    • undergo frequent laboratory testing

    Your child's physical and mental health is important in the success of a transplant. We take every measure to minimize complications and promote a healthy, happy and safe environment for your child.

    When does engraftment occur?

    Engraftment means that the donated cells have successfully traveled to the marrow and begun making new healthy blood cells. Depending on the disease and the type of transplant, this usually occurs between day +15 and +30.

    • Engraftment can be delayed because of infection, medications or low donated stem cell count.
       
    • Although the new bone marrow may begin making cells in the first 30 days following transplant, it may take months or years for the immune system to fully recover.

    What complications and side effects may occur following transplant?

    Complications may vary, depending on:

    • type of marrow transplant
    • type of disease requiring transplant
    • preparative regimen
    • your child's age and overall health
    • the strength of the tissue match between your child and the donor

    While each child may experience complications differently, some of the most common include:

    • infections - Any infection can cause an extended hospital stay, prevent or delay engraftment and/or cause permanent organ damage. Antibiotics, anti-fungal medications and anti-viral medications are often given to prevent serious infection. Preventative measures for common sources of infection are also a part of transplant, including:
      • special air-filtered rooms
         
      • diet restrictions
         
      • isolation requirements
         
      • restriction of visitors
         
      • strict hygiene regimen
         
      • frequent linen changes
         
    • low platelets and low red blood cells - Thrombocytopenia (low platelets) and anemia (low red blood cells) can be dangerous and even life threatening. Most children receiving a transplant will require multiple blood transfusions.
       
    • pain and GI irritation - Pain related to mouth sores and gastrointestinal (GI) irritation is common. Your child may also experience diarrhea, nausea and vomiting due to chemotherapy, radiation and/or GI irritation.
       
    • fluid overload - Sometimes the kidneys can't keep up with the large amount of fluid being given in the form of medications, and nutrition and blood products. The kidneys may also be damaged from disease, infection, chemotherapy, radiation or antibiotics. During transplant and recovery, we will watch for signs and symptoms of fluid overload, which can lead to pneumonia, liver damage and high blood pressure.
       
    • respiratory distress - Infection, inflammation of the airway, fluid overload, graft-versus-host disease and bleeding are all potential life-threatening complications that may occur in the lungs and pulmonary system.
       
    • organ damage - Temporary or permanent damage may be caused by infection, graft-versus-host disease, high doses of chemotherapy and radiation or fluid overload. Close monitoring of your child's blood work and vital signs is an important step in detecting and minimizing any organ damage that has occurred.
       
    • graft failure - This may occur as a result of infection, recurrent disease or if the stem cell count of the donated marrow wasn't high enough. If a source is available, this may be treated with an additional marrow transplant.
       
    • graft-versus-host disease (GVHD) - GVHD can be a serious and life-threatening complication of a bone marrow transplant. GVHD occurs when the donor's immune system reacts against the recipient's tissue. The new cells do not recognize the tissues and organs of the recipient's body. Your child will be monitored closely for signs and symptoms of GVHD.

    When will my child be discharged?

    Your child's discharge date will depend on many factors, including:

    • the success of engraftment
       
    • the presence of complications
       
    • your child's overall health
       
    • your distance from the facility (Occasionally, a bone marrow transplant patient will be required to stay within a certain distance or travel time from the facility to ensure safety if complications arise.)

    Your child's length of stay can vary significantly depending on these factors. On average, children stay in the hospital for about 30 to 40 days.

    Frequent follow-up visits to your child's transplant team are necessary to determine the effectiveness of treatment, quickly detect any complications or recurrent disease and manage the late effects associated with this procedure. The transplant team will tell you how frequent these visits should be.

    What is the long-term outlook for a stem cell transplantation?

    Your child's prognosis will greatly depend on the following:

    • type of marrow transplant
    • your child's age and overall health
    • type and extent of the disease being treated
    • disease response to treatment
    • genetics
    • severity of complications
    • your child's tolerance of specific medications, procedures or therapies

    The number of transplants occurring for an increased number of diseases and medical developments has greatly improved the outcome for bone marrow transplant in both children and adults, but continuous follow-up care is essential. New methods to improve treatment and decrease complications and side effects are continually being discovered.

    Post-transplant care

    Following a successful transplant, your child will require specialized care and precautions as her immune system recovers.

    Rebuilding your child's immune system

    Your child needs a stem cell transplant because her bone marrow has either been damaged by disease or been suppressed by intensive chemotherapy. Since bone marrow cells produce all forms of blood cells, including infection-fighting white blood cells, your child's immune system will also be impaired.

    Once the donor stem cells start working, your child's bone marrow will begin to produce healthy white blood cells. However, it will take time for these new cells to become strong enough to fight off infection. It's important you and your child understand that rebuilding your child's immune system is a process that will take several months.

    Protecting your child at home

    At Children's, your child is protected from bacteria, viruses and fungi by special air filtering and infection-control precautions. When your child returns home, we will ask your family to take several precautions to provide as safe a recovery environment as possible.

    Some of the steps we will ask you to take include:

    • removing ho seplants
    • adopting stringent hand washing habits
    • avoiding certain foods, like raw fish, which may lead to infection

    Although we require all transplant patients to observe certain precautions against infection after transplant, some of the post-transplant restrictions vary based on the type of transplant performed. An example of this is the time period we ask a patient to wait before visiting public places and returning to school.

    • In general, we ask autologous transplant patients (those who receive a transplant of their own stem cells) to avoid common areas like these, which heighten the risk of infection, for at least six months after transplant.
       
    • In comparison, we generally ask allogeneic transplant patients (those who receive donor stem cells) to wait nine to 12 months.

     

    We can't predict exactly when it will be safe for your child to visit public places or return to school. Our first priority is protecting your child's health, and we will ask you to keep your child at home for a longer period of time if necessary.

    Post-transplant vaccinations 

    In addition to rebuilding itself naturally over time, your child's immune system will also require vaccinations to help produce disease-specific antibodies.

    Although your child may have been vaccinated, her new immune system needs to be refreshed through another vaccination. Even if your child received routine immunizations prior to transplant, her new immune system will have no memory of those vaccinations. For this reason, your child must be re-vaccinated after a bone marrow transplant.

    We recommend waiting a year after the transplantation before your child receives any vaccinations. However, each child is different, and we will adjust this recommendation if necessary. We also suggest your child receive all vaccinations from the same physician. This makes it easier to track vaccination records for things like school, sport or camp applications.

    Your child can be vaccinated by Jimmy Fund Clinic staff members or by her primary care provider. In either case, we'll provide a helpful list to track your child's post-transplant vaccinations.

    Our physicians will explain more about immune system reconstitution during your new patient consultation.

    Long-term follow-up

    We offer several programs for your child after her stem cell transplant.

    • Dana-Farber's David B. Perini, Jr. Quality of Life Clinic helps survivors of childhood cancer address the long-term effects of their therapy. The Clinic includes special programs to ease patients' transition to post-transplant life, such as the School Liaison Program.
       
    • In addition, we offer a multidisciplinary clinic staffed by nutritionists, endocrinologists, physical therapists, dermatologists, psychologists and social workers for childhood cancer survivors of all ages, as well as a special follow-up clinic for stem cell transplant patients.
       
    • Dana-Farber Cancer Institute's GVHD Clinic is a special program within the Jimmy Fund Clinic that addresses the needs of transplant patients with graft-versus-host disease (GVHD), a serious potential complication of stem cell transplant. At the Clinic, patients meet with multiple medical experts during one outpatient visit in order to manage the disease and its symptoms.

    Read more about our patient and family support services available through Dana-Farber/Boston Children's Cancer and Blood Disorders Center.

    Resources and support

    We understand that you may have a lot of questions if your child needs to have a stem cell transplant. How will this affect my child long-term? What do we do next? We've tried to provide some answers to those questions in these pages, but there are also a number of resources and support services to help you and your family through this difficult time.

    Back to School program

    At age 11, Ronald (R.J.) Agostinelli was diagnosed with acute lymphoblastic leukemia, a cancer of the white blood cells. He missed seven months of elementary school while having chemotherapy. R.J. talks about what it was like returning to his class after a long absence.

    Clinical trials

    Find out more about the innovative stem cell transplant clinical trials available at the Dana-Farber/Boston Children's Cancer and Blood Disorders Center.

    Continuous improving care
    The Pediatric Stem Cell Transplantation Program at Dana-Farber/Boston Children's Cancer and Blood Disorders Center has a highly controlled environment to help protect patients with compromised immune systems undergoing bone marrow and stem cell transplantation. For example, families and clinicians have to scrub up before entering the unit. Dana-Farber/Boston Children's understands that comfort matters just as much as safety, and have made improvements to care, such as providing beds for parents and families to sleep over in so they can provide emotional support for their child.

     

     

     

     

     

     

  • Research & Innovation

    Dana Farber/Boston Children’s Cancer and Blood Disorders Center is a world leader in pediatric stem cell transplantation and stem cell research.

    Our doctors work with national research groups, including the Children’s Oncology Group, Blood and Marrow Transplant Clinical Trials Network and the Pediatric Blood and Marrow Transplant Consortium to develop innovative clinical trials and expand transplantation to new patients.

    Some of our current research activities include:

    • Researchers are investigating the use of gene therapy to improve stem cell transplantation. Gene therapy is a method of altering the genetic information stored in cells and thus correcting a defect. Our research focuses on the use of gene therapy and stem cell transplant for children with severe combined immunodeficiency (SCID) and adrenoleukodystrophy, and we hope to expand these techniques to treat other conditions in the future.
    • We are expanding the use of stem cell transplants to treat non-cancerous conditions. Both sickle cell disease and thalassemia can be cured through stem cell transplantation. We are currently working to make stem cell transplant safer for patients with these diseases and to make the therapy available to a broader patient population. Your child’s hematologist can talk with you about whether stem cell transplantation is possible therapy for your child.
    • We are very involved in research investigating supportive care of patients before, during and after transplant including evaluating the role of vitamin D in stem cell transplantation, post-transplant fatigue and pulmonary complications following transplant.

    For more information about our research, visit our stem cell research website.
     

    Children speak: What’s it like to be a medical research subject?

    View a day in the life of  Children's Clinical and Translational Study Unit.

    Stem cell transplant saves “bubble boy” from Argentina

    Can you imagine how you’d feel if you couldn’t hold your child? Agustin Caceres’s parents could not come in physical contact with him when he had Severe Combined Immunodeficiency, better known as “bubble boy disease.”Read how Children’s and the Dana Farber’s Cell Manipulation Core Facility were able to use stem cell transplant treatment so he could be in touch with his family and the world again, literally and figuratively. Read more about the international gene therapy trial.

     

    “Imprinted” genes help control stem cells

    Carla Kim, PhD, of the Stem Cell Research Program studied stem cells in the lung and the role of “imprinted” genes, which help regulate the growth of stem cells. Learn more about the imprinted gene research on Children’s newsroom.

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
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