Though Wiskott-Aldrich syndrome (WAS) is not a cancer, it is treated through Dana-Farber/Boston Children's Cancer and Blood Disorders Center because of our expertise in performing stem cell (bone marrow) transplants here.
What are the treatment options for WAS?
Guarding against infection
Any child with WAS has a compromised immune system and is at serious risk of developing infections. This means consistent and thorough infection control measures are a must. However, in many instances, taking simple precautions, like having your child wear a protective mask, can be enough to keep him protected before or in between more involved treatments, like a stem cell transplant.
In general, families of children with WAS should take the following steps:
- follow a strict handwashing regimen for all family members and visitors
- if advised by the treating clinician, administer antibiotics, antifungal or antiviral medications as a preventive measure for the child
- avoid having the child in crowds, dirty places or in the company of anyone who is ill or seems to be "coming down with something"
- watch closely for any sign of a possible infection and seek immediate medical attention
- follow the clinician’s recommendations for vaccinations
Some of the standard childhood vaccinations are safe for children with WAS and some are not. Because their B-cells of children with WAS do not function properly, their bodies cannot produce the normal antibodies that fight off viruses. Since some vaccines are actually live viruses, they pose too high a risk of infection to be safe for a child with a weakened immune system.
However, other types of vaccines that are killed vaccines (against pneumococcus, hemophilus and meningococcus) are safe and may help prevent severe bacterial infections in patients with WAS.
Because your child's B cells may not produce antibodies against infection, he may need regular infusions (administration through a vein) of the antibody immunoglobin (also known as immune globin or gammaglobin).
Your child's clinician can advise you about the exact steps you should be taking to help reduce the risk of infection.
Guarding against bleeding/bruising
Some measures for lowering the risk of uncontrolled bleeding and bruising can include:
- avoiding activities that pose significant risks of trauma (such as contact sports)
- wearing a helmet during physical activities that may pose a risk of head trauma (such as biking or skating)
- taking corticosteroids (drugs that help prevent allergic and inflammatory responses) (this is usually done only in an acute situation)
- receiving infusions of the antibody immunoglobin
- receiving platelet transfusions (this is usually only prescribed in an emergency situation)
- removing the spleen (this is usually only prescribed in an emergency situation)
Managing eczema (atopic dermatitis)
There are several useful ways of managing eczema. Learn more.
Stem cell/bone marrow transplants
A stem cell transplant (also known as a bone marrow transplant) is the mainstay of treatment for WAS. This is the only available treatment option that has a chance of providing a permanent cure.
Stem cells are a versatile type of cell found in bone marrow. These cells have a unique and powerful ability: They can develop into several different types of specialized cells.
In the case of a child with WAS, stem cells from a healthy donor are injected into the child's bloodstream. They will then become healthy white blood cells and platelets that replenish blood and immune functions – essentially building a whole new, functional blood and immune system for the child. If the platelets and immune system regain complete function, the child may be permanently cured.
Not every child with WAS will benefit from a stem cell transplant .The odds of success depend on:
- the child's overall health at the time of the procedure
- the match between the patient and donor's bone marrow (the best option is marrow taken from a matched sibling)
- the child's age at the time of the transplant; ideally, the transplant should take place before he turns 5 years old
The Pediatric Stem Cell Transplant Center at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center is one of the oldest, largest and most experienced pediatric transplant centers in the nation. Our experts perform more than 90 transplants for children of all ages, with a wide variety of health conditions and from all around the world, every year.
Read about the process and what to expect during a stem cell transplant.
Stem cell transplants are not always perfect treatments for WAS. For example, children may have improvement but not complete recovery of the platelets to a normal level or may have partial but not complete recovery of the immune system.
In addition, any transplant carries a risk of a phenomenon known as graft-versus-host disease. This means that the new immune system coming from the donor attacks the patient’s body, as if it is an unwanted intruder. This condition is more likely if the donor is an unrelated person or if the tissue type is not fully matched. Some cases of graft-versus-host disease are mild but others are severe or even fatal.
A new and promising field, gene therapy, may have the answers to these treatment obstacles. In gene therapy (also called gene transfer), patients receive stem cells from their own bone marrow or blood (rather than from another person). These cells also have an added ingredient: they've been infused with a working, healthy version of the mutated gene responsible for the child's disease.
If the gene therapy is successful, the child will enjoy all the benefits of a stem cell transplant without the potential hazard of graft-versus-host disease.
Click on the Research tab above to learn more about our gene therapy clinical trial for children with WAS.
If your child's blood and immune system is restored to good working order, he should be able to enjoy a rich, active adult life, including having a family.
It is important to note, though, that genetic counseling is essential for prospective parents with a family history of WAS or any other immune deficiency.
Please note that neither Boston Children's Hospital, the Division of Allergy and Immunology, the Cancer and Blood Diseases Center nor the Dana-Farber/Children's Hospital Cancer Center Stem Cell Transplantation Program unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.