Stem cell transplant

Autologous transplants (transplants using the child’s own stem cells) are undertaken for the treatment of some solid tumours such as neuroblastoma and brain tumours.  

If your child needs an autologous transplant, their stem cells will be collected, frozen and then given back via an intravenous infusion after high dose chemotherapy or radiotherapy.

The timing of transplant varies according to the disease. In some settings it may be done once the disease is under control and in other settings, it may only be done if the disease relapses. 

Allogeneic transplants are the treatment of choice for all other diseases and situations. If your child needs an allogeneic transplant, the best stem cell donor they can have is a histocompatible (matched) sibling.

There is a 25% chance that any two siblings will be a match. If there is no matched sibling donor available, the national and international donor registries will be searched to identify a matched unrelated donor. 

There are four main complications following transplant: 

1. Rejection: the new marrow may not engraft or may be rejected
2. Veno-occlusive disease: this is a unique type of liver impairment seen after transplant, usually within the first 20 days
3. Graft-versus-host-disease: the immune cells contained in the transplant recognise the patient as ‘foreign’ and attack organs of the body including the skin, gut and liver. 
4. Infection: because the immune system is so suppressed during the transplant and for a period after transplant, there is a high risk of infection including bacterial, viral and fungal infections. 

The chance of each of these problems occurring depends on the type of transplant being undertaken. 

Any child who receives a stem cell transplant must be isolated for the duration of conditioning therapy and for a period of up to four months after transplant. 

The length of isolation varies according to the type of transplant and the length of time that immunosuppressive therapy continues.  

While in isolation in hospital:

• your child may receive visits from members of the immediate family and four other designated relatives or friends
• children (including siblings under the age of six) are not permitted to visit.
• after discharge from hospital, your child must not return to school or go to public crowded places until the isolation period is over. 

You have the highest risk of infections in the first few weeks after transplant. Fortunately, most of these infections are easy to treat with antibiotics.

However, your immune system may need a long time to recover after a transplant. Your health care team will talk with you about ways to reduce your risk of infections.  

Immediate side effects 

• nausea and vomiting 
• sores in your mouth 
• fatigue  
• low levels of platelets, making it more difficult for your blood to clot  
• low levels of red blood cells, causing anaemia  
• diarrhoea.

Long-term side effects 

• Cataracts, an eye condition that causes cloudy vision 
• thyroid problems 
• lung or bone damage 
• another cancer.

Call your doctor right away if your child: 

• has a fever of 100.4°F (38.0°C) or higher taken orally (in the mouth)  
• has a runny nose, cough or congestion 
• has vomiting or diarrhea 
• has black bowel movements (poops) 
• has easy bruising or bleeding 
• has blood in the pee  
• has a headache, dizziness, or blurred vision 
• coughs up blood or has a nosebleed that won't stop after a few minutes.