Children who are having an autologous stem cell transplant will need to have their cells collected before treatment. 

Collecting stem cells can take several days and will generally involve:

1. a dose of chemotherapy 
2. 5-10 days of medication to help the body produce more stem cells
3. a blood test to check the level of stem cells.

When your child has enough stem cells in their blood, they will have a procedure called apheresis.

In apheresis: 

1. blood is taken from your child’s body using a thin tube called an intravenous cannula
2. the blood is put into a machine that takes out the stem cells
3. the blood is put back into your child’s body.

Children needing an allogeneic transplant will receive stem cells from a matching donor, usually a family member. 

Your child's medical team will search a donor registry if no family donors are suitable. The donor's stem cells and white blood cells will be collected and stored for treatment. 

Your child will be in a germ-free hospital room during and after treatment. The length of isolation depends on the type of transplant and treatment. 

The hospital will give you information and visitation rules to prevent your child from getting sick. 

Immediate side effects after a stem cell transplant can include:

• nausea and vomiting 
• sores in the mouth 
• feeling very tired  
• low levels of platelets in the blood, making it difficult to clot  
• anaemia - low levels of red blood cells
• diarrhoea.
   

Complications and long-term side effects from stem cell transplants can depend on your child and the type of transplant. 

Four main complications after a stem cell transplant are:

1. rejection - when the new stem cells don’t settle or are rejected by your child’s body
2. veno-occlusive disease – a liver disease that can develop in the first 20 days after transplant
3. graft-versus-host-disease – when the transplanted white blood cells treat your child’s body as ‘foreign’ and attack organs like the skin, gut and liver
4. infection – when illness develops from bacteria, viruses and fungus while your child’s immune system is not working properly.

Long-term side effects can include

• cataracts - an eye condition that causes cloudy vision 
• problems with the thyroid – glands that make and release certain hormones 
• damage to the lungs or the bones
• cancer returning, or another type of cancer developing.
   

Your child’s treatment team will give you contact details for who to call in an emergency.

Contact your child’s team immediately if they have symptoms including:

• a fever – temperature over 38˚c
• chills or shivering 
• diarrhoea, constipation, or stomach cramps 
• nausea and vomiting 
• blood in their urine or poo 
• bleeding gums  
• nose bleeds
• difficulty breathing
• headaches 
• general pain
• rash or itching.

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. 

A cancer diagnosis can leave families and children feeling overwhelmed, scared, anxious, and upset. Practical and emotional support during and after treatment is essential and can come from: 

• family
• friends
• healthcare professionals
• specialised support services.

Speak to your child’s treatment team for information about support services.