UCSF Children's Hospital | Medical Services | Cancer and Blood Diseases

On this page is an overview of the preparation process for a bone marrow transplant. For more details, please see:

There is a lot involved to first decide whether a bone marrow transplant (BMT) is the best option for your child and second to prepare your child for the transplant. The process begins with an initial consultation, where you and your child will meet with various members of the bone marrow transplant team.

Your child's history will be reviewed and potential donors discussed. Additional blood studies may be obtained in order to complete the tissue typing. We will review with you and your family the basic issues of the bone marrow transplant and answer any questions that you might have. For some diseases there also may be evaluations such as developmental testing and a consultation with other specialists.

Following the initial consultation, a decision is made by both you and the doctors as to the feasibility and desirability of going ahead with the transplant. If the decision is to move forward, your child will have a work-up and evaluation. This will assess your child's medical and psychological status with respect to his or her ability to undergo a transplant. The work-up will include a thorough medical evaluation, including various tests to assess your child's overall health and the state of his or her condition. The timing of this work-up typically takes place a few weeks prior to the transplant. If an unrelated donor search needs be performed or if your child needs additional treatment, then the work-up will be delayed until a transplant date is set.

Following the pre-transplant evaluation you and your family will have an informed consent conference. You will meet with a bone marrow transplant doctor, nurse, social worker and other members of the health care team to review the results of the pre-transplant evaluation and the treatment plan, and discuss the benefits and risks of a transplant. The consent forms are documents that review the essential purposes and procedures of the bone marrow transplant, as well as the risks and benefits. Signing the consent form indicates that everyone understands as much as possible about what is involved in the bone marrow transplant process and agrees that it is the best treatment available. The consent conference is recorded so that you can share this information with other family members or review it again. In addition, you may invite other family members or friends to the consent conference.

Prior to entering the BMT Unit, your child will require the insertion of a special intravenous catheter, which is a special type of intravenous line (IV) central venous catheter throughout the entire transplant process and helps avoid the pain and discomfort of multiple IVs and blood draws.

The catheter is inserted in the operating room. Some children already may have had this operation in order to facilitate treatment of their disease. While under general anesthesia, the catheters are inserted into major blood vessels in the neck and exit the skin on the front of the chest or abdomen.

In addition to the catheter, your child may require one or more of the following:

The average stay in the hospital is six to eight weeks and sometimes longer. The adjustment to being away from home and getting comfortable with the hospital can take a while, but it's easier when you know what to expect. Please see Coming for a Bone Marrow Transplant to find packing tips and suggestions for keeping the entire family involved in the transplant process.

Upon admission to the BMT Unit, a countdown period of usually five to 10 days begins. Day 0 marks the end of the countdown and the day of transplant. During the countdown period, one of the conditioning regimens is administered. This involves treatment with chemotherapy agents and possibly radiation, called total body irradiation.

Immediate relatives are encouraged to spend time with the patient while he or she is hospitalized for a bone marrow transplant. However, there are a few rules that must be followed. Please see Rules for Visiting the BMT Unit for details.

There are several routines that are done daily or several times a day to minimize those problems that may occur during the bone marrow transplant process. This includes:

Antibiotics and medicines are given throughout the transplant period to reduce irritation of the stomach and intestines and prevent certain kinds of infections that frequently occur in a transplant recipient.

For more details, please see:

There are two main types of bone marrow transplant:

To learn more, please see Conditioning Regimen.

On Day 0, the day of transplant, the recipient will receive the bone marrow stem cells collected from the donor. The collection may be either directly from the bone marrow, from umbilical cord blood, or from peripheral blood using a procedure called leukapheresis. The bone marrow stem cells are stored in a special blood transfusion bag and administered to the recipient in his or her room the same way a blood transfusion is given, through the central line. The infusion typically takes one to two hours to complete. The donor marrow stem cells travel in the bloodstream to the bone marrow space where they grow and mature.

In some cases, the bone marrow stem cells will be treated or processed before transplant. For example, if the donor is a parent or other close relative whose human leukocyte antigens (HLA) type is only partially matched with the recipient, the stem cells will be specially treated to enrich for stem cells, called CD34 positive cells, and remove the T cells responsible for graft-versus-host disease (GvHD). This process takes 10 to 12 hours to complete. The resulting stem cells usually fill one syringe and are administered through an IV by a doctor.

If the donor and recipient are HLA matched but have different blood typess, the marrow is treated to remove most of the red blood cells and minimize a transfusion reaction. This process takes several hours to complete. The resulting marrow is slightly pink and is administered from a blood transfusion bag.

For autologous transplants or umbilical cord blood transplants, the marrow stem cells that have previously been collected, and frozen are thawed and administered as a blood transfusion in one or more blood bags. The chemical (DMSO) that is used to safely freeze the marrow, peripheral blood or umbilical cord blood has an unusual odor that you will notice within minutes of beginning the infusion. This odor, which will be on your child's breath, is harmless but will persist for several days. In addition, you may notice that your child's urine is red following the transplant. This is due to another chemical added to the marrow and is completely harmless.

For more information, please see Bone Marrow Transplant Process.

On this page is an overview of the recovery process after a bone marrow transplant. For more details, please see:

Within hours of the transplant, the new bone marrow stem cells will find their way to the marrow space in your child's bones where they will grow and start making red cells, white cells and platelets. It will take the new bone marrow about two to four weeks to grow, or engraft, in the bones.

While waiting for the new marrow to engraft, the patient will continue to be at a very high risk for developing infections, including pneumonia, and must remain in isolation. During this time, especially if mouth sores, called mucositis, develop, it is likely your child will have fevers and will need additional antibiotics.

In addition, multiple transfusions will be needed to support platelet and red blood cell counts. All blood products are tested as carefully and completely as possible by the Blood Bank to minimize transfusion reactions and infection.

Your child's absolute neutrophil count (ANC) will be monitored on a daily basis during the post-transplant period. Neutrophils are the most common type of white blood cells and are responsible for protecting the body against bacterial and fungal infections. The ANC is the number of neutrophils present in the total white blood cell count. Before the attending physician will discontinue strict isolation, your child's ANC must be greater than 500 for three consecutive days.

Your child will be discharged from the hospital when he or she has the following:

The primary caregivers -- usually the parents -- will need to receive complete discharge teaching by the nursing, dietary and pharmacy team. Your child will not be discharged from the hospital until everyone is comfortable with the care at home.

The risk of developing infections lasts for as long as six to 18 months following a bone marrow stem cell transplant. Your child will be followed closely by the transplant team along with his or her own doctor.