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When chemotherapy alone isn’t profitable in treating blood cancers like leukemia and lymphoma in pediatric patients, a stem cell transplant may be an possibility. They may also help treat some non-cancerous bone marrow diseases, like sickle cell disease, thalassemia, extreme aplastic anemia and Kostmann syndrome.

To study pediatric stem cell transplants and what parents should know, we spoke with Priti Tewari, M.D.

What's a stem cell transplant?

Stem cells are produced in our bone marrow; they mature to turn out to be our pink blood cells, white blood cells, platelets and the cells of our immune system.

Stem cell transplants exchange broken or defective stem cells with healthy cells. They may assist replace a weakened immune system. There are two varieties:

Autologous stem cell transplants use a patient’s own stem cells to assist battle cancers like high-threat Hodgkin lymphoma, Ewing’s sarcoma, medulloblastoma and neuroblastoma. These cancers might require high doses of chemotherapy. Autologous transplants use patients’ personal wholesome stem cells to help with restoration.Allogeneic transplants substitute patients’ stem cells with wholesome cells from a donor.

Are stem cells transplants secure for teenagers?

Stem cell transplants come with risks, however they are often an choice for patients as younger as only a pair months previous.

With some non-cancerous diseases like extreme mixed immunodeficiency, the transplant ought to happen as soon as potential. Pediatric patients with this condition typically have weaker immune methods and are at larger risk for infection.

With some inherited disorders, we might watch your little one for a few years and allow the organs to mature a bit bit earlier than transferring forward with a stem cell transplant.

What are allogeneic stem cell donor options for pediatric patients?

Suitable donated stem cells ought to match your child’s cells. Siblings are generally -- however not at all times -- a match. If a sibling isn’t an option, we will search for a matched unrelated donor by the National Marrow Donor Program.

If we can’t discover a matched donor, we are able to use an alternate donor. That might be a mismatched unrelated donor, an umbilical cord blood donation or a haploidentical donation, which is a half-matched household member like a dad or mum or typically a sibling.

When you've got a toddler with a condition that may require a stem cell transplant and you’re expecting a baby, it could possibly be helpful to preserve the baby’s umbilical cord in a process referred to as umbilical cord blood banking. If the siblings’ cells are a match, the banked cord may be used for a transplant later.

How are donated stem cells extracted?

They’re extracted in two methods. With peripheral withdrawal, the donor receives growth factor pictures to stimulate stem cell manufacturing. The cells are then removed intravenously by apheresis, a course of like blood donation.

The second strategy is called bone marrow harvesting. It removes the stem cells from the pelvic bone by a surgery; it requires normal anesthesia.

We decide which approach is best primarily based on the diagnosis, the donor’s physical measurement and the child’s general health. If the donor is one other youngster, we take particular precautions. We want to make sure the donor is willingly coming into this course of. At MD Anderson, the donating youngster meets with a separate physician on our workforce, a psychologist, our ethicist and a toddler life specialist to ensure they understand the procedure.

How do patients prepare for a stem cell transplant?

To wipe out cancer cells and to help make space for the brand new stem cells, patients receive chemotherapy before the transplant. Some excessive-risk acute lymphoblastic leukemia patients may additionally obtain total physique irradiation, a type of radiation therapy.

If your baby is receiving an allogeneic transplant, we frequently use immunosuppressive agents to assist decrease the risk of a aspect effect known as graft-versus-host disease, which is when the patient’s physique rejects the donated cells.

What are the unintended effects of a pediatric stem cell transplant?

Many patients expertise pancytopenia, which is a lower in purple blood cells, white blood cells and platelet counts.

The conditioning chemotherapy and radiation therapy commonly trigger mucositis, which is irritation and ulcers throughout the digestive tract and mouth. Patients also can have painful sores, stomach discomfort and diarrhea, however medications can assist.

Also, it’s rare, but the organs that assist course of chemotherapy -- such because the kidneys, liver and lungs -- are at risk for failure.

Another risk is infection. During and following a stem cell transplant, patients don't have any immune system to help battle infections. So, even a chilly can be harmful.

But we carefully monitor patients to establish uncomfortable side effects earlier than they develop into life-threatening. That’s one of many reasons why patients stay within the hospital for about four to six weeks, however generally it’s extra. Our aim earlier than your youngster leaves the hospital is for the new stem cells to start growing inside the physique. We additionally need to get your baby comfortable and strolling, taking sips of water and sleeping comfortably till their blood counts are up once more. Once they’re nicely sufficient to depart the hospital, they’ll start coming in for checkups three to 5 days every week.

Do stem cell transplants affect fertility?

Cancer and its treatment can have an effect on fertility. Every affected person who’s beyond puberty sees our fertility specialists to find out about their dangers and choices.

It’s additionally very important to discuss fertility with patients with non-cancerous diseases since these situations are sometimes hereditary. We wish to make sure patients understand what meaning for their future kids and what options they have for starting a family.

What does life seem like after a stem cell transplant?

If all goes properly, life sometimes begins feeling normal a couple of yr after the transplant.

During that 12 months, we’re weaning down the immunosuppressive agents to help construct up your child’s immune system. So, if they return to a standard school they usually get a virus from any person, their our bodies can struggle it.

In case your little one has siblings in class, they’ll be exposed to germs. It may be difficult, however it’s essential for everyone to wash their palms and avoid sharing cups, utensils and food. It’s crucial to avoid being around others with colds or the flu, too.

What research is underway in children with blood diseases?

Car T cell therapy is a brand new type of immunotherapy that’s given like a stem cell transplant. It’s being used to deal with B-cell acute lymphoblastic leukemia and sure lymphomas in patients ages 25 and youthful. However the side effects may be extreme. MD Anderson has developed the first tips for managing these side effects in children to assist more patients receive Car T cell therapy extra safely.

What's your recommendation for households considering a stem cell transplant?

There's lots to learn, and it can be overwhelming. Ask your care group for assets to learn extra at your own pace.

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