Why Choose Us for Your Child’s BMT?

During a blood and marrow transplant (BMT), also commonly known as a bone marrow transplant, your child will receive healthy stem cells to help restore bone marrow stem cells that are damaged, missing or not working. A BMT is not a surgery. It is a treatment that can take place over a number of weeks and months, when transplant cells are given intravenously (through a vein) like a blood transfusion.

At the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, we understand that a BMT can seem alarming and overwhelming. But our highly skilled team of experts is here to walk you and your family through every step of the process, providing the information and resources needed to feel confident, supported and informed about the BMT procedure.

As one of the largest BMT programs in the country, we perform more than 85 lifesaving BMTs each year. Our volumes and survival rates are a testament to the level of expertise and quality of care each patient and family receives at the Aflac Cancer and Blood Disorders Center.

What Happens During the BMT Process?

The first few steps of preparing your child for a BMT may involve him undergoing chemotherapy and/or radiation treatments. This is called a conditioning regimen. The kind of therapy your child needs depends on his disease and health. Your child will start therapy about five to 22 days before a BMT depending on the conditioning regimen prescribed.

Chemotherapy

Your child will have chemotherapy, even if he does not have cancer, because it:

  • Stops your child’s bone marrow cells from fighting the new blood and bone marrow.
  • Clears the bone marrow of your child’s cells, making room for the new donor marrow cells.
  • Kills any cancer cells if your child has cancer.

Side effects of chemotherapy may include:

  • Nausea or vomiting
  • Loss of hair
  • Mouth sores
  • Poor appetite and diarrhea

Radiation

Your child may need radiation before his BMT to help kill any cancer cells and help his body accept the graft. This therapy uses strong X-rays aimed at your child’s cancer once or twice a day for 10 to 15 minutes.

Side effects of radiation may include:

  • Red skin like a sunburn
  • Sensitive skin to perfumes, soaps and deodorants
  • Nausea and diarrhea
  • Dry mouth

Collecting Healthy Blood Stem Cells

The early stages of the BMT process include collecting healthy blood or bone marrow for a bone marrow transplant to help restore bone marrow stems cells. This is called a graft and can be done in three ways:

  • Bone marrow harvest: For a bone marrow collection, blood stem cells are most often collected from bone marrow in the hip bone. The hip bone has a large amount of bone marrow and is easy to access. This done in the operating room while the donor is under general anesthesia. The total number of cells removed depends on the weight of your child and the weight of the donor. The bone marrow collection takes about one hour.
  • Peripheral blood stem cell collection: Blood moving through the bloodstream is called peripheral blood. Blood stem cells can be removed from the peripheral blood. The donor may receive a medicine called a growth factor—granulocyte-colony stimulating factor (GCSF) or granulocyte macrophage colony-stimulating factor (GM-CSF). This medicine helps the bone marrow make a lot of new blood stem cells quickly and pushes them into the bloodstream. The blood stem cells are collected through a large I.V. in the arm or a central venous line (CVL) into a machine called an apheresis machine. The machine returns other important cells, including red blood cells, white blood cells, platelets and plasma, back into the donor’s blood. The machine does not cause pain.
  • Umbilical cord blood collection: The placenta and umbilical cord of a newborn baby are a rich source of blood stem cells. The blood stem cells can be collected soon after a baby is born by cutting the umbilical cord or removing the blood from the cord and placenta right away.

During a BMT

The day of your child’s BMT is called Day 0, which is when your child will get the new blood stem cells infused through an I.V.

Engraftment is the when healthy donor cells begin to grow. It usually happens about two to four weeks after a BMT.

Recovery After a BMT

Recovery starts in our hospital but lasts several months after your child is discharged. Each child is different, so he may need to rest for a longer or shorter amount of time. Our doctors and nurses will let you know how your child is doing and when he can go home. On average, children who had:

  • Autologous transplants stay two to three weeks.
  • Allogenic transplants stay three weeks to a little more than a month.

Special issues after a BMT

Our staff will monitor your child each day he is in the hospital, checking him for:

  • Infections
  • Low red blood cells (anemia)
  • Low platelets (thrombocytopenia)
  • Low white blood cells
  • Fever
  • Mouth sores (muscositis)
  • Diarrhea
  • Irritation of the urinary bladder causing bleeding (hemorrhagic cystitis)
  • Stress to other organs, such as the kidneys, liver, heart or lungs
  • Graft-versus-host disease (GVHD)

After Engraftment From a BMT

Your child will need to take some steps in his everyday life to stay healthy and active, including paying close attention to:

  • Infections: Your child’s immune system is very weak the first six to nine months after a BMT, which makes it difficult to fight off common infections like a cold. This is because the immune system is new and your child will need to take medicines in the early months after a transplant. However, these medicines prevent rejection of the new bone marrow and GVHD. To prevent infections, your child cannot go anywhere with a lot of people during his recovery, including school, church, stores and other peoples’ homes. Any signs of infections should be brought to the attention of your BMT medical team immediately.
  • GVHD: GVHD is when the graft that is made up of donor cells can sense your child’s body (the host) as different. Donor cells attack your child’s body. It only occurs in allogeneic transplants, because the donor cells are from someone else. Having your child take his medicines on time every day is the single most important thing you can do to help prevent GVHD.
  • Medicines: Your child may have to take medicines for months after his BMT. It is important that he takes all his medicine on time every day. Taking his medicines on time is the best way to fight GVHD and stay healthy throughout the recovery process.
  • Mouth care: Your child’s system for fighting infections in his mouth is also weakened. It is important to regularly clean his mouth to help keep him from getting mouth sores that could become infected.
  • Blood pressure: Your child’s blood pressure may be high as a result of his medicines. This is called hypertension. Though this is normal for children who undergo a BMT, your child may also need to take medicine to control his blood pressure.
  • Body changes: Your child may see some changes in his body, including weight gain or loss, skin color changes, acne or stretch marks, and more facial or body hair. For teenagers already undergoing body changes, their skin may be darker, more sensitive or dry for many months. Most of these changes will go away with time or as his medicines change.
  • Sun protection: The sun is even more dangerous if your child has had a BMT. It can cause skin cancer and trigger GVHD, or make it worse. To protect your child, he should wear protective clothing and use sunblock with 30 SPF or higher.
  • Pets: Most pets are fine but talk with your doctor to see if it is OK to have a pet near your child.
  • Nutrition: Making sure your child eats well is important after a BMT. Our team will provide food safety instructions to follow.
  • Vaccines: Your child’s immune system for fighting diseases will be weakened. We recommend checking with us if your child needs any vaccines the first year after his transplant. Any vaccines given before the transplant for those receiving an allogeneic transplant will no longer work. They will need their vaccines administered again, and these will be given starting six months after the transplant and spread out over a period of months. We can give your family doctor a vaccine schedule to follow to help make sure your child does not get a vaccine too soon.
  • Going back to school: It is important your child returns to school only after it is medically safe. This can take six to nine months. Every child recovers differently. We will work with you to get your child back to school as soon as possible, but while he is out of school, our social worker will assist your child’s school in enrolling him in a homebound school program.

Additional Resources

It is a testament to our careful attention to family-centered care when our patients have among the best survival rates in the country. Our hope is to provide families with the information and resources they need to feel supported during this stressful time in their child’s life.

Before your visit

Learn how to prepare for your visit to the Aflac Cancer and Blood Disorders Center, including information about our transitional housing options for families traveling from outside metro Atlanta.

Financial assistance

Bone Marrow Foundation: This patient aid program assists patients with transplant-related costs, such as a donor search, compatibility testing, bone marrow harvesting, medicines, home and child care services, medical equipment, transportation and housing expenses.
bonemarrow.org
800-365-1336

Cancer Care: This program is staffed by oncology social workers who provide emotional support, information and financial assistance to cancer patients and their loved ones.
cancercare.org
800-813-HOPE (4673)

Children’s Organ Transplant Association (COTA): COTA provides fundraising assistance for children and adults needing lifesaving transplants. Staff members and advocates work with the family to set up the initial organization and campaign goals prior to an on-site visit. Volunteers, family members and staff work as a team to raise the necessary funds.
cota.org
800-366-2682

Leukemia and Lymphoma Society: This organization provides education, sponsors, research and limited financial assistance to patients who need treatment for leukemia/lymphoma, Hodgkin’s disease or myeloma. Contact your local Leukemia and Lymphoma Society chapter for more information.
leukemia-lymphoma.org
800-955-4572

Lymphoma Research Foundation: This foundation provides reimbursement grants to lymphoma patients in need of financial assistance. The grants are available for uncovered expenses incurred during treatment, such as child care, travel costs needed to undergo treatment, medical aids and devices, educational and support meetings, camps, cosmetic aids (i.e., wigs or scarves) and hygienic products. Grants must be used within one year of the award date.
lymphoma.org
800-235-6848

Be the Match: This organization, along with the National Marrow Donor Program, helps patients afford a BMT, find a matching donor and build a future as advances in medical research are made.
marrow.org
202-638-6601

Medicaid: Medicaid is a medical assistance program that helps eligible people who cannot afford medical care pay for some or all of their medical bills. Medicaid can be obtained through a variety of programs administered by the Division of Family and Children Services (DFCS) and the Social Security Administration (SSA). Information regarding eligibility requirements can be obtained from a transplant financial counselor or social worker.

National Children’s Cancer Society: This organization supports children with cancer and their families. It provides financial assistance for blood stem cell transplant and emergency ancillary expenses, education, information, advocacy and emotional support for children and families dealing with a child’s cancer.
nationalchildrenscancersociety.com
800-532-6459

Travel and housing

Angel Flight of Georgia: This organization provides free transportation for people who have a medical need that cannot be filled in their local area. Pilots donate time and expenses to provide air travel to treatment centers.
angelflightsoars.org
877-452-7958 or 770-452-7958

Local hotels: Transplant social workers maintain a current list of hotels in the area. Some of these hotels provide a hospital discount. The transplant social worker can suggest which hotels will best fit your needs (i.e., short-term, long-term, necessary amenities, location).

Medicaid non-emergency transportation: Nonemergency transportation services, subsidized by Georgia Medicaid, are provided for patients who have Georgia Medicaid coverage. Information about services provided in your local area and contact numbers can be obtained from the transplant social workers or by calling your local Division of Family and Children Services (DFCS).

National Patient Air Transport Helpline (NPATH): This organization provides information and referrals to low-income patients who need air transport to distant locations for specialized treatment or recovery. If charitable means cannot meet the patient’s financial need, NPATH will provide information on discounts from all known commercial services.
patienttravel.org
800-296-1217

Atlanta Ronald McDonald House: This facility provides lodging for patients and their families in metro Atlanta during medical treatment. The initial referral must come from transplant social workers. A donation of $10 per day is requested.
armh.com
404-315-1133

Camps, events and support groups

Camps, retreats and other events offer many therapeutic benefits for children and families who are dealing with serious illness. BMT patients must talk to their doctors before planning camp activities due to limitations as a result of the procedure.

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