Bone Marrow Transplant

A bone marrow transplant (also known as a stem cell transplant) replaces diseased or damaged blood-forming stem cells with healthy cells from your child or a donor. The cells are called hematopoietic stem cells. They mature and develop into all the other blood cells, including red blood cells, white blood cells and platelets.

Bone marrow is the main source of these stem cells. The marrow is the spongy area inside the bones. Bone marrow transplants are also called stem cell transplants, hematopoietic stem cell transplants, or blood and marrow transplants.

Bone marrow transplants are defined by the source of the donor cells:

• Autologous bone marrow transplants use donor cells collected from the patient.
  
• Allogeneic bone marrow transplants use donor cells collected from someone other than the patient.

St. Jude has one of the world’s largest bone marrow transplant programs that treats only children, teens, and young adults. Our doctors have been pioneers in bone marrow transplantation for more than 40 years.

Learn more about bone marrow transplant.

Diseases treated with bone marrow transplant at St. Jude

Your child will get the type of bone marrow transplant that best treats their disease.

Autologous bone marrow transplants may treat:

• Neuroblastoma and certain other solid tumors
• Hodgkin lymphoma
• Non-Hodgkin lymphoma
• Acute promyelocytic leukemia

Allogeneic bone marrow transplants may treat:

• High-risk leukemia and lymphomas
• Immune system diseases
• Inherited disorders (hemoglobinopathies) that affect red blood cells, including sickle cell disease, alpha thalassemia, and beta thalassemia.
• Bone marrow failure syndromes
• Certain metabolic storage disorders
• Certain high-risk solid tumors

Bone marrow transplant clinical trials

St. Jude offers clinical trials and cancer research studies for children, teens, and young adults who need bone marrow transplants. Learn more about clinical research at St. Jude.

Why St. Jude for a bone marrow transplant?

St. Jude provides the highest quality of care for patients having bone marrow transplants.

• The Transplant Unit at St. Jude is dedicated to the care of patients receiving bone marrow transplants or immunotherapy.
  
• A St. Jude patient was the first person to be cured of sickle disease with a bone marrow transplant.
• Our doctors developed a type of transplant that uses parents as donors for pediatric cancer treatment. This is called a haploidentical transplant.
• We have been part of the National Marrow Donor Program since 1990. Our center also provides information about transplants to the Center for International Blood and Marrow Transplant Research.
• The St. Jude Transplant Program is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) for transplantation and immunotherapy.
  

More reasons to choose St. Jude for care include:

• We are consistently ranked among the best childhood cancer centers in the nation by US News & World Report. 
• At St. Jude, we have created an environment where children can be children and families can be together.  
• St. Jude patients and families never pay for services authorized by St. Jude. 
• We lead more clinical trials for childhood cancer than any other hospital in the U.S.  
• St. Jude is the only National Cancer Institute–designated Comprehensive Cancer Center just for children. A Comprehensive Cancer Center meets rigorous standards for research that develops new and better approaches to prevent, diagnose, and treat cancer. 
• The nurse-to-patient ratio at St. Jude is about 1:3 in hematology and oncology and 1:1 in the Intensive Care Unit. 

Bone marrow transplant team

Your child will be assigned a bone marrow transplant doctor and a nurse practitioner or physician assistant. They will oversee your child’s care. The team caring for your child also includes other medical staff, researchers, and care team members. They all have special training in bone marrow transplant care and treatment.

Meet the bone marrow transplant and cellular therapy team

What to expect during your visit

Before the bone marrow transplant

Before the transplant, your child will have many tests, including blood work and tests to check the health of major organs. You will also meet with members of our support teams.

Your child must have a central line for transplant. This allows your child to easily give blood samples and receive medicines. It also eliminates the need for most needle sticks.

Depending on the type of transplant your child has, the stem cells are either collected locally or shipped to St. Jude. The cells may be collected from the bone marrow or from blood in the veins (peripheral blood).

Cells for autologous bone marrow transplants are collected from your child weeks to months ahead of transplant. The cells are then stored until they are needed. Donor cells for allogeneic transplants are usually collected within a few days of transplant. The cells used for both autologous and allogenic transplant are processed in our Human Applications Laboratory before being given to the patient.

During the bone marrow transplant

Your child will typically be admitted to the St. Jude Transplant Unit the day before the conditioning regimen begins. The conditioning regimen is also known as the preparative regimen. It is a key part of the transplant.

The process prepares your child’s body to receive the donor cells by making space in the marrow for new cells. Sometimes the conditioning regimen also means killing any cancer or abnormal cells that are present.

The conditioning regimen may include chemotherapy, and radiation. Sometimes it also involves antibody therapies. The preparation is typically given over 5–14 days, depending on the type of transplant your child will have.

On the day of the transplant, the stem cells are given in your child’s room. The cells are given through a vein or central line, in a process much like a blood transfusion. The cells then travel through the bloodstream to the center of the long bones. There they begin to grow.

The new cells will take several weeks to grow enough to be able to measure them with a blood test. Your child will remain in the hospital until they have recovered from the transplant. That often takes at least 4–6 weeks. If problems occur, the hospital stay may be longer.

Infection prevention is crucial during your child’s recovery. The Transplant Unit staff will explain how you and other visitors can help keep your child safe during recovery.

Learn more about the St. Jude Transplant Unit

What are the possible side effects of a bone marrow transplant?

Bone marrow transplants are sometimes unsuccessful because the disease returns, or severe treatment-related side effects develop.

The type and frequency of possible side effects varies depending on:

• The type of transplant your child receives (autologous or allogeneic)
• The conditioning regimen used
• Possible risk factors your child may have for developing specific side effects.

Possible side effects will be discussed by your child’s care team throughout treatment. Side effects include:

• Graft-versus-host disease (allogeneic transplant only)
• Graft rejection or failure
• Infections, including bacterial, viral, and fungal infections
• Organ complications, possibly involving the heart, lungs, kidneys, or liver

After the bone marrow transplant

When your child is ready to leave the hospital, specialists from different departments will meet with you to plan your child’s discharge. They will also explain how to care for your child after leaving the hospital.

After an allogeneic transplant, children usually stay close to the hospital for at least 100 days after leaving the hospital. That allows us to monitor their recovery. During this time we provide housing for families who do not live in Memphis.

Once your child is safe to return home, your child’s St. Jude doctor will send a letter to the care provider who referred your child for treatment. The letter will outline your child’s treatment.

If your child has an autologous transplant, your child will be seen in our transplant clinic until they have recovered. Then they will be transferred to the care provider who referred them for treatment.

Follow-up visits after returning home

• If your child had an autologous transplant, your child will return to the St. Jude transplant clinic only for tests needed for the clinical trial.
• If your child had an allogeneic transplant, your child will return every 1–2 months during the first year.
• During the second year, patients who had allogeneic transplants typically return to the hospital every 3–6 months.
• After 5 years, care of children who received an allogeneic transplant may be transferred to the After Completion of Therapy Clinic.
• Long-term follow-up patients are seen once a year in the clinic until they are 18 years old or until 10 years after the transplant has passed, whichever is longer. Patients are then discharged permanently from St. Jude. They receive a summary of their entire treatment.

Learn more