Pediatric Bone Marrow Transplantation is a life-saving medical procedure. It can treat various types of cancer, blood disorders, and immune system diseases through blood stem cell donation and other procedures. According to the World Marrow Donor Association, more than 50,000 bone marrow transplants are performed each year worldwide with over 3,000 cases in India. However, this procedure has unavoidable risks and requires specialized medical care to ensure its success. It is essential to have a comprehensive understanding of the procedure, its complications, and post-transplant care to ensure a successful outcome for the child.

What do you understand by Paediatric Bone Marrow Transplantation?

Paediatric Bone Marrow Transplantation (BMT) is a medical procedure used to treat various diseases and conditions affecting children, such as leukemia/lymphoma, solid tumors, thalassemia, sickle cell disease, aplastic anaemia, primary immune deficiency and certain metabolic disorders. BMT involves transplanting healthy bone marrow stem cells through blood stem cell donation into the child's body to replace the damaged or diseased ones. The new bone marrow will produce healthy blood cells. This will help the child recover from their illness.

Significance of Bone Marrow Transplantation in Children

Bone Marrow Transplantation is a life-saving treatment alternative for many children with serious life-threatening diseases. It helps in restoring the immune system, rebuild blood cells, and provide a chance for a better quality of life for all those affected. Bone Marrow Transplantation or BMT is often the only treatment alternative for some childhood cancers, genetic disorders, and immune system disorders. It can also improve the long-term survival rates for children with these conditions.

Types of Paediatric Bone Marrow Transplantation

There are three types of paediatric bone marrow transplantation:

1. Autologous Transplantation: Autologous Transplantation involves collecting the child's bone marrow stem cells before they undergo chemotherapy or radiation therapy. The stem cells are then stored and returned to the child after treatment to help restore the immune system and rebuild blood cells. It is generally performed for lymphoma, neuroblastoma, medulloblastoma and few other  relapsed/refractory solid tumors

1. Allogeneic Transplantation: Allogeneic Transplantation involves transplanting bone marrow stem cells from a donor, a family member, or an unrelated individual with a compatible tissue type. Before this process, the patient undergoes chemotherapy or radiation therapy for destroying the old marrow and disease cells. Its commonly offered for children suffering from leukemia, thalassemia, sickle cell disease, aplastic anemia, primary immune deficiency and certain metabolic disoders.

1. Syngeneic transplantation: Syngeneic transplantation involves transplanting bone marrow stem cells from an identical twin with an equivalent tissue type. In this process, a patient receives healthy stem cells to replace their own stem cells which have been destroyed during the high intensity treatment of chemotherapy. 

Procedure for Paediatric Bone Marrow Transplantation

• Pre-Transplant Evaluation

Before a bone marrow paediatric transplant, the child will undergo a thorough medical evaluation, which includes blood tests, imaging scans, and other tests to assess their overall health and suitability for the procedure. The child will also be evaluated for any potential complications or risks associated with the transplant.

• Bone Marrow Collection and Conditioning

If the child receives an autologous transplant, their bone marrow stem cells will be collected and stored before undergoing chemotherapy or radiation therapy. If the child gets an allogeneic or syngeneic transplant, the donor's cells for the process of blood stem cell donation will be collected and prepared for transplantation. Bone marrow stem cells can be collected directly from bone under general anesthesia or from peripheral blood after giving injections which stimulate bone marrow stem cells to come in circulation.

The child will also undergo conditioning therapy, which involves high-dose chemotherapy or radiation therapy to destroy any remaining cancer cells and suppress their immune system to prevent rejection of the new bone marrow.

• Transplantation Process

The bone marrow stem cells are then transplanted into the child's body with the help of a vein. It is like a blood transfusion. The stem cells travel to the bone marrow and grow and produce healthy blood cells. The child will be keenly monitored for any signs of complications or in case of adverse reactions to the transplant.

Post-Transplant Care and Complications:

• Complications related to Bone Marrow Transplantation

Complications related to bone marrow transplantation include infections, organ damage graft-versus-host disease (GVHD), and other serious medical conditions. GVHD is a common complication. In this condition, new bone marrow cells attack the patient’s tissues. It often leads to severe symptoms like skin rashes and liver damage.

• Post-Transplant Care and Follow-up

Post-transplant, the child will require keen monitoring and medical care to ensure that the new bone marrow is functioning properly and to manage any possible complications. They will also need to follow a strict regimen of medications to prevent infection, rejection of the new bone marrow, and other complications.

Follow-up appointments will be scheduled regularly to monitor the child's progress and to check for any signs of complications or relapse. These appointments generally include blood tests, imaging scans, and other tests to assess the child's overall health.

The child will also need to make lifestyle changes. It is advised by the experts to practice good hygiene, and follow a healthy diet and exercise routine and avoid contact with sick people. It may take several months or even years for the child's immune system to recover completely and for them to resume normal activities.

Conclusion

Pediatric Bone Marrow Transplantation is an intricate and high-risk procedure. It requires specialize care assisted by specialists to ensure its success. If your child needs a hypocellular bone marrow transplant, it is important to work with a technical team of doctors and nurses who can provide comprehensive care throughout the journey. The Department of Bone Marrow Transplantation at MedantaHospital has a team of experts led by Dr SP Yadav, who has broad experience performing bone marrow transplants in children.