What We Treat

The Blood and Marrow Transplant (BMT) Program at the Aflac Cancer and Blood Disorders Center is one of the largest in the nation. But to us, your child is more than a number. Your child deserves the best care designed just for him.

What is a BMT?

During a blood and marrow transplant (BMT), your child will receive healthy blood or bone marrow to help to restore blood stem cells that are damaged, missing or not working. A BMT is not a surgery; it is a treatment that takes place over weeks and months. The cells are given intravenously (through a vein).

Conditions treated with BMTs

A BMT can be used to treat many types of malignant (cancerous) diseases and nonmalignant (noncancerous) disorders, such as:

  • Blood cancers: Leukemia, lymphoma
  • Solid tumor cancers: Neuroblastoma, certain brain tumors
  • Noncancerous blood and genetic disorders: Sickle cell disease, thalassemia, stem cell disorders (aplastic anemia, Fanconi anemia, paroxysmal nocturnal hemoglobinuria, myelodysplastic syndromes), phagocyte disorders, histiocyte disorders, immune deficiency syndromes (Wiskott-Aldrich syndrome), metabolic storage diseases (Hurler’s syndrome)

Types of BMTs

  • Autologous transplant: An autologous transplant is when the patient is the donor. Blood or bone marrow is taken from your child and given back later during the transplant.
  • Allogeneic transplant: An allogeneic transplant is when the blood or bone marrow is taken from a donor and given to your child. This donor could be a sibling, parent or an anonymous matching donor. Finding a matching donor may take some time.

The type of BMT your child needs depends on his condition and who will give your child the best blood or bone marrow to treat his illness. Your doctor will discuss all your options with you before making any decisions.

BMT process

Collecting healthy blood stem cells

The process of collecting healthy blood or bone marrow for BMT is called a graft. It can be done in three ways:

  • Bone marrow: 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 get to. The collection is done in the operating room while the donor is under general anesthesia. The total amount 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 (GCSF or GMCSF). 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 (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 when a baby is born by cutting the umbilical cord or removing the blood from the cord and placenta right away.

Before transplant

Your child may have chemotherapy or radiation therapy to get him ready for his BMT. The kind of therapy your child needs depends on his disease and health. Your child will start his therapies about seven to 10 days before his BMT.

Chemotherapy

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

  • Stops your child’s bone marrow cells from fighting the new blood and bone marrow
  • Kills any cancer cells, if your child has cancer

Side effects of chemotherapy include:

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

Radiation therapy

Your child may need radiation therapy 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 once or twice a day for 10 to 15 minutes.

Side effects of radiation therapy include:

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

During transplant

The day of your child’s transplant is called Day 0. This is the day your child will get the new blood stem cells.

  • For an allogeneic BMT transplant, cells are placed in a sterile bag and given through a central venous line (CVL). This process should take a few hours.
  • For an autologous BMT transplant, your child’s cells will be thawed and will be given to him by a syringe. This takes 10 to 20 minutes.

Engraftment is the when healthy donor cells begin to grow. It usually happens about 10 to 28 days after the BMT.

Recovery

Recovery starts in our hospital. Each child is different so your child may need to rest for a longer, or shorter, 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 BMT

Our staff will be monitoring your child every day he is in the hospital to check him for:

  • Low blood cells, called anemia
  • Low platelets, called thrombocytopenia
  • Low white blood cells
  • Fever
  • Mouth sores, called muscositis
  • Diarrhea
  • Hair loss, called alopecia
  • Irritation of the bladder, called hemorrhagic cystitis
  • Graft-versus-host disease (GvHD)

What is graft-versus-host disease (GvHD)?

After your child’s BMT, the graft that is made up of donor cells can sense your child’s body (the host) as different. In GvHD, the donor cells attack your child’s body. Having your child take his medicines on time every day is the single most important thing you can do to help stop GvHD. (GvHD does not occur in an autologous transplant using previously collected blood or marrow from your child’s own body.)

After BMT

After a BMT, your child will need to take some steps in his everyday life to stay healthy and active. Here are some things to watch for:

  • Body changes: Your child may see some changes in his body. Most of these changes will go away with time, or as his medicines change. Changes may include weight gain or loss, skin color changes, acne or stretch marks, and more facial or body hair.
  • Sun protection: The sun is even more dangerous if your child has had a BMT. It can cause skin cancer, and it can trigger GvHD—or make it worse. To protect your child, wear protective clothing and use sunblock that is 30 SPF or higher.
  • Going back to school: It is important your child returns to school only after it is medically safe. Every child recovers differently. We will work with you to get your child back to school as soon as possible.
  • Vaccines (immunizations): After a BMT, your child’s system for fighting diseases is weakened. So, we recommend checking with us if your child needs any vaccines the first year after his transplant. We can give your family doctor a vaccine schedule to follow to help make sure your child does not get a vaccine too soon.
  • Blood pressure: Because of the medicines your child takes after his BMT, your child’s blood pressure may be high. High blood pressure is called hypertension. Though this is normal for children with BMTs, your child may need to take medicine to keep his blood pressure under control. 
  • Mouth care: After a BMT, your child’s system for fighting infections in his mouth is weakened. It is important to regularly clean his mouth to help keep him from getting mouth sores that could become infected.
  • Skin care: For teenagers already undergoing body changes, your child’s BMT can cause his skin to be darker, more sensitive or dry for many months. This is a common side effect of the treatments your child received. Most of these will go away with time.
  • 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 his BMT. We will give you food safety instructions to follow.
  • Medicine: 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.

Our Unique Approach

As one of the top pediatric BMT programs in the country, the Aflac Cancer Center provides expertise in both autologous and allogeneic transplants. In addition to treating cancer, we are also proficient in treating a variety of noncancerous diseases through transplant, such as sickle cell disease. In fact, we are a national leader in curing children with sickle cell disease through transplant.

Learn more about BMT for sickle cell disease


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Camps, events and support groups

Camps, retreats and other events offer many therapeutic benefits for children and families who are dealing with serious illness.

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We understand you want to be certain your child is receiving the best possible treatment available anywhere in the world. Second opinions can help provide the information you need to make an informed decision about the treatment for your child. For families traveling outside the U.S., we are here to help meet your unique needs and challenges.

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Meet the Team

Meet our BMT physicians

Led by Lakshmanan Krishnamurti, MD, Director of BMT, our team includes the following pediatric BMT providers: