Paediatric Bone Marrow Transplant

BMT is often recommended for children with:

• Blood cancers, such as leukaemia and lymphoma
• Bone marrow failure syndromes, such as aplastic anaemia
• Inherited immune system disorders
• Certain metabolic or genetic disorders

A bone marrow transplant involves the following:

• Conditioning treatment includes chemotherapy, radiotherapy, or both to destroy the disease marrow and space for new cells.
• Healthy bone marrow or stem cells are then infused through a central line, similar to a blood transfusion.
• The transplanted cells travel to the bone marrow, where they begin to grow and produce healthy blood cells. 

The duration of a bone marrow transplant and recovery can vary depending on the child’s condition and response to treatment:

• The transplant itself (stem cell infusion) usually takes a few hours.
• The hospital stay lasts several weeks to months, depending on how quickly the new marrow starts working.
• Full recovery and immune system rebuilding may take 6–12 months. 

Tests

Before your child’s transplant, they will undergo several tests to ensure they are ready for the procedure. These may include:

• X‑ray
• Ultrasound scan
• Blood tests
• Breathing tests
• Height and weight measures
• Kidney function tests
• Any other test as per the doctor discretion

Central Line

A central venous line is inserted for medicines, blood tests, and treatments. It usually remains for 3–6 months. Swimming is restricted while the line is in place. 

A central venous line is inserted for administering medications and drawing blood for blood tests. Swimming will be restricted while the line is in place.

Conditioning treatment 

Your child will receive preparatory treatment before the transplant, which may last from a few days to two weeks and can include chemotherapy, radiotherapy, or both.

• Chemotherapy uses special medications, administered either through the central line or orally, to destroy malfunctioning cells in the body, including bone marrow cells, so that new, healthy bone marrow cells can grow.
• Radiotherapy is not required for all children who undergo a bone marrow transplant. It involves a special type of X‑ray designed to destroy abnormal cells and the bone marrow. The procedure itself does not hurt, but is very important that your child remains still during the 20-minute session. No one else can stay in the room during radiotherapy; however, the parents can usually see and hear their child through a special television screen.

Chemotherapy and radiotherapy may cause:

• Mouth sores, nausea, and loss of appetite
• Temporary hair loss lasting about 2 weeks later (including eyebrows and eyelashes), with regrowth occurring after 3–6 months (sometimes with a change in colour or texture)
• Tiredness and lowered immunity

Coping measures

• Encourage your child to drink small sips of water or suck on ice cubes.
• Maintain good oral hygiene (brushing with a soft toothbrush or sponges).
• Nurses can provide the medication to ease discomfort.
• Hair can be cut short before treatment or covered with a wig, cap, or hat until their hair grows back, which typically takes 3–6 months. Sometimes hair can be a bit darker or a bit lighter when it grows back.

Nutrition support

If eating is difficult a feeding tube (Ryle’s tube) may be used for nutrition and medicines. If the tube feeding makes your child too sick, special feeds (TPN) may be administered through a Hickman line. 

After a bone marrow transplant, children need ongoing medical care that includes regular monitoring and gradual adjustments at home to support safe recovery and long-term health. These include:

Medicines 

After the transplant, your child will require medications at home to prevent infection, control side effects, and support the growth of new marrow. You may be able to choose between liquid or tablet forms. Please ask your healthcare provider if the options are not made available to you during consultation.

Follow-up visits 

After leaving the hospital, your child will have regular check-ups to monitor recovery and prevent complications. Your child may need to stay on special medications if they experience side effects such as rashes or digestive issues. Sometimes, you may have to come back into the hospital for a few days in case of any problem.

Returning home 

After discharge, you can protect your child from infection through the following means: 

• Limit visits to a few healthy family members or friends who are free of infections.
• Avoid crowded places such as shopping malls during the early recovery period.
• Short walks in fresh air are encouraged if your child feels strong enough.
• Returning to school may be delayed for a few months, and it is often best to start with half-days or attendance for a few hours at a time.
• Your child will likely feel tired, especially if they have undergone radiotherapy, but their energy levels improve gradually over time.  

At home care during recovery

During early recovery, white blood cell counts are low, and infection is high. To protect your child:

• It is preferable to stay in a private room, rather than sharing with other children, to and restrict visitors to minimise exposure to germs.
• A family member can stay with the child.
• Daily sitz baths are recommended for hygiene and comfort.
• Your child's hair will start growing back after a few months. 

Diet and nutrition 

Certain foods are restricted during transplant recovery (e.g., skin on fruit, a half-boiled egg). The hospital’s dieticians will provide a list of foods that are safe for your child.

Feeling better and visiting 

• As your child’s new bone marrow begins to function, they will gradually be able to have visitors and leave their room.
• Blood counts are monitored to ensure your child’s safety.
• If infection occurs, your child may need to stay in isolation for longer.

Line

Your child will have a central line for medicines, blood transfusions, and to collect blood samples without repeated needles. This line usually stays in place for 3–6 months after the transplant. Once it is no longer needed, the line will be removed in a short procedure. After removal, your child can return to normal activities, such as taking regular baths and swimming.