At age 3 Uzbekistan-born Zhamshid was diagnosed with acute aplastic anemia. His family’s 11-year-long journey through a variety of treatments and across the globe ended at Children’s Hospital & Research Center Oakland where the boy received successful sibling donor cord blood and bone marrow transplants.
We believe in empowering parents by educating families about their child's health and stem cell transplantation. A pediatrician who specializes in stem cell transplants and a nurse coordinator will be available to answer your questions. Outcomes, complications, length of stay and procedures vary based on the type of transplant, your child's illness, age and overall health, and the degree of tissue matching between the donor and your child. Therefore, many concerns must be considered on a case-by-case basis. However, questions and answers that follow are a good place to start.
What are stem cells?
Stem cells are immature blood cells that can grow into red blood cells, white blood cells or platelets.
Where are stem cells found?
There are three main sources of stem cells: the bone marrow, the bloodstream (also called peripheral or circulating blood), and umbilical cord blood.
How are stem cells collected?
Bone marrow stem cells are collected through a procedure called "harvesting." Usually, several small cuts (not requiring stitches) are made in the skin over the hip (pelvic) bone. A harvesting needle is inserted through the cuts and into the bone to draw the marrow out of the bone. The donor receives anesthesia and will not feel pain caused by the needle. The process of obtaining the marrow takes about an hour. The harvested bone marrow is then processed to remove bone fragments, or when necessary, red blood cells and/or plasma.
Peripheral blood stem cells are collected by apheresis. During apheresis, the donor is connected to a cell-separation machine via a needle inserted in the vein. Blood is taken from one vein and circulated through the machine, which separates stem cells and returns the remaining blood and plasma to the donor through another needle inserted into the opposite arm.
Umbilical cord blood stem cells are collected from the umbilical cord and placenta immediately after delivery.
What is a matching donor?
For a transplant to be successful, donor stem cells should match genetically the patient's cells as closely as possible. Matching involves typing the human leukocyte antigen (HLA) genes. The HLA antigens on the surface of white blood cells determine the genetic make-up of a person's immune system. There are at least 100 different HLA genes. We test the major HLA antigens to determine whether a donor and recipient match. The more antigens match, the better the chance that the engraftment of donated stem cells will occur. Stem cell engraftment occurs when the donated cells make their way to the marrow and begin reproducing new blood cells.
How do we find a matching donor?
We look for a suitable donor among the patient's relatives first. If tests reveal there is no match in the family, we seek an unrelated donor through donor registries.
What does the stem cell transplant involve?
After a suitable donor is identified, we prepare the child for a transplant. Preparations for a stem cell transplant vary depending on the type of transplant, the type of illness and your child's tolerance for certain medications. Often high doses of chemotherapy and/or radiation are required before transplantation. Such therapy prevents blood cell production so that the marrow becomes empty, making room for the new stem cells to grow and establish a new production system. Children stay in the hospital during pre-BMT therapy.
After a child has finished pre-transplantation therapy, we perform the donor stem cell transplantation. Stem cell transplantation is not a surgical procedure. It is similar to a blood transfusion. The transplant is given through a central venous catheter into the bloodstream. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.
After the transplant, children receive special care to prevent and treat infections, transplant complications and treatment side effects. Patients must live within a 30-minute drive of the hospital for approximately 100 days after the transplant. They will spend some of that time, especially immediately after transplant, in our BMT inpatient unit.
What outcomes do patients have at Children's Hospital Oakland?
As of December 2005, the overall survival rate for our patients was 79 percent. Outcomes vary significantly depending on the patient's underlying disease, the genetic match with the donor and the patient's disease status at the time of transplantation. Your transplant physician can discuss this question with you once he or she has reviewed your child's treatment, disease status, source of donated stem cells, and pre-evaluation results.
Who will care for my child at Children's Hospital Oakland?
The group of specialists who care for children going through transplant is often referred to as the "transplant team." These professionals work together to ensure the best chance for a successful transplant. The team consists of:
Physicians who are specialists in oncology, hematology, immunology and bone marrow transplantation will provide medical care to your child.
The nurse coordinator organizes all aspects of care provided to your child before and after the transplant, offers patient education and coordinates diagnostic testing.
The physician assistant delivers patient care and education under the supervision of the doctors.
Social workers help your family address issues that may arise, including lodging and transportation, finances and legal issues.
Dieticians help your child meet his or her dietary needs before and after transplant.
Physical therapists help your child become strong and independent through movement after the transplantation.
Medical interpreters eliminate language barriers so non-English speaking families can receive quality care.
Child Life specialists offer age-appropriate therapeutic play activities for your child.