In Part 1 of this series we explained that this series of articles is not meant to be medical advice, but a guide that may help you as a parent of a newly diagnosed child with cancer cope just a bit better. Information is knowledge, and never more so than when you are dealing with childhood cancer!
These articles are meant to help you be the key part of your child’s treatment that you will need to be. Take what works for you according to your situation and your child’s temperament, personality, fears, strengths, and how they deal with adversity, and leave what does not pertain to your situation.
Part 5 deals with Different Types of Treatment and Possible Side-Effects of that treatment. As this is quite a long section, it has been split it into 5(i) Surgery 5(ii) Chemotherapy 5(iii) Radiation Therapy 5(iv) Immunotherapy and 5(v) Bone Marrow & Peripheral Blood Stem Cell Transplants.
Complementary and Alternative Medicine treatment (CAM) is very involved and will contain a lot of information, so that will be dealt with separately in Part 6 of this series of articles.
Bone Marrow & Peripheral Blood Stem Cell Transplants
Children who have leukaemia or some other types of cancer may require a bone marrow transplant (BMT) or a peripheral blood stem cell transplant (PBSCT).
Both of these treatments involve replacing the blood cells in the diseased or damaged bone marrow (the spongy material that fills the inside of bones and makes blood cells) with healthy cells (stem cells), which will grow new healthy cells.
Stem cells are immature cells that produce the 3 types of blood cells:
- White Blood Cells, which fight infection
- Red Blood Cells, which carry oxygen to and remove waste products from organs and tissues
- Platelets, which enable the blood to clot.
The majority of stem cells are found in the bone marrow, but there are also peripheral blood stem cells (PBSCs), which are collected from the bloodstream. Stem cells also occur in the blood of the umbilical cord.
Stem cells for a stem cell transplant for your child could come from a donor’s bone marrow, bloodstream, or umbilical cord blood; it could also be harvested from your child’s own bone marrow or bloodstream.
Healthy stem cells grow in two ways:
- They divide to form more stem cells; or
- They mature into white cells, red cells, and platelets.
Stem cells that are transplanted into a cancer patient can help the damaged blood-forming system to recover.
The need for a transplant is created by two circumstances:
- When the cancer itself has injured the bone marrow. PBSCT and BMT are commonly used in the treatment of leukaemia and lymphoma; and
- When a cancer treatment requires such huge doses of chemotherapy or radiation therapy that the child’s bone marrow is damaged during treatment. (Chemotherapy and radiation therapy target all cells that divide rapidly).
Cancer cells divide more rapidly than most healthy cells, which is the reason that they are destroyed by the therapies. Unfortunately bone marrow cells also divide more rapidly than other healthy cells, which means that high-dosage treatment can have a damaging effect on them as well.
A BMT or PBSCT can be done in 3 ways:
1. Allogeneic Transplant: The marrow or PBSCs from a parent, sibling, or someone not related to the child can be used for the transplant. The transplant material must be as closely matched to the patient’s blood cells as possible. Cord blood transplant is allogeneic.
2. Autologous Transplant: The patient’s own PBSCs cells or stem cells are used. These cells can be obtained from either the bone marrow or from the blood, using the apheresis procedure (blood is drawn and separated into its components by dialysis). Stem cells are collected while the child is in remission.
The marrow may be treated with anticancer drugs to ensure that any cancer cells that remain are destroyed. Once the PBSCs or marrow has been collected, the patient will receive high-dose chemotherapy, usually over 2 to 6 days. Total body irradiation, during which the whole body is radiated, is also often done, in one dose or in many doses over several days, to get rid of the cancer. Once this has taken place, the collected marrow or PBSCs are then returned to the patient via a vein, as in a blood transfusion.
3. Syngeneic Transplant: A Syngeneic transplant is when perfectly matched PBSCs or marrow from an identical twin are used for the transplant.
A catheter will generally be inserted into a large vein in the chest prior to your child undergoing such a transplant; it will be used for transplanting the marrow or PBSCs, as well as for giving blood, antibiotics and other drugs, and for drawing blood.
Your child will be given high doses of anticancer drugs and/or radiation. This will destroy the cancer cells along with some healthy bone marrow cells, and it is at this stage that the new, healthy marrow or PBSCs will be given.
The healthy marrow or PBSCs are introduced through the catheter; they will then travel through the bloodstream to the bone marrow, where they begin making red and white blood cells and platelets.
It takes between 14 and 30 days after the transplant for the transplanted stem cells to manufacture sufficient white blood cells to fight infection and to make other blood cells. Your child will be at higher risk for infections, anaemia, and bleeding during this period.
Complete recovery of your child’s immune system can take 1 to 2 years after an autologous, allogeneic, or syngeneic transplant. It may be necessary for your child to remain in a sterile hospital room to avoid infection during this time. Supportive care, which includes blood transfusions and antibiotics, will be given.
After undergoing BMT or PBSCT, your child may be required to remain in the hospital for 1 to 2 months (sometimes longer), although outpatient BMT can be done for children with brain tumours. Children receiving BMT or PBSCT may need supportive care.
See the charts for more information on side effects from chemotherapy and radiation therapy.
Graft-versus-host disease (GVHD) sometimes occurs in patients who receive bone marrow or peripheral stem cells from a donor. GVHD occurs when donated stem cells realise they are in a different body and attack the patient’s tissues, such as the liver, skin, or digestive tract.
GVHD can be mild or severe, and can occur any time after the transplant – even years later. The doctor may give your child medication to reduce the risk of GVHD and to treat the problem if it occurs.
Supportive Care for BMT & PBSCT
|Problem||Supportive Care Provided|
|Low counts of all types of blood cells||
|Difficulty eating enough food||
Remember, if you are not sure of anything, speak to a professional on your child’s oncology treatment team; they will be only too glad to help give you information or allay any fears you or your child may have regarding the treatment.
You are not alone in this; there are many individuals out there able and willing to lend a hand, some support, or even just listen – do not be afraid to reach out for help!
Do some research on the internet, reach out to an organisation like Little Fighters Cancer Trust for a bit of support and information and/or access to resources that will help you find out more and make an informed decision regarding your child’s treatment.
This article concludes Part 5 of this series of articles: Different Types of Treatment and Possible Side-Effects of that treatment.
Part 6 of this series of articles will deal with Complementary and Alternative Medicine Treatment (CAM)