Allogeneic transplants are those in which the stem cells come from another person who is not the child's identical twin. This would include a sibling, parent, close relative, or an unrelated individual. Sometimes a matched unrelated donor (called MUD) can be located through the US National Marrow Donor Program or similar donor registries in the US or other countries. The risk of complications increases if the donor is mismatched or unrelated.
Adele's transplant was June 16, 1997. She was 51/2 years old at the time. Donor marrow was harvested from 21/2 year old Ben. Harvesting took approximately one hour, and after it was prepared for infusion, Adele received it (about 45 minutes later). The actual infusion was very simple—just hanging an IV bag. The doctor and nurses were, understandably, extremely careful with it, and it was very dramatic!
One hour after completion, Adele could get up, and she and Ben immediately went running to the playroom! She had not crashed yet from the preparative chemotherapy, which had just been completed two days before. Just like her response to most of the treatment, however, this was not the norm. The nursing staff said they'd never seen a kid who felt well enough to do that following a BMT.
Adele first showed something above a zero ANC on Day T+15 (fifteen days after transplant). From then on, she improved quickly and steadily. She was released about six weeks after transplant, and met her goal of being at home and better (at least not sick!) for her sixth birthday She did so well that she was off all medication except for prophylactic Bactrim by the end of October. Because Adele showed basically no signs of graft-versus-host disease, she was taken off almost all meds early She returned to school in January.
The primary life-threatening complications of an allogeneic bone marrow transplant are rejection, graft-versus-host disease (GVHD), and infection. The new stem cells must relocate and grow in their new body. If the patients immune system has not been suppressed adequately, the new marrow may be rejected. Rejection is more frequent in mismatched or unrelated donor transplants.The donors marrow also may not grow well if the patient has a significant infection. Fortunately, in patients with leukemia, rejection occurs in less than 5 percent of transplants.
GVHD affects approximately 30 to 50 percent of patients who have undergone an allogeneic transplant; it affects a higher percentage of patients whose transplants used mismatched marrow or marrow from an unrelated donor. GVHD is a reaction of the donor stem cells against the patient (host). It may be triggered by HLA antigen differences, by the chemotherapy and irradiation used to prepare the child for transplantation, or by infections. While GVHD is a serious complication, it may decrease the likelihood that the child will relapse. This not-well-understood phenomenon is called the graft-versus-leukemia (GVL) effect. GVHD is discussed in detail later in this chapter.
Transplant centers use different and various methods to reduce the risk of infection. The most effective methods are single-room isolation; thorough hand washing; and using screened, filtered, and irradiated blood products. Other infection control methods—air filters; requirements to cap, gown, and wear masks before visiting the patient; prohibiting live plants, fruits, and vegetables in the patients room—remain unproven.
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Although nobody gets a parenting manual or bible in the delivery room, it is our duty as parents to try to make our kids as well rounded, happy and confident as possible. It is a lot easier to bring up great kids than it is to try and fix problems caused by bad parenting, when our kids have become adults. Our children are all individuals - they are not our property but people in their own right.