When are transplants necessary

In some children, leukemia cannot be cured with conventional doses of chemotherapy and/or radiation. These cancers may be sensitive to extremely high doses of chemotherapy, but these doses would permanently damage normal bone marrow. A stem cell transplant allows the delivery of high-dose, potentially curable therapy follwed by an infusion of normal stem cells to rescue bone marrow function.

Stem cell transplants are sometimes recommended for children with CML in the chronic phase, JMML after diagnosis, or AML in first or second remission. Transplant is recommended for some children with very high-risk types of ALL (e.g., Ph+ ALL) in first remission and for ALL in second remission, especially if relapse had occurred less than eighteen months after initial remission. Guidelines change over time as new information becomes available, and practices vary among institutions.

If a transplant has been recommended for your child or teenager, you may want to get a second opinion before proceeding. Chapter 19, Relapse, and Chapter 6, Forming a Partnership with the Medical Team, give several methods for obtaining an educated second opinion. In addition, to fully understand the issue, you may want to ask the oncologist some or all of the following questions:

• What are all the treatment options?

• For my childs type of cancer, history, and physical condition, what chance for survival does he have with a transplant? With other treatment?

• What are the short-term and long-term risks from the transplant? Explain the statistical chance of each risk.

• What will be my childs short-term and long-term quality of life after the transplant?

• What is the institutions procedure for this type of transplant?

• What portion of the procedure will be outpatient versus inpatient?

• How long will she have to take medicines after the transplant?

• What are the side effects of these medicines?

• Is this transplant considered to be experimental, or is it accepted clinical practice?

My daughter was 6 years old when she was diagnosed with AML. When she relapsed four months into treatment, an allogeneic bone marrow transplant was her only hope.

After my son's second relapse from ALL, the doctors told us that a BMT was his last option for a cure.

The day my daughter was diagnosed with CML, they told us her only chance for a cure was a BMT

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