Blood and Marrow Transplant (BMT) is a therapy for treatment of cancer and other life threatening non-malignant diseases. The purpose of BMT is to replace absent, diseased or damaged stem cells with healthy bone marrow.
The BMT process begins with assessing the patient's health to undergo the transplant and identifying the donor source. There are two types of BMT: autologous, which means the stem cell source is the recipient him/herself; and allogeneic, which means the stem cell source is from someone other than the recipient. This can be a related sibling, parent, unrelated adult or unrelated umbilical cord blood.
Autologous transplants are generally used in the treatment of solid tumors. High doses of chemotherapy are given which not only destroys tumour cells but also health bone marrow cells. It will take months for healthy bone marrow cells to recover and risk of infection is very high during this period of recovery. Your child will undergo stem cell collection if BMT is part of his/her treatment protocol. Your child's own stem cells are collected, cryopreserved (frozen) and stored in a lab at the BCCH site. When the stem cells are due to be infused, the cells are thawed and re-infused directly into your child.
Donors are assessed by a special typing called human leukocyte antigen (HLA) typing, and these antigens (or proteins) are inherited as a grouping from each biological parent. Therefore, the best chance for well-matched donors is from a full sibling. Otherwise, an alternative donor may be used either from a cord blood bank or from unrelated adult donor registries e.g. OneMatch. Using a fully matched donor decreases the risk of engraftment failure (failure of the new stem cells to make healthy blood cells) as well as graft vs host disease (GVHD).
GVHD is a disease whereby the new immune system of the donor (graft) recognizes the recipient's (host) body as foreign and attacks the host. Almost all allogeneic transplant patients are given prophylactic medication called immune suppression to prevent GVHD. Despite this medication, a significant proportion of patients still develop GVHD.
There are two forms of GVHD, an early form (acute) and late onset form called chronic GVHD.
In the first few months after transplant, acute GVHD can develop as an immune response against the skin (rash), the gut (diarrhea or pain), or the liver (increased liver enzymes and jaundice). This can be a potentially debilitating and devastating condition. It is generally treated with systemic steroids, and/or immune suppressive therapy.
Chronic GVHD develops slowly and is very slow to resolve. Sometimes it never goes away. Chronic GVHD is a very complicated disease and can affect any organ or tissue in the body. We have been able to significantly decrease the impact of GVHD partially by using various medications.
The transplant team will have a BMT meeting with the families if BMT transplant is part of treatment protocol or recommended to treat your child's illness.
Director of Pediatric BMT, Clinical Associate Professor of Pediatrics: Dr. Jeff Davis, MD
Director, Michael Cuccione Childhood Cancer Research Program, Professor of Pediatrics: Dr. Kirk Schultz, MD
BMT Nurse Practitioner: Juliana Roden MN NP (P) 604-875-2345 ext 6811 Juliana.firstname.lastname@example.org