There are three phases to the bone marrow transplantation process at NewYork-Presbyterian Morgan Stanley Children's Hospital:
The pre-transplant phase, which includes consultations, identifying a donor, undergoing a complete physical examination, and receiving education about the procedure. Tests during this phase include evaluation of the heart, lungs, and kidneys, as well as a full sickle cell disease evaluation including MRI, transcranial Doppler ultrasounds, and liver evaluations. Care during this phase is delivered on an outpatient basis. All patients will be evaluated during this phase to determine if they are eligible for transplantation, and the right treatment plan will be selected for them based on the results of pre-transplant testing.
The conditioning/transplant phase, during which time the patient stays in the hospital for an average of 8 to 12 weeks. For the first week of this hospital stay, chemotherapy will be administered once or twice a day for seven to eight days. These chemotherapy agents will destroy the old bone marrow and promote acceptance of the new donor bone marrow, which is given one to two days after completing chemotherapy. Side effects to expect during this phase of treatment are largely related to the chemotherapy and include nausea, vomiting, diarrhea, hair loss, infections, and mouth sores.
The recovery phase begins in the hospital after the patient has received the healthy bone marrow. Patients may leave the hospital once doctors see that the bone marrow has been accepted and the patient has recovered from the side effects of the chemotherapy. In the first months after transplant, the focus will be on recovery: eating well, avoiding infections, monitoring for a complication called graft-versus-host disease, taking medications, and regular outpatient visits. We continue to monitor and support patients on an outpatient basis for an additional six to twelve months. We provide care to reduce the risk of infections and complications after transplantation. For most children, the return to normal activity and school takes approximately one year, but every child is different.