Pediatric Bone Marrow Transplant Program
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The Day of the Transplant
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| Nurse preparing IV in BMT room |
On Day 0, the day of transplant, the recipient will
receive the bone marrow stem cells collected from the donor. The collection
may be either directly from the bone
marrow or from the blood using a procedure called leukapheresis. The
bone marrow stem cells are stored in a special blood transfusion bag and
administered to the recipient in his or her room the same way a blood
transfusion is given: through the recipient's central line. The infusion
typically takes 1-2 hours to complete. The donor marrow stem cells travel
in the recipient's blood stream to the bone marrow space where they grow
and mature.
Special treatment of marrow
In some cases the bone marrow stem cells will be treated or processed before
transplant. For example, if the donor is a parent whose HLA type is only partially
matched with the recipient, the stem cells will be specially treated to
enrich for stem cells (CD34 positive cells) and remove the T cells responsible for graft
vs. host disease. This process takes 10-12 hours to complete. The resulting stem
cells usually fill one syringe and are administered through an IV by a physician.
If the donor and recipient are HLA matched but have different blood
types (for example, types A and B respectively), the marrow is treated in
order to remove most of the red blood cells and minimize a transfusion
reaction. This process takes several hours to complete. The resulting marrow
is slightly pink and is administered from a blood transfusion bag.
For autologous transplants, the marrow stem cells that have previously been collected, treated and frozen, are thawed and administered as a blood transfusion in one or more blood bags. The chemical (DMSO) that is used to safely freeze the marrow has an unusual odor that you will notice within minutes of beginning the infusion. This odor, which will be on the patient's breath, is harmless but will persist for several days. In addition, you may notice that the recipient's urine is red following the transplant. This is due to another chemical added to the marrow and is completely harmless.