Pre-Transplant: Pediatric Bone Marrow Tranplant Program

During the initial consultation visit to the Bone Marrow Transplant Clinic, you and your child will meet with an attending physician, nurse specialist, social worker, and financial counselor. Your child's history will be reviewed and potential donors discussed. Additional blood studies may be obtained in order to complete the tissue typing. We will also review with you and your family the basic issues of the bone marrow transplant and answer any questions that you might have. For some diseases there may also be evaluations such as developmental testing and a consultation with the Geneticist.

Following the initial consultation visit, a decision is made by both you and the doctors as to the feasibility and desirability of going ahead with the transplant. Your child's case is presented at the Pediatric BMT Clinical Conference at which oncologists, hematologists, immunologists, nurses, and social workers meet to discuss all of the patients. A consensus is reached at that time regarding whether or not to proceed with a transplant.

The pre-transplant work-up and evaluation

The next stage in the pre-transplant process is the completion of the work-up and evaluation. The purpose of the pre-transplant work-up is to thoroughly evaluate the patient's medical and psychological status with respect to his/her ability to undergo a transplant. Many potential bone marrow recipients have already had significant problems from their primary diseases. These problems as well as their treatment (e.g., chemotherapy to induce remission) can damage vital organs including the heart, lungs, kidney, liver and brain.

Generally, 2-3 weeks prior to admission the patient undergoes a thorough medical evaluation. The studies which are done include:

Depending on the type of transplant and conditioning, the patient may undergo a special study of the kidneys (glomerular filtration rate or GFR). Your referring physician can complete most of the studies while some must be done at UCSF. The patient may need a bone marrow aspirate and biopsy, and/or a spinal tap prior to the transplant. Visits will also be scheduled with our radiation oncologist (if radiation therapy will be used during the conditioning period), and child life specialist. For children with some genetic diseases, additional evaluations by specialists in the nervous system (neurologist), hormonal glands (endocrinologist), lungs (pulmonologist), and heart (cardiologist) may be necessary and a liver biopsy (for some diseases) may need to be performed. All of these evaluations will be done as an outpatient.

While the pre-transplant work-up and evaluation is being completed, a tentative schedule is established for admission for transplant. This will vary depending on your child’s need for additional treatment prior to transplant, whether an unrelated donor search is necessary, and bed availability.

Informed consent conference

By now, you probably will have met with the transplant physicians several times to discuss the transplant. In addition, following the pre-transplant evaluation you and your family will have an informed consent conference. You will meet with a bone marrow transplant physician, nurse, social worker and other members of the health care team to review the results of the pre-transplant evaluation and the treatment plan, and discuss the benefits and risks of a transplant. It is important for you to take as much time as you need to understand every aspect of bone marrow transplantation and to have all of your questions fully answered. The conference takes about 1 1/2 hours, and it is essential that both parents &/or legal guardians be present. Depending on age and other factors, the recipient and the bone marrow donor may also be present or may have a separate meeting with the BMT team.

We will tape record the informed consent conference so that you can listen to it again. Prior to admission for the transplant, both parents must sign the consent forms. The consent forms are documents which review the essential purposes and procedures of the bone marrow transplant, as well as the risks and benefits. The consent form is signed by the patient and donor (depending on age) and their parents as well as the transplant physician. Signing the consent form indicates that everyone understands as much as possible about what is involved in the bone marrow transplant process and agrees that it is the best treatment available.