Stem Cell Transplantation
Rebuilding your Child's Immune System
Your child needs a stem cell transplant because his or her bone marrow has either been damaged by disease or been suppressed by extensive amounts of chemotherapy. Since bone marrow cells produce all forms of blood cells, including infection-fighting white blood cells, your child's immune system will also be significantly impaired.
Once the donor stem cells start working, your child's bone marrow will begin to produce healthy white blood cells. However, it will take time for these new cells to become strong enough to fight off infection. It is important you and your child understand that rebuilding your child's immune system is a process that will take several months.
Protecting your Child at Home
At Children's Hospital Boston your child is protected from bacteria, viruses and fungi by special air filtering and infection-control precautions. When your child returns home, we will ask your family to take several safety measures to provide as safe a recovery environment as possible. Some of the steps we will ask you to take include removing houseplants, adopting stringent hand washing habits and avoiding certain foods, like raw fish, which may lead to infection.
Although we require all transplant patients to observe certain core precautions against infection after transplant, some of the post-transplant restrictions vary based on the type of transplant performed. An example of this is the time period we ask a patient to wait before visiting public places and returning to school. In general we ask autologous transplant patients to avoid common areas like these, which heighten the risk of being exposed to bacteria, viruses and fungi, for at least six months after transplant. In comparison, we generally ask allogeneic transplant patients to wait nine to 12 months.
It is important to explain that we cannot predict exactly when it will be safe for your child to visit public places or return to school. Our first priority is protecting your child's health, and we will ask your child to remain at home for a longer period of time if necessary.
Post-Transplant Vaccinations
In addition to rebuilding itself naturally over time, your child's immune system will also require vaccinations to help it produce disease-specific antibodies. Some of these vaccinations include the diphtheria, tetanus and polio vaccines. Although your child may have been vaccinated, their new immune system needs to be refreshed through another vaccination. Even if your child received routine immunizations prior to transplant, his or her new immune system will have no memory of those vaccinations. For this reason patients must be re-vaccinated to protect against diphtheria, tetanus and polio, among other diseases, after a bone marrow transplant.
Our general recommendation is to wait 12 months after transplantation before delivering any vaccinations. However, each child is different, and we will adjust this recommendation if necessary. We also suggest your child receive all vaccinations from the same physician. This makes it easier to track vaccination records for things like school, sport or camp applications.
Your child can be vaccinated by Jimmy Fund Clinic staff members or by his or her primary care provider. In either case, we will provide a helpful list to track your child's post-transplant vaccinations.
Our physicians will explain more about immune system reconstitution during your new patient consultation.
