Chronic myelogenous leukemia, or CML, is a blood cancer that is fairly rare in children, according to Children's Hospital Boston. In CML, immature white blood cells crowd out the healthy mature cells in the blood. A bone marrow transplant, or stem cell transplant, is a treatment for CML that involves transplanting stem cells from a donor to the patient. Stem cells are cells from which other blood cells develop. By transplanting these bone marrow stem cells, healthy normal blood cells can be newly made. Although this is an effective treatment, it carries risks.
Graft Versus Host Disease
A major complication of bone marrow transplants is a condition called graft versus host disease, or GVHD. This occurs when a donor's bone marrow views the patients' bone marrow as a foreign substance and starts attacking the body, causing jaundice, diarrhea, hepatitis, skin rash and weight loss. According to the University of Maryland Medical Center, GVHD typically occurs within the first three months after the transplant, which is called acute GVHD. Chronic GVHD starts three or more months post-transplant and can last for three years or more. Individuals who are related to one another are less likely to cause a GVHD reaction, with only 30 to 40 percent of related donors causing GVHD. Unrelated matches carry a 60 to 80 percent rate of GVHD. Treatment includes high doses of corticosteroids to help minimize the immune response while not damaging the new marrow. For those who do not respond to the steroids, antibodies to T-cells may be given to minimize the body's response.
Fertility Issues
Having a bone marrow transplant involves using high doses of radiation and chemotherapy before the procedure to eradicate any cancer cells. These treatments also affect healthy cells in the body, including cells in the reproductive organs, says the Cleveland Clinic. These fertility issues may be temporary or permanent. Boys may become sterile due to the high doses of chemotherapy and radiation, so banking sperm before treatment is an option for those who choose. Girls may experience temporary or permanent menopause due to the treatments. Egg and embryo freezing are options for these patients.
Infections and Other Complications
Infection is a significant danger in children with CML who have recently had a bone marrow transplant. According to Children's Hospital of Wisconsin, bacterial infections are most common because the child's immune system has been weakened by the intensive treatment. Viral and fungal infections are also common, and medications given post-transplant typically include anti-fungal and anti-viral drugs and antibiotics to help prevent any infections. Decreased platelet counts and lowered red blood cell counts may occur because of non-functioning marrow, increasing the risk of internal bleeding since the blood cannot clot easily and causing anemia, says Children's Hospital of Wisconsin. When the new marrow starts making new cells, these counts start to go up. Pain, diarrhea and nausea are also all complications of a bone marrow transplant.
