Among the diseases seen in childhood, genetically inherited ones have an important place. Especially in our country, the high rate of consanguineous marriages, genetically inherited hematological diseases, immune system deficiencies and metabolic disorders cause a higher incidence. An important part of many diseases, from acute leukemia involving different systems and organs, to Mediterranean anemia, from neuroblastoma to multiple sclerosis, can be treated with Bone Marrow Transplantation performed in childhood. The rules to be followed after bone marrow transplantation increase the chance of success of this treatment. Prof. from Memorial Ankara Hospital Pediatric Hematology Department and Bone Marrow Transplantation Center. Dr. Bülent Barış Kuşkonmaz gave information about bone marrow transplantation and what needs to be considered in the next process.
Stem cell may differ according to its source
The stem cell, which is found in the bone marrow and forms the blood cells, also called the shaped elements of the blood, is called hematopoietic (blood-forming) stem cells, and the process of giving the hematopoietic stem cells to the patient is called hematopoietic stem cell transplantation. If bone marrow is used as a source of stem cells, it is called bone marrow transplantation, if peripheral blood (the blood circulating in our veins) is used, peripheral stem cell transplantation is called, and if cord blood is used, it is called cord blood transplantation. Bone marrow transplantation is performed in various cancers and non-cancer diseases that cannot be treated with other treatment methods or have a low chance of being cured.
Consanguineous marriages increase disease risk
Since consanguineous marriages are common in our country, genetically inherited hematological diseases, immune system deficiencies and metabolic diseases are more common. Bone marrow transplantation is required for the treatment of some of these diseases. seen in children; bone marrow in hematological cancers such as acute leukemias, in benign hematological diseases such as Mediterranean anemia, hereditary bone marrow deficiencies, in hereditary immune system deficiencies such as severe combined immunodeficiency, in solid tumors such as neuroblastoma, Hodgkin lymphoma, inherited metabolic diseases such as Hurler syndrome and autoimmune diseases such as multiple sclerosis transplant therapy can be applied
Bone marrow transplant is not a surgical procedure
Before bone marrow transplantation, a treatment called a preparatory regimen, generally lasting 7-10 days, including chemotherapy and sometimes radiotherapy, is applied to pediatric patients. Its two main purposes are; It is to eliminate the stem cells of the patient in the bone marrow, to make room for the healthy stem cells of the donor and to prevent the rejection of the healthy stem cells to be given by suppressing the patient's immune system. Bone marrow transplant is not a surgical procedure or surgery. The collected stem cells are given to the patient intravenously. In order to minimize the risk of infection during the transfer process, patients stay in private rooms.
Bone marrow transplant does not cause health problems in stem cell donors
Volunteers who apply to the Bone Marrow Bank Turkey Stem Cell Coordination Center in our country are first checked for infectious, immune or infectious diseases. Donors selected from healthy people may experience mild pain, such as temporary pain lasting for a few days and bone pain due to drugs, in the area where the stem cell collection is performed. Apart from these complaints, no serious health problems were reported in the donors. It should not be forgotten that many patients' lives can be saved with stem cell donation, which has not shown any serious side effects.
Transplant success rates and the chance of long-term survival in children vary depending on the disease and condition of the transplant. In some diseases (for example, aplastic anemia, beta thalassemia), the success rate of transplantation may be over 80-90%, while this rate is around 70-80% in leukemias.
Nutritional measures must be applied after transplantation.
Since the immune system of the transplanted children will be weak for a certain period of time, nutritional measures in the hospital should be continued against infections that can be transmitted from food. Among the allowed foods; well-cooked meats and vegetables, pasteurized milk, dairy products and juices, thick-skinned fruits such as oranges and bananas, compotes, packaged products, salt and spices added during cooking, and trusted brand or boiled waters. Among the prohibited foods are raw and uncooked foods, unpasteurized products, thin-skinned fruits such as grapes and strawberries, nuts, pickled products and unpackaged products.
Things to consider after transplant
Patients are followed closely, more frequently in the first months after bone marrow transplantation. While it takes time for the immune system to return to normal after the transplant, particular attention should be paid to the risk of infection. In this context, the points that patients with bone marrow transplant should pay attention to are as follows:
- Pay attention to personal hygiene (hand washing, bathing at least twice a week)
- The house to live in after discharge should be thoroughly cleaned.
- The patient should stay in a separate room, the walls should be painted with wipeable paint.
- Visitors should not be taken as much as possible, if it is necessary, the number of visitors should be small.
- Sunscreen should be applied before going out in the sun.
- Do not enter the sea and pool for 1 year after the transplant.
- Home renovations should not be done until the immune system regains its normal function after the transplant.
- After the transplant, the child should not be sent to school for at least 6 months, education should be continued at home.
- Pets should not be kept at home and contact with animals should be prevented.
- Avoid close contact with people who have received live vaccines.
- Cotton clothes should be preferred instead of woolen and nylon clothes; Newly purchased clothes should be washed before wearing.
- Children who are taken out of the house should wear masks
- Avoid contact with people who have an infection
- Crowded environments and environments with a high risk of infection should be avoided.
- In pediatric patients with bone marrow transplantation, the recommended vaccination schedule should be strictly followed.