Blood and Marrow Transplant/Cellular Therapy Patient and Family Resources

Autologous transplants are generally used in the treatment of solid tumours.

High doses of chemotherapy are given, which not only destroys tumour cells but also healthy bone marrow cells.

The patient's own stem cells, which have been previously collected and frozen, are then thawed and infused into the same patient to help them recover from the high doses of chemotherapy.

Your physician will discuss this procedure with you in detail if it is part of your child's protocol.

Allogeneic transplant uses stem cells from someone other than the patient.

Through a special typing process called Human Leukocyte Antigen (HLA) typing, an appropriate stem cell donor can be found for most patients. HLAs are inherited in groupings from biological parents, therefore the best chance for fully-matched donors is from a full sibling.

If there is no sibling donor, an alternative donor can be used from the unrelated donor registry (e.g. One Match). Using a fully matched donor decreases several transplant-related complications, such as graft vs host disease (GVHD).

If allogeneic BMT is in your child's protocol, your physician and health care team will discuss this procedure with you in depth prior to the infusion.

Graft vs host disease (GVHD)

There are two forms of GVHD, an early form (acute) and a late-onset form called chronic GVHD.

In the first few months after the transplant, acute GVHD can develop as an immune response against the skin (rash), the gut (diarrhea or pain), or the liver (increased liver enzymes and jaundice). It is generally treated with systemic steroids, and/or immune suppressive therapy.

Chronic GVHD (cGVHD) develops more slowly and can be very slow to resolve. It is also an immune response from the donor immune system fighting against the recipient's (patient's) body tissues.

Chronic GVHD is a complicated disease and can affect any organ or tissue in the body, but most often will affect the skin, joints, eyes and/or mouth. Treatment generally involves steroids and immune suppression.

If you suspect cGVHD in your child who has had an allogeneic BMT, it is very important to report signs of GVHD early to your health care team so it can be diagnosed and treated as early as possible. cGVHD symptoms can include:

• Skin problems such as dryness, rash, itching, peeling, darkening, hard texture and feeling tight
• Dry eyes that may have a burning or gritty feeling
• A dry mouth with or without mouth ulcers
• Diarrhea, loss of appetite, stomach cramps, vomiting
• Pain in muscles and joints
• Infections
• Weight loss
• Difficulty breathing

T-cell therapy is a newer method of treating cancer. In this therapy, the patient's own cells, specifically the T-cells, are taken from the patient's own blood and genetically modified in the lab to recognize a target on the patient's cancer cells.

The cells will then be infused back into the patient. The cells' job is now to recognize the cancer cells, bind to them and destroy them.

The patient may or may not require an allogeneic BMT after the CAR T cell therapy.