Childrens Services

Chemotherapy for children undergoing Bone Marrow Transplantation

This page give information about chemotherapy for children undergoing bone marrow transplantation.


IntroductionShow [+]Hide [-]

This information is to supplement the discussions you have with medical and nursing staff regarding your child’s chemotherapy. For more information please ask the doctor who assesses your child daily or the nurse who is looking after them.

The aim of your child’s chemotherapy is to make space in the bone marrow for new bone marrow cells to grow. Chemotherapy works by interfering with the ability of cells to divide and reproduce. The effects are seen in cells that are dividing quickly which are in your mouth, digestive system, skin, hair and bone marrow. Your child will become anaemic and need blood transfusions. Your child’s neutrophils (primary cells to fight infection) will be destroyed so they will be at greater risk of infection. Antibiotics and medications to stimulate the neutrophils to recover may be given. Your child’s platelets (which help stop bleeding) will be reduced and they will be more likely to get bruises and will be more at risk of bleeding. The bleeding may be minor, in areas such as your child’s nose and gums. Your child will be given platelet transfusions during the first few weeks following transplant, if their platelet level becomes too low.

Why chemotherapy?Show [+]Hide [-]

The chemotherapy to be given to your child is necessary to enable the best chance of success with bone marrow transplant. There are risks associated with the chemotherapy and occasionally people die due to the complications. You may wish to talk about your child’s conditioning several times even after making the decision to progress with bone marrow transplantation.

Potential risksShow [+]Hide [-]

There are other potential risks associated with chemotherapy, which are explained below.

  • Hair loss (alopecia). In most patients receiving bone marrow transplant conditioning chemotherapy, the hair will be lost. This occurs gradually starting 7-10 days after chemotherapy ends and loss will continue up to 21 days. All body hair may be lost, but alternatively, sometimes patients may not lose all their hair. The hair will start to regrow 1-2 months after treatment.
  • Hypersensitivity reaction. It is extremely rare to have an allergic reaction to the chemotherapy medication used. A reaction can be mild like a rash, or severe affecting your child’s breathing. Supportive treatment would be given should this occur.
  • Mucositis. Occurs as the mucous membranes (lining) that protect your child’s mouth and gut are damaged by the chemotherapy. Your child may complain of a sore mouth and throat and there may be drooling of saliva. Although there is little you can do to stop this occurring, you may help prevent secondary infections by assisting your child with mouth care. The nursing staff will show you how. Although mucositis may alter your child’s taste it is important to encourage some eating and drinking to assist with healing. Mucositis usually occurs 4-7 days after chemotherapy ends and resolves within 2-4 weeks. Pain relief will be given if necessary. Codeine is often used first for pain relief but frequently a morphine infusion is required. Mucositis may also cause your child to develop diarrhoea and tummy pain. Very occasionally bleeding can occur from the damaged gut and it is extremely unusual for bleeding from mucositis to cause severe complications.
  • Subfertility/Infertility. There is a significant risk of damage to your child’s reproductive system from the high doses of chemotherapy necessary for bone marrow transplantation. Your child may not be able to produce sperm, or eggs, but there is no reason why he/she cannot undertake normal relationships in other respects.
  • Nausea and vomiting. This can occur prior to chemotherapy through anticipation, during chemotherapy or after chemotherapy. Distraction techniques are often useful in this situation and using music / computer games / television can sometimes reduce the potential for vomiting. Medications will be given to try to prevent this occurring and how well they are working will be monitored. The medications will be changed if they don’t work. If your child has had chemotherapy before it would be useful to know which medications helped last time.
  • Veno-occlusive disease (VOD). This is a potential complication that affects your child’s liver. This may occur from seven days prior to the bone marrow transplant up until 35 days following it. Rarely it may occur later than this. Veno-occlusive disease can vary from mild to severe. If your child develops VOD they will get a large tummy, which is painful to touch. Pain relief will be given as required. The large tummy may affect your child’s breathing and they may need some assistance in the form of oxygen or sometimes a breathing machine (ventilator). Your child’s skin and eyes may look yellow (jaundiced). Your child’s body may retain fluid so they may only be allowed small measured amounts, which the nursing staff will explain. Your child may bruise easily and will be at risk of bleeding. They will need frequent platelet transfusions and will more than likely require medications to break down the blood clots that can block the veins in the liver. The possible complications related to this condition are bleeding, which may be severe in some cases, and liver failure, which very rarely requires a liver transplant. It is uncommon for VOD to be fatal.

Specific side effects from chemotherapy medicationShow [+]Hide [-]

Busulphan

 

Occasionally convulsions occur due to busulphan, your child will be given a medication called clonazepam for four days during the time the busulphan is given to reduce this risk. Clonazepam may make your child sleepy and the dose may be reduced. Busulphan can increase the risk of your child developing a potentially serious liver disorder called venoocclusive disease, which is mentioned in more detail in the accompanying leaflet. There is an increased risk of lung damage associated with busulphan and a possibility of developing inflammation of the lungs (pneumonitis). Your child’s skin may become darker in some places (e.g. in areas such as skin creases) or could become patchy in appearance, due to an increase in skin pigment. However, this is usually only temporary.

The busulphan is given to your child either by mouth or naso-gastric tube into the stomach and it will be given at 8.00 am and 8.00 pm for four days. It is important to inform the nursing staff if your child vomits within the hour following their dose of busulphan and you should not attempt to clean up, nursing staff will do this using protective measures. Blood levels of the busulphan will be taken every half an hour on the first day of treatment; these will be taken from your child’s central line and shouldn’t cause any distress.

Fludarabine

 

Malaise, fatigue and chills are sometimes experienced with fludarabine. Nausea and vomiting can also occur, but is less common. We aim to prevent or minimise this with appropriate antisickness medication, which will be given before the fludarabine and continued after. Your child’s liver function may also be affected. Fludarabine will be given into your child’s central line over 30 minutes.

Cyclophosphamide

 

Nausea and vomiting can occur due to the high doses of cyclophosphamide that are given for bone marrow transplant conditioning. We aim to prevent or minimise this with appropriate anti-sickness medication, which will be given before the cyclophosphamide begins and will continue after. Cyclophosphamide can cause damage to the bladder lining (haemorrhagic cystitis) and to help prevent this, extra fluid is given for three hours prior to its administration, during administration and for the 24 hours following. A medication called Mesna is given continuously during the treatment and for the 24 hours following the treatment. This medication can help prevent damage to the bladder. Your child's urine will be monitored for the presence of blood and any symptoms of cystitis should be reported to the nurse looking after your child, e.g. pain/stinging sensation when passing urine, or any cloudiness of their urine. During the time the cyclophosphamide is given, your child may experience nasal stuffiness/sneezing, a metallic taste in the mouth and may occasionally suffer from watery eyes. The cyclophosphamide is given into your child’s central line over one hour on each day that it is prescribed.

Melphalan

 

Kidney damage rarely occurs with melphalan and extra fluids are given in the three hours before the melphalan and for 24 hours after the dose, to reduce this risk. Nausea and vomiting is severe and immediate with melphalan. We aim to prevent or minimise this with appropriate anti-sickness medication, which will be given before the melphalan is given and will continue after. There is a risk of lung damage associated with melphalan and a possibility of developing inflammation of the lungs (pneumonitis). Rare complications include veno-occlusive disease, which is mentioned in more detail above. Melphalan will be given into your child’s central line over three minutes.

Methotrexate

 

Methotrexate is used in the prevention of Graft versus host disease. Side effects can include skin rashes, mild nausea and vomiting and mucositis. If your child is suffering from severe mucositis a dose of methotrexate may not be given. Occasionally, methotrexate can cause liver, lung or renal problems, although it is unusual for these to be a major problem. Methotrexate will be given into your child’s central line over three minutes.

More informationShow [+]Hide [-]

For more information, please contact Ward 3 New Victoria Wing (GNCH).

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