Q. Are the risks of late effects after a transplant different in children as compared to adults?
Yes. Because a child's body is still developing, the effects of radiation and chemotherapy, whether used directly to treat the disease or as part of the transplant, can cause long-term problems not faced by adult transplant patients. Cells that are growing rapidly are more prone to damage from these treatments. This damage can impair the body's ability to develop normally. Also, patients living a normal life span have a longer period of time to develop other late effects, such as secondary cancers, as compared to patients transplanted later in life.
- For more information on the effects of childhood cancer treatment, see: Childhood Cancer: Late Effects of Cancer Treatment from the American Cancer Society.
- For post-transplant follow-up recommendations, see: General Long-Term Follow-Up Recommnedations for Pediatric Patients from SCCA/FHCRC.
Q. What types of problems in growth and development can children have after a transplant?
Depending on the age of the child, different aspects of growth and development may be affected. Many children require supplemental growth hormone to continue to develop in height. Children who have not reached puberty at the time of treatment may require hormone supplements in order to develop secondary sexual characteristics. Very young children whose permanent teeth have not yet formed may have abnormal or absent secondary teeth. This problem can be treated with dental implants. Pediatric transplant patients also have a higher risk of endocrine problems such as diabetes and thyroid disease.
- For more general information on the late effects of pediatric transplant, see Possible Late Effects of Your Child's Transplant from the National Donor Marrow Program.
- For research on height after pediatric transplant, see Final adult height of patients who received hematopoietic cell transplantation in childhood from Blood, the journal of the American Society of Hemotology.
- For research on endocrine problems after childhood transplant, see the articles Diabetes mellitus in long-term survivors of pediatric hematopoietic cell transplantation and Endocrine dysfunction and parameters of the metabolic syndrome after bone marrow transplantation during childhood and adolescence.
Q. Can a pediatric bone marrow or stem cell transplant cause lung and breathing problems?
Studies have shown that even if a child doesn't have any respiratory symptoms, there may be significant impairment of lung function after a transplant. The risk varies depending on the type of conditioning regimen and other factors. Total body irradiation and certain medications may increase the risk of lung problems. Development of chronic graft-vs.-host disease also increases the risk of lung problems. Pediatric transplant patients over the age of six years should have lung function tested each year as part of their routine follow-up care.
- For research on lung function after a pediatric transplant, see the article Pulmonary function in long-term survivors of pediatric hematopoietic cell transplantation.
Q. Can a transplant cause learning disabilities in a child?
Children who received irradiation to the head before a transplant can develop some learning disabilities after a transplant preparative regimen containing total body irradiation. However, children who have not received any irradiation except for the total body irradiation appear to not have learning disabilities. The risk of permanent problems with memory, concentration and speed of processing information may be greater when very young children have a transplant, because the brain is still developing at that age.
- For more information, read Cognitive and Academic Functioning in Survivors of Pediatric Bone Marrow Transplantation from the Journal of Clinical Oncology.
Q. What can be done to help a child with learning differences after a transplant?
There are many ways to help a child with learning differences after transplant. Having information presented in multiple ways is very helpful. For example, to teach a child to tie a shoelace, you could explain how to do it, let them watch you do it, and then guide their hands while they do it. Also, be sure allow enough time for the child to complete a task rather than setting time limits. If your child is in school, work closely with the teachers to be sure they understand your child's needs.
- For more information, read Changes in Memory or Learning from the article "Possible Late Effects of Your Child's Transplant" from the National Bone Marrow Transplantation Web site.
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