To help prepare your child for their blood and marrow transplant (BMT), doctors will start your child on high-dose chemotherapy as soon as possible.
Sometimes standard dosages of chemotherapy and radiation therapy are not enough to cure a child’s disease. Higher doses of chemotherapeutic medicines may be more likely to cure the disease. Destroying all the diseased and healthy stem cells also makes room for the transplanted cells.
However, such high doses also destroy your child’s healthy blood stem cells. This makes your child very susceptible to infection. Because your child receives intensive chemotherapy, they are hospitalized during the entire conditioning phase. This way, the health care team can provide optimal care and support for your child.
How is chemotherapy given?
There are several different ways to give chemotherapy. This depends on the type of illness your child has, and on the medicine your child is taking.
The doctor gives your child chemotherapy drugs according to a schedule or timetable for each cycle or phase. You may hear your doctor refer to this as the “protocol.” The protocols are specific to your child’s condition and type of transplant (allogenic versus autologous).
Routes of administration
Your child is given chemotherapy intravenously (IV). The drugs are delivered through a needle directly into the central line. This is the most common way to give chemotherapy.
Medicines your child takes during chemotherapy
The specific protocol will vary depending on what type of illness your child has, and the type of BMT they receive.
Your child’s conditioning chemotherapy regimen may include the following medicines:
- busulfan, IV
- cyclophosphamide, IV
- etoposide, IV
For more information, please see Medicines and Side Effects.
Short-term side effects of chemotherapy
Some medicines have unwanted effects on the body. These are called side effects. The side effects from chemotherapy drugs depend on the type of drugs, the dose of drug and your child’s reaction. Some children may not have any side effects.
Bleeding and infection
Chemotherapy medicines can also make it difficult for the bone marrow to produce normal blood cells. If this happens, your child becomes prone to infections, bleeding, and developing anemia. Children who receive a more intense treatment are at a greater risk of developing these side effects. To protect against these possible risks, your child’s treatment team will provide the necessary supportive care, such as:
- antibiotics
- antifungal drugs
- red blood cell and platelet transfusions
Fever
Treatment commonly causes fever in children. Sometimes, this fever is associated with a decrease in white blood cells which causes a condition called neutropenia, in which the immune system is weakened. This makes a child prone to bacterial infection.
Other side effects during chemotherapy
While on chemotherapy, your child may experience:
- nausea or vomiting. Medications like ondansetron, ganisetron, dimenhydrinate (Gravol®), or lorazepam (Ativan®) can usually help.
- fatigue
- headaches
- loss of appetite
- sore mouth or throat (mucositis)
- diarrhea or constipation
- taste changes
- pain and damage to the ends of nerves in hands, feet, or jaw (neuropathy)
- seizures, rarely
- blood clots (thrombosis), rarely
Monitoring while your child is on chemotherapy
While your child is being treated, nurses will draw blood frequently. The physician will also examine your child every day.
Using antibiotics after finishing chemotherapy
Chemotherapy weakens your child’s immune system, making them prone to infection. When this happens, your child may develop pneumonia, called pneumocystis carinii pneumonia (PCP). It is caused by the fungal organism Pneumocystis jiroveci. This fungus is normally present on our lungs, but it does not cause any disease in healthy people because their immune systems are functioning well.
To prevent your child from becoming infected, the doctor gives them an antibiotic called co-trimoxazole (Septra®). It is usually given by mouth in a tablet or liquid form, once or twice a day, three days a week throughout treatment. Your child continues to take the medicine for three or six months after they finish treatment.
Septra is currently the best way to protect against PCP. However, some children cannot tolerate Septra very well. If your child experiences side effects or allergies to the medicine, they can take one of the following:
- dapsone, which is taken by mouth
- pentamidine, which is either inhaled or given by IV