In some children, leukemia cannot be cured with conventional doses of chemotherapy, radiation, or targeted therapy. SCT allows the delivery of high-dose therapy to kill the cancer cells, followed by an infusion of donated stem cells to help the bone marrow begin to make healthy red blood cells, white blood cells, and platelets again. The donor’s stem cells also play an important role in killing any leukemia cells not destroyed by the chemotherapy/radiation, a phenomenon known as the graft vs. leukemia (GVL) effect.

The use of SCT has declined as conventional chemotherapy and use of targeted drugs has improved cure rates of children and teens with leukemia. As a result, SCTs are currently recommended for some children who have:

• Juvenile myelomonocytic leukemia
• Early relapse of an acute leukemia
• A slow response to therapy
• Unfavorable cancer cell characteristics (cytogenetics)

Guidelines about which children need transplants change over time as new information becomes available, and practices vary among institutions.

They said he would start chemo the next day, but that plan came to a grinding halt when they found out it was T-cell ALL with some AML characteristics. His blood work and test results were sent off to a bigger children’s hospital for more tests. We signed up for a COG clinical trial for T-cell ALL. William was inpatient for all of induction and nothing seemed to go smoothly for him and there were many issues. I was so emotionally stressed that I literally felt like I might die. I asked loads of questions because I needed to understand what we were facing. Induction is all a blur. On day 29, his MRD [minimal residual disease] was 0.14 (supposed to be <0.01). After consolidation and three extra intensification blocks, he was still MRD positive. So, after seven months of being mostly inpatient for intensive chemotherapy treatment, he came off the trial and we were told he needed a transplant.

If an SCT has been recommended for your child or teenager, you may want to get a second opinion before proceeding. You also may want to ask the oncologist and transplant physician some or all of the following questions:

• What are all the treatment options for my child’s type of leukemia?
• For my child’s type of leukemia, history, and physical condition, what is the chance for survival with a transplant? What are my child’s chances with other treatments?
• What are the risks and the benefits of this type of transplant?
• What will be my child’s likely short-term and long-term quality of life after the transplant?
• Where would my child receive this type of transplant?
• What portion of the procedure will be outpatient versus inpatient?
• What is the average length of stay in the hospital for children undergoing this procedure?
• What are the anticipated and the rare complications of this type of transplant?
• Will my child have to take medicines after the transplant? For how long?
• What are the side effects of these medicines?
• Is this transplant considered to be experimental, or is it the current standard of care?
• Do insurance companies usually pay for this type of transplant?

My daughter was 6 years old when she was diagnosed with AML. When she relapsed four months into treatment, a transplant was her only hope.

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After my son’s second relapse from ALL, the doctors told us that a transplant was his last option for a cure.