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Alternative donor sources in pediatric bone marrow transplantation
1Bone Marrow Transplant Service, Egleston Children's Hospital, Emory University, Atlanta, GA 30322, USA.
Summary
Many children needing bone marrow transplants lack sibling donors. Alternative donors increase risks like graft failure and graft-versus-host disease (GVHD), posing challenges for care.
Area of Science:
- Pediatric Hematology
- Transplant Immunology
- Oncology Nursing
Background:
- Leukemia and other diseases necessitate bone marrow transplants in 2,800 children annually.
- A significant percentage (30-60%) of pediatric leukemia patients relapse, requiring transplants.
- Only 30% of children have a matched sibling donor, necessitating alternative sources.
Purpose of the Study:
- To review risks associated with alternative donor sources for pediatric bone marrow transplants.
- To highlight challenges in managing complications for patients and healthcare providers.
- To inform nursing strategies for novel transplant therapies.
Main Methods:
- Review of current literature on alternative donor sources in pediatric stem cell transplantation.
- Analysis of risks including graft failure and graft-versus-host disease (GVHD).
- Identification of nursing challenges in patient guidance and complication management.
Main Results:
- Alternative donors (unrelated, mismatched related, cord blood) increase risks compared to matched siblings.
- Graft failure rates range from 5-10% for unrelated/mismatched donors and 8% for cord blood.
- Graft-versus-host disease (GVHD) risk approaches 80% with unrelated/mismatched donors, potentially less severe with cord blood.
Conclusions:
- Alternative donor transplants carry significant risks of graft failure, GVHD, and infections.
- Nursing care must address patient/family education and management of transplant complications.
- Graft failure and GVHD remain primary concerns in alternative donor stem cell transplantation.