Late Effects after a Bone Marrow Transplant in Children

Pediatric transplant survivors are at risk of developing the same long-term side effects as adults. But unlike adults, children's bodies are still developing and they may face additional challenges.

Growth Problems after Transplant

Eighty percent of children who undergo a transplant achieve a normal height, but they may be at the low end of the normal range.

Some children experience slow or stunted growth after transplant. The problem occurs most often in children who received total body irradiation (TBI).

If your child was age 10 or less at the time of transplant, growth hormone replacement therapy may help spur growth.
Growth hormone therapy does not typically improve height in children who were older than 10 at the time of transplant.

A thyroid hormone deficiency can also affect your child's growth. Thyroid hormone deficiencies usually do not show up until two or more years after transplant. Your child should be tested regularly to ensure that this is not an issue.

Puberty and Fertility after a Bone Marrow Transplant

Boys who are transplanted before they reach puberty are often sterile after transplant. Risk factors include:

total body irradiation, as part of the conditioning regimen before transplant
certain chemotherapy drugs received prior to transplant such as cyclophosphamide and platinum-based drugs

Boys who receive a bone marrow transplant after they have gone through puberty may retain their fertility or recover it several years later. A semen analysis can determine whether or not a male is infertile.

Girls transplanted before puberty are more likely to retain fertility than those transplanted after puberty. If there is evidence of fertility after transplant, it's important to make family planning decisions earlier, rather than later, because the fertility may be lost over time.

Infants born to women who had a bone marrow transplant as a child, are as healthy as those born to women who did not undergo a transplant.

Learn about treatments before transplant that may enable a young girl, who is infertile after transplant, to become pregnant later in life. [1]

Heart Health after Transplant

Some chemotherapy drugs used prior to transplant can damage heart muscle cells. Total body irradiation can also increase the risk of heart problems later on.

Although there may be no symptoms of a heart problem for several years, your child should have an echocardiogram every two to five years to monitor for heart problems.

Dental Problems after Transplant

The high dose chemotherapy and/or total body irradiation your child received prior to transplant can damage developing teeth. A tooth may not come in when it should. Teeth may have poor enamel or root formation, leading to tooth loss.

An annual dental exam is important to catch and treat dental problems related to transplant.

Learning Issues after Transplant

Many children who had a bone marrow transplant excel in school with no problems. However, some children experience learning difficulties after transplant and will need special accommodations in school.

Children who undergo total body irradiation are at greatest risk of developing learning problems, but chemotherapy can affect learning skills as well.

Learning problems are more common among children transplanted at an early age. They may include:

difficulty remembering things
poor eye-hand coordination
problem solving difficulties
attention deficit disorder

Neuropsychological tests can help determine if a learning disability exists and the type of school accommodation a child needs. Similar tests help teens and young adults identify types of work that match their learning and performance skills.

By law, schools are required to develop special education plans for children with learning disabilities. Your child's transplant center can help you discuss these issues with your child's teachers and create an education work plan appropriate for your child.

Watch a video about learning and attention problems that sometimes arise in children after transplant.

Long-Term Follow Up Guidelines

The Children's Oncology Group has created long-term follow-up guidelines [2] for survivors of childhood, adolescent and young adult cancers.

The guidelines are appropriate for children who had a diagnosis other than cancer who underwent a transplant as well.

Transitioning to Adult Care

As children become older and more independent, they should begin taking an active role in their healthcare. Young adults often do not realize the importance of knowing their full medical history and how it might impact their long-term health. In fact, if they received their transplant as a young child, they may not remember the transplant at all.

Encourage your child to take the initiative in contacting and working with healthcare providers. Teach them to

schedule and keep appointments
take the lead in contacting the healthcare team promptly if health issues arise

You can begin the transition gradually when the child is a teen, so that he or she is comfortable managing healthcare needs long-term.

Be sure your child has access to an individualized survivorship care plan that he or she can share with all future healthcare providers.