High-dose chemotherapy and stem cell rescue for neuroblastoma
High-dose chemotherapy and stem cell rescue is sometimes used to treat neuroblastoma. It uses particularly strong doses of chemotherapy to kill remaining neuroblastoma cells. To allow the bone marrow to recover from this chemotherapy, stem cells will be given back afterwards. These stem cells will be collected from your child's blood during initial chemotherapy and stored for later use. This is sometimes called a stem cell transplant. A stem cell transplant is risky and complex, and the procedure must be done in a specialized transplant centre or hospital.
Your child may be offered a stem cell transplant to treat neuroblastoma if it:
- is high risk
- has spread to other parts of the body
- has come back (recurred) after treatment
- busulfan and melphalan
- carboplatin, etoposide and melphalan
- cyclophosphamide and thiotepa
Your child may receive 1 or 2 rounds of high-dose chemotherapy and stem cell rescue depending on the individual circumstances.
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Side effects can happen any time during, immediately after or a few days or weeks after a stem cell transplant. Everyone's experience is different. Sometimes late side effects develop months or years later. Most side effects go away on their own or can be treated, but some may last a long time or become permanent.
Side effects of a stem cell transplant will depend mainly on the type of chemotherapy drug or drug combination given, if radiation therapy was given, the type of transplant and your child's overall health. Common side effects of a stem cell transplant include:
- low blood cell counts, which can cause infection, bleeding and anemia
- veno-occlusive disease (VOD)
- digestive system problems, including sore mouth and throat, loss of appetite and diarrhea
- skin problems
- organ problems, such as kidney, lung or heart problems
- fertility problems
- graft failure or graft rejection
- second cancers
Tell the healthcare team if your child has side effects you think might be from a stem cell transplant. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.
American Cancer Society. Neuroblastoma. Atlanta, GA: 2014: http://www.cancer.org/acs/groups/cid/documents/webcontent/003125-pdf.pdf.
American Society of Clinical Oncology. Neuroblastoma. 2014.
Bartholomew, J . Neuroblastoma. Baggott C, Fochtman D, Foley GV & Patterson Kelly, K (eds.). Nursing Care of Children and Adolescents with Cancer and Blood Disorders. 4th ed. APHON; 2011: 30: pp. 1038-1053.
Brodeur GM, Hogarty MC, et al . Neuroblastoma. Pizzo, P. A. & Poplack, D. G. (Eds.). Principles and Practice of Pediatric Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2011: 30:886-922.
National Cancer Institute. Neuroblastoma Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.