Late Effects after a Bone Marrow Transplant in Children

Children may experience late effects many years after a bone marrow transplant, even as adults. Learn how to detect and manage these problems.

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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

Many children who undergo a transplant achieve a normal height, but it may be at the low end of the normal range. Others experience slow or stunted growth.

The problem occurs most often in children who received total body irradiation (TBI). A thyroid hormone deficiency can also affect your child’s growth, and usually does not show up until two or more years after transplant.

If your child was age 10 or less at the time of transplant, growth hormone replacement therapy may help spur growth.

Puberty and Fertility after a Bone Marrow Transplant

Most girls who are transplanted during or after puberty will be infertile. Boys who are transplanted before puberty typically maintain normal testosterone levels but most will be infertile.

Oocyte and embryo cryopreservation are available for females who have initiated puberty before transplant, and who wish to preserve their family building options after transplant.

For male patients, sperm preservation is the standard of care.

Click here to learn more about preserving fertility after transplant.

Heart Health after Transplant

Most children who had a transplant are at risk of developing heart problems earlier than the general population. An echocardiogram every one-to-five years is recommended to monitor children for heart problems.

Dental Problems after Transplant

Children transplanted before the age of five may experience significant dental problems, such as loose teeth, tooth loss and dry mouth, and may be unable to wear braces.

Ideally, they should be followed by a dentist who is experienced in treating children who’ve been exposed to high-dose chemotherapy or total body irradiation.

Learning and Organizational Challenges

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.

Learning problems are more common among children transplanted at an early age and those who had total body irradiation. Problems may include:

  • difficulty remembering things
  • poor eye-hand coordination
  • attention deficit disorder
  • organizational problems
  • problems focusing, concentrating and setting priorities

A pediatric neuropsychologist can test your child to 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.

Testing should be done one year after transplant and then when the child enters first grade, middle school and high school.

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 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. 

Watch a video about long-term complications following a pediatric transplant.

(To view this page in Spanish click here)

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Updated June 2024