Stem Cell Transplant Journey: A Step-by-Step Timeline

What to Expect

Your child has been diagnosed with a serious condition such as a malignant cancer, an immunodeficiency disease or a blood disease. Some of the most common conditions that may be treated with a stem cell transplant include: 

• Leukemia
• Lymphoma
• Sickle Cell Disease
• Beta-Thalassemia
• Aplastic Anemia
• Severe Combined Immunodeficiency Syndrome (SCID)
• Bone Marrow Failure Syndromes
• Neuroblastoma (autologous transplant)
• Hurler Syndrome

Additional Information

Your child’s diagnosis involves a disorder for which a stem cell transplant may offer a potential cure or help slow the progression of the disease. The decision to proceed with a transplant evaluation is based on several factors, including the specific diagnosis, how far the disease has progressed and your child’s age and overall health. The decision is made collaboratively by the referring provider and the transplant team. 

What to Expect

During the transplant evaluation, you and your child will meet with a primary transplant physician who specializes in your child’s specific diagnosis and stem cell transplantation.

These initial consultations are an opportunity to discuss how a transplant may benefit your child, as well as review potential risks and considerations. 

You will also meet with other key members of the transplant team, including an advanced practice provider (nurse practitioner or physician assistant) who works closely with the physician to coordinate care and ensure all your questions and concerns are addressed.

In addition, you will l have the chance to connect with our social worker, child life specialist and nursing staff who each play an important role in supporting your child and family throughout the transplant journey.

Additional Information

As part of the evaluation, the transplant team will discuss potential donor sources and treatment options. Stem cell transplants can be performed using cells from various sources, including: 

• Matched sibling transplant
• Matched unrelated donor (selected from national registries)
• Umbilical cord blood transplant
• Haploidentical transplant (a half-matched family member)
• Autologous transplant (from the patient’s own stem cells)

The most appropriate donor source will depend on your child’s diagnosis, treatment plan and available matches. 

Day - 100 through Day - 14 (approximately two to three months before transplant)

What to Expect

If you and your care team decide to move forward with a transplant, your child’s transplant team will coordinate any necessary pre-transplant testing, consults and procedures. 

Additional Information

The following tests and procedures are commonly performed during the work-up phase:

• Blood tests
• X-rays and CT scans
• Consultations with other specialists
• Stem cell or bone marrow harvest (if your child is the donor or receiving an autologous transplant) 
  
   

Day - 30 to Day - 0

What to Expect

Your child will be admitted to the hospital approximately one to three weeks prior the day of the stem cell transplant to begin the conditioning regimen. This treatment is carefully selected based on your child’s diagnosis and the type of donor being used. 

The purpose of the conditioning regimen is to:

• Create space in the bone marrow for the new stem cells
• Suppress the immune system to reduce the risk of rejecting the transplant
• Help eliminate any remaining disease

During this admission, a central line will be placed if not already in place. This line is essential for daily blood draws, administering the chemotherapy and medications and for the infusion of the stem cell transplant. 

You may notice that the transplant timeline is marked by a countdown. The days leading up to the transplant are labeled as Day – 30, - 29, etc., with Day 0 representing the actual day of the stem cell infusion. After transplant, the days are counted forward (e.g., Day +1, Day +2) to track recovery milestones.

A dedicated team including physicians, advanced practice providers, nurses, pharmacists, nurse coordinators, dieticians and transplant coordinators will work together to support your child with a personalized care plan throughout this phase. 

Day 0

What to Expect

On Day 0, your child will receive the new stem cells as an intravenous (IV) infusion using their central line. The process is similar to receiving a blood transfusion and is typically painless. Before the infusion, your child will be given pre-medications to help their body accept the cells and reduce the risk of reactions.

The transplant takes place in your child’s hospital room within the bone marrow transplant unit. During the infusion, your child will be closely monitored by the team to ensure their safety and comfort. 

Day 0 to Day +30

What to Expect

After the transplant, the focus shifts to supporting your child while waiting for engraftment, the process where the new stem cells begin to grow and make healthy blood cells in the bone marrow. This typically occurs within the first month after transplant.

The transplant team will monitor your child’s blood counts closely, especially the absolute neutrophil count (ANC), which is a key indicator that engraftment is occurring.

During this time, your child will receive:

• IV medications to prevent and treat infections and manage side effects
• Blood products as needed
• Immunosuppressive medications to help prevent graft- versus-host disease (GVHD), which will continue through at least Day +100

Additional Information

Every child’s experience is unique, but some common side effects during this phase may include:

• Fever
• Mouth sores
• Nausea and vomiting
• Diarrhea
• Fatigue
• Weight gain or loss
• Hair loss

The care team will be there every step of the way to manage symptoms, provide comfort and support your child’s recovery.

 

 

Day +21 to Day +35

What to Expect

Once your child shows signs of engraftment and meets other key recovery milestones, they may be ready to transition from inpatient care to outpatient follow-up. 

In the weeks leading up to discharge, you will meet with the transplant care team to review important education and preparation materials. These meetings are designed to help you feel confident and supported as you continue your child’s care at home.

Additional Information

Most children are considered ready for discharge when they meet the following criteria:

• Engraftment of neutrophils (a sign the new stem cells are working)
• Stable laboratory results
• Adequate nutrition (either eating by mouth or a reliable home plan)
  
• Able to tolerate oral medications
• No fever or signs of active infection

Your care team will continue to monitor your child closely throughout outpatient visits and provide guidance on managing medications, preventing infections and recognizing signs of complications.

Day +35 to Day +365 (one month to 12 months post-transplant) 

What to Expect

After discharge, your child will continue recovery either at home or at the Ronald McDonald House (if your family lives more than one hour from Children’s National). Although no longer in the hospital, your child remains vulnerable to infection and will require close monitoring of labs, medications and overall health.

Your child will be seen in the outpatient clinic one to three times per week by their transplant physician or nurse practitioner. These visits are essential for tracking progress and managing any complications.

For many families, Day +100 is a meaningful milestone, often marking the beginning of a return to normal routines. Around this time—or later for some patients (e.g., Day +180)—the care team may begin reducing immunosuppressive medications, which can lead to less frequent clinic visits.

Additional Information

Clinic visits vary in length depending on your child’s needs. Some may be as short as 30 minutes, while others may last two to four hours. During these appointments, the team will:

• Check blood counts and other labs
• Monitor for signs of infection and graft-versus-host disease (GVHD)
• Discuss how your child and family are coping
• Adjust medications and provide supportive care

While the goal is to keep your child out of the hospital, readmission may be necessary at times for further evaluation or treatment to ensure their safety and well-being.

 

 

One year post-transplant

What to Expect

Around the one-year anniversary of your child’s transplant (Day +365), they will begin annual visits with our Long-term Follow-up Program. This is a multidisciplinary clinic designed to monitor for any late effects of transplant and to support a healthy transition back to everyday life, including care by your child’s primary pediatrician. These visits are an important part of your child’s ongoing recovery and help ensure that any long-term complications are identified and managed early.

Additional Information

During the annual long-term follow-up visit, your child will be seen by specialists from a variety of disciplines, depending on their individual needs. These may include:

• Cardiology
• Endocrinology
• Gynecology
• Urology
• Neurology
• Pulmonology
• Psychiatry and Behavioral Sciences
• Social Work

This comprehensive approach helps us support your child’s physical, emotional and developmental health as they continue to grow and thrive after transplant.