The process in which the stem cells establish themselves in your child's bone marrow and begin to make new blood cells is called engraftment. It usually happens during the first two to four weeks after transplant. As early as a week after the BMT, your child's white blood cell counts will be checked. The presence of white blood cells is one of the earliest signs of stem cell growth. A bone marrow biopsy may be done to check for engraftment in the third or fourth week after the transplant. Your child's white blood cell counts will vary a great deal as the new graft of stem cells establishes itself. Recovery of platelets and red cells is often a bit slower, so your child will continue to receive transfusions until they can make enough of these cells on their own.
A rare but serious complication of BMT is graft failure. This happens when the new stem cells don't grow or your child's own immune system rejects the cells. Your child's old cells may grow back instead. Graft failure is more common after allogeneic BMT than autologous BMT. Unrelated donor or cord blood grafts may lead to graft failure more often than related donor BMT. Rarely, after autologous transplantation, the patient's own cells may fail to recover completely. Some patients may need transfusions of red cells or platelets for a few weeks or months. If no cells grow, it is a life-threatening condition, because your child's body is not producing any blood cells to fight infection. Sometimes more stem cells can be obtained from the donor. The medical team will talk with you about options. Learn More.