What are the biggest challenges children face during recovery, and how can they be managed?

What are the biggest challenges children face during recovery and how can they be managed?

Some of the complications we see before that new bone marrow starts to grow and the blood counts start coming in, and that immune system starts waking up. So when the immune system does wake up, we still have risk for infections because not all parts of the immune system wake up at the same time, and some take a much longer time to recover. But the parts that do wake up can cause problems where that immune system that we've brought in to attack the cancer can attack the body. And this is something that we call graft versus host disease. Graft versus host use has an earlier form that tends to cause nausea, vomiting, diarrhea, rashes or jaundice and has a later form that we have to watch for even months after the transplant that can cause thickening of the skin. Problems with breathing, liver irritation, dry mouth, dry eyes, and a lot of other things. So these are things that we have to actively monitor, which is part of why even when things are going well, we're still coming periodically to see the transplant doctors to look for early and subtle signs of some of these later things. On top of that, know that you'll be coming to the clinic at least a couple times a week, and we're going to have a prolonged period of time. We're not going to be able to be around big crowds or back in school or going to church, because these are places where people go, even when they're sick, and we can't go back to work for children that are working like teenagers and young adults that can't go back to work or college, just yet, because these are areas where they're working close with people, many of whom may be sick, and we really don't want them exposed to viruses that may stress the immune system, may stress the bone marrow, sometimes even to the point of failure, which is something that we always worry about. So they're going to be somewhat isolated. They're going to be relying on family members to go and get things to bring to them if they need them, including sometimes bringing meals and things like that, or bringing groceries so they can prepare things at home. Family members can go out and about, but we do ask them to try to avoid actively sick people and consider wearing a mask like people everybody did during the pandemic, to try to minimize bring anything home to this child while they're still so vulnerable. As we monitor them and we see that their immune system is recovering, we start getting rid of some of these restrictions, loosening some of these restrictions. And really, the last phase of recovery is getting this child back out into everything that they should be doing and letting them be exposed to these things all over again. So it's like when they first went to preschool or daycare and they had the cold all winter long. This is a brand new immune system they have, and it's going to be similar to that again. And that's one of the last phases of recovery, is letting that immune system get back out in the wild, get exposed to things that it's going to be exposed to, and show us that it can fight them off.For all these patients, we also have to give them all their vaccinations over again.And that's also part of that later recovery after transplant.