Pediatric Bone Marrow/Stem Cell Transplant and Cell Therapy

Dr. Eneida Nemecek smiles at a young patient in front of a colorful mural at Doernbecher Children’s Hospital.
Dr. Eneida Nemecek leads Doernbecher’s bone marrow/stem cell transplant program. “It’s a great advantage being in a setting like this, where all experts share their ideas and resources,” she says.

At OHSU Doernbecher, you’ll find exceptional expertise in bone marrow/stem cell transplant and cell therapies and a team that treats your child with compassion at every step. We are the only program in Oregon to offer transplant and cell therapies for children.

We offer:

  • Doctors who are international experts with deep experience in transplant and cell therapies.
  • A state-of-the-art transplant facility with HEPA filtration to block germs and lower infection risk.
  • Survival rates among the best in the nation.
  • A caring staff and an environment built just for children.
  • Housing support for patients and families who live outside the Portland area.
  • Doctors and scientists who work in partnership with the OHSU Knight Cancer Institute to devise new therapies.
  • Access to national clinical trials to test promising new treatments.

Learn more about:

Advanced care

Our team includes doctors, advanced practice providers, nurses, dietitians, social workers and other specialists working together to care for your child and family.

  • We’ve done thousands of bone marrow/stem cell transplants and cell therapy procedures.
  • Our transplant program earned an “excellent” rating from U.S. News & World Report. Doernbecher is nationally ranked as one of the top children’s hospitals for cancer care.
  • We offer the most advanced transplant and cell therapies available. Our team was one of the first in the U.S. to offer chimeric antigen receptor T (CAR T) cell therapies, a breakthrough treatment for a type of leukemia.
  • We are committed to the highest quality of care.  We are part of the National Marrow Donor Program network and are accredited by the Foundation for the Accreditation of Cellular Therapy.

Conditions we treat

We treat many types of cancer and noncancerous conditions with transplants or cell therapies.

Cancers we treat:

  • Leukemia
  • Lymphoma
  • Myelodysplastic syndromes
  • Neuroblastoma
  • Brain tumors
  • Other solid tumors

Noncancerous blood disorders we treat:

  • Sickle cell disease and other hemoglobin diseases
  • Immunodeficiencies
  • Fanconi anemia and other bone marrow failure syndromes
  • Inborn errors of metabolism

Understanding bone marrow/stem cell transplants

Bone marrow is the soft, spongy material inside bones that contains stem cells. Stem cells produce blood cells for our bodies.

Stem cells grow and mature into:

  • White blood cells that fight infection.
  • Red blood cells that carry oxygen throughout the body.
  • Platelets that help the blood clot.
This diagram of a bone shows what it looks like inside, and images of the types of blood cells that stem cells can become.
Bone marrow makes stem cells that can become red blood cells, white blood cells and platelets.

A bone marrow transplant replaces unhealthy stem cells with new healthy stem cells to treat cancer or noncancerous blood disorders. The healthy new cells may come from different sources:

  • Bone marrow transplant: The healthy stems cells come directly from the bone marrow of a donor.
  • Peripheral blood stem cell transplant: Stem cells move from the bone marrow into the bloodstream and are collected from blood.
  • Umbilical cord blood transplant: Stem cells are collected from the umbilical cord blood and placenta after babies are born.

One type of transplant uses your child’s own cells. The other uses donated cells from another person. Each type has risks and benefits.

Autologous transplant uses your child’s own stem cells. This eliminates the risk of your child’s body rejecting the cells or of cells attacking the body.

In this type of transplant, stem cells in your child's blood are removed and frozen. After intensive chemotherapy that kills most of your child’s normal bone marrow cells, the stored stem cells are returned to your child's bloodstream in an IV drip.

The transplanted stem cells grow into normal bone marrow cells.

Allogeneic transplant uses stem cells from a donor. We choose the best donor available, based on a close genetic match with your child. Donor cells may also come from cord blood.

Donor cells are very good at killing diseased cells. But they may also target your child’s healthy cells, or your child’s body may reject donor cells.

Bone marrow/stem cell transplant treatment

If tests show a transplant can help your child, we’ll begin the transplant process. The transplant is like a blood transfusion. However, treatments that happen before the transplant, like chemotherapy, can be difficult. Our doctors, nurses, social workers and other experts work together to support your child and family.

Your child will be in the hospital for about a month. We will closely monitor your child to watch for infections and other issues.

We will talk with you about your child’s medical history and whether they would benefit from a transplant.

The first meeting will include your child's transplant doctor, a nurse coordinator to help your family through the process and a social worker to support your family. We’ll also start the process of insurance authorization.

Evaluation: After the first meeting, your child will have tests to help us better understand if a transplant is the best option.

If we plan to use your child’s own stem cells, we’ll collect them from your child’s blood. We will freeze the cells and store them until it is time for the transplant.

If we are using donor cells, we will find the best available matching donor. Donors usually donate their stem cells close to when they will be given to your child.

Stem cells from cord blood are already frozen and stored. We will have them shipped to use right before the transplant.

Once a transplant type and donor are chosen, we will admit your child to the hospital. Over the next few weeks, they will get chemotherapy, radiation therapy or both, depending on their condition.

This treatment helps your child’s body prepare for a transplant. It destroys cancer cells and prepares their immune system to receive the new stem cells.

The new stem cells are placed in your child’s bloodstream through a central venous catheter (a thin, flexible tube we place in a large vein on the neck, chest or arm). After a few weeks, they start to produce new blood cells.

Transplants can be physically and emotionally challenging. Our whole team is here to support your child and family.

Your child will usually stay in our transplant unit for about a month before, during and after the transplant.

Our unit is designed with children’s safety and comfort in mind. It has HEPA filtration to reduce germs and the risk of infection.

Once your child leaves the hospital, we will see them regularly for several months. We will monitor their recovery and look for any signs of problems with the transplant.

It is very important to stay nearby in the first few months after your child’s transplant. If you live more than one hour outside the Portland area, you and your child will need to stay close to the hospital. Our team can help you find a place to stay, such as OHSU’s Rood Family Pavillion.

Understanding cell therapies

Cell therapies can boost your child’s own immune system to help it recognize and kill cancer cells. OHSU Doernbecher Children’s Hospital is a leader in offering cell therapies for treatment of children and young adults.

There are many types of cell therapies. One we offer for children is CAR T-cell therapy. This treatment harnesses the immune system to kill cancer cells. Gene therapy can replace a missing or defective gene in the blood or immune system.

These specialized treatments are available only at top medical centers with the expertise to do them. We are the only pediatric center in Oregon offering cell therapies.

Your child’s T cells — a type of white blood cell — are collected from their body and genetically modified to:

  • Recognize a specific type of cancer cell to destroy it, or
  • Carry a new gene to replace a missing or defective gene. 

The T cells are then put back into your child’s bloodstream through a central venous catheter.

At your child’s first appointment, we’ll talk with you about whether CAR T-cell therapy might be the best option for your child. The process includes:

  • T-cell collection (leukapheresis) through an IV, which takes three to six hours.
  • Modifying the cells at a lab, which takes three to four weeks.
  • Chemotherapy to prepare your child’s body to accept the cells back. This takes about four days.
  • Return of the modified T-cells. This IV infusion takes 30 minutes.
  • Monitoring closely for side effects. Your child will need to stay near Doernbecher for at least four weeks so we can monitor and treat any side effects quickly.

For families

Call 503-346-0640 to:

  • Request an appointment.
  • Seek a second opinion.
  • Ask questions.

Find resources and support.

Locations

Parking is free for patients and their visitors.

Doernbecher Children’s Hospital
700 S.W. Campus Drive
Portland, OR 97239
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Powerful cell therapies

A photo of a young boy outside on a sunny day smiling.

When conventional cancer treatment stalled for Macario Martinez, Doernbecher offered him CAR-T cell therapy. Soon, his leukemia was in remission.