Once a donor is found, timing of the transplant must be arranged so that the donor cells are ready at the same time as the child has completed conditioning and ready to receive the cells.
When the hematopoietic stem cells are administered to the child, it is done intravenously, though a tube inserted in the central line. Similar to a blood infusion, the stem cell transplant is a minor procedure that can take as short as 30 minutes or as long as a few hours. General anesthesia is not necessary and parents may be present during the procedure.
Whether a child with SCID stays at home for the period of time before the HSCT or stays in the hospital before the HSCT, the child must be in isolation. The reason for the isolation is to reduce exposure to germs as much as possible. To view steps taken in the hospital and/or at home for isolation, go to https://primaryimmune.org/scid-compass/reducing-germs.
The recovery process for a child with SCID after an HSCT will take at least several months, and will vary according to conditioning, the type of donor, any complications, and the individual hospital or transplant center’s criteria for discharge.
After an HSCT, doctors expect engraftment to occur. Engraftment is when the hematopoietic stem cells of the donor are growing in the child with SCID and making healthy blood cells.
The anticipated time for different cell types to recover to a safe level is different for different cells. Until doctors are sure that there is good engraftment, the child will be monitored very closely.
Because monitoring is required, the child will either stay in the hospital or temporarily live near the hospital and remain in isolation, as previously discussed.
Once engraftment occurs, and the frequency of blood draws goes down, the central line may be taken out of the child.
In isolation at home, visitors will remain restricted, and the child will not be allowed outside, or in public places, for several months. Find additional isolation information, such as preparing the home for post-treatment, at https://primaryimmune.org/scid-compass/support-and-resources.