Stem cell transplant -- also called bone marrow or cord blood transplant -- involves three phases: conditioning (preparing the body for the transplant), transplantation, and recovery. To keep your child as healthy as possible and to help manage any side effects from conditioning, your child will stay in the pediatric transplant and cellular therapy inpatient unit during this time. 

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Central Line Placement

A central line -- a special IV catheter -- can be used to give chemotherapy, medications, blood products, and nutritional fluids and to infuse stem cells. Your child will have a central line inserted by a surgeon in the hospital before chemotherapy or radiation begins. It will stay in place throughout the transplant and for many weeks or even months afterward. A central line can also greatly reduce the need for needle sticks to draw blood. 

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Conditioning -- also known as cyto-reduction or preparative regimen -- will prepare your child's body for stem cell transplant. It usually begins the day after their central line is placed and lasts seven to 12 days. Conditioning may involve chemotherapy and sometimes radiation, depending on the underlying disease. Most of the time, conditioning is done on the inpatient unit, but in some cases, the first few days of treatment are given on an outpatient basis. The purpose of conditioning is to:

  • Destroy unhealthy cells such as cancer cells 
  • Make room in the bone marrow for new cells to grow
  • Suppress the immune system to reduce the risk for rejection of the transplanted cells


Your child may receive one or more chemotherapy drugs through their central line. The number and type depend upon your child's disease and their size. Our doctors and nurse coordinators will provide you with a detailed treatment plan and educational materials and will conduct multiple training sessions to teach you about all of your child’s medications and their side effects.

Radiation Treatment

Many patients with leukemia receive total body irradiation (TBI) in addition to chemotherapy. TBI is a painless procedure that uses high-energy radiation over the entire body to:

  • Destroy any cancer cells in the body that were not eliminated with chemotherapy
  • Suppress the immune system so that it will not reject the new cells

Each TBI treatment takes a few minutes and is typically given twice a day for several days in a row. 

Side Effects

During conditioning, your child will experience a number of expected side effects. Our goal is to keep your child as comfortable as possible throughout the process. We provide treatments for nausea, headaches, pain, and any other issue. In the hospital, they will have frequent lab tests to monitor for side effects. 

Duke Children's Hospital and Health Center

Learn about the child- and family-centered care offered at Duke Children's Hospital and Health Center.

Stem Cell Transplant

The stem cell transplant can take place one to three days after the completion of conditioning. Whether the source of stem cells is bone marrow, peripheral blood, or cord blood, the transplant process is similar. Infusion of stem cells is a painless procedure that takes place in your child's room. The stem cells are given through your child's central line.

Within minutes of the infusion, the stem cells migrate to the bone marrow. Once settled, they begin to grow normal bone marrow. This process -- called engraftment -- takes two to six weeks. You will know the bone marrow is growing again when your child’s white blood cell count steadily rises after being low for several days to weeks after transplant. 

After your child’s stem cell infusion, they will remain in the hospital while they recover. We closely monitor for infections, signs of graft versus host disease (GvHD), low blood counts, and other side effects of conditioning and transplant. We strive to keep your child safe and comfortable so they can focus on life after stem cell transplant.

Clinical Trials at Duke

We are exploring the use of umbilical cord blood and umbilical cord tissue for treating children with acquired and genetic brain injuries and disorders such as autism and cerebral palsy. 

Recovery in the Hospital


Your child will take many medications while they are in the hospital. These may include immunosuppressive medications to reduce the likelihood of rejection and GvHD, drugs to prevent and fight infections, pain medications, and others. Our transplant team will watch your child closely for side effects and drug interactions and will help you and your child manage these medications. Our dietician will monitor your child’s nutritional needs.


Until the transplanted stem cells have a chance to recover and begin making blood cells, your child may need regular transfusions of red blood cells and platelets. They may also take a growth factor drug to help their white blood cells grow more quickly.

Blood Tests

Blood samples will be taken often to measure the amount of white blood cells, red blood cells, and platelets circulating in your child’s blood. The results of this complete blood count help determine if your child needs a transfusion. They are also used to gauge progress after transplant.

Outpatient Care

After about four weeks, the transplanted stem cells begin producing new blood cells. By this time, your child should have more energy and will be taking fewer medications. You will meet with the discharge nurse and others to begin planning for life as an outpatient. 

Staying Local

For about 100 to 180 days after transplant, your child will need to stay close to Duke Children's Hospital and Health Center. This ensures easy access to your transplant team should your child get a fever, have trouble with their central line, or experience any other health problems. After discharge, your child will visit the outpatient clinic for frequent checkups. Our lodging coordinator can arrange appropriate housing for you and your family.

Follow-Up Care

At first, you and your child will come to our outpatient clinic every day to assess their response to therapy. Gradually, these visits will become less frequent. When appointments are only required once a week, your team will start to plan for your return home. Follow-up visits will be scheduled at three, six, nine, and 12 months, then yearly. Your Duke transplant doctor will stay in close contact with your home care team and will always be available for advice.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

Long-Term Follow-Up and Survivorship

Many of our patients who received transplants or cellular therapy are now long-term survivors. After treatment, we will follow your child closely even years later. Through our survivorship program, we offer annual medical assessments that incorporate physical exams, blood work, organ function tests, and more. The program also provides:

  • Evaluations for long-term effects associated with previous treatments
  • Mental health screenings 
  • Vaccinations
  • Education about preventative screening tests and ways to stay healthy
  • Personalized summaries of treatments and recommendations for continued monitoring
  • Assistance with college and vocational planning and scholarships
  • Referrals to specialists and additional services as needed

Every year we celebrate our patients and their families at the Rainbow of Heroes Walk. This reunion brings together patients, families, doctors, nurses, therapists, volunteers, and supporters who got to know each other during the transplant journey.

This page was medically reviewed on 05/22/2023 by