20.4.7 Hematopoietic Stem Cell Transplantation

20.4.7.1 Problems

•High-risk therapy, sometimes the “last chance”

•Life-threatening complications (toxicity of therapy itself, infections, graft- versus-host disease)

•Isolation, separation from the family

•Identification of a donor among family members

•Waiting to find a donor

•Differential meanings for donor and non-donor siblings, influence on mutual relationships

•Long-term risks (relapse, chronic graft-versus-host disease, immunosuppression)

20.4.7.2 Requirements

•Dealing with the risks and delayed effects

•Enduring a long stay in hospital, in isolation

•Organization of the family (often “two homes”)

•Dealing with what is “self” and “other”

20.4.7.3 Reactions

•Acute disturbances, often marked by severe regression

•Disorders of body image

•Mediumor long-term difficulties in taking food and medication

•Parental exhaustion if the stay in hospital is long and they have to be present throughout

•Strong sense of responsibility among donor siblings; guilt if the result is poor

•Feelings of neglect on the part of the non-donor siblings

20.4.7.4 Interventions

•Involvement of the entire family in the preparations

•Organizational measures (childcare, presence of parents at the hospital or at work, etc.)

•Continuous support during isolation

•Discussion of the influence of transplant on the donor and non-donor siblings and on intrafamilial relationships

•Supportive measures (relaxation techniques, art and music therapy)

20.4.8 End of Therapy

20.4.8.1 Problems

•Therapy has caused loss of security

•Fear of recurrence

•Unrealistically high expectations of the return to normal life