Dear Fellow Lactnetters,

On Dec 8, 1995 I posted an inquiry asking for info about the feasibility of a
mother continuing to breastfeed her infant who has a rare form of leukemia
and was scheduled for bone marrow transplant from sister.  Many of you have
responded to my post and I thank you one and all.  There were too many posts
for me to respond individually so I hope each of you will consider this my
personal thank-you!

Dee Keith passed along to me the name of an RN, IBCLC who was a former
oncology nurse and who had worked at a hospital that developed a protocol for
allowing babies and mothers facing this particularly daunting challenge to
continue breastfeeding pre-transplant until the baby's absolute neutrophil
fell below a certain level and after that point in time to receive holder
pasteurized expressed breastmilk both pre-transplant and  post-transplant.  I
spoke with this nurse and she passed along valuable information that  I was
able to pass along to the mother I am counseling.

At the present time, the baby is most likely in the hospital (my attempts at
contact have been unsuccessful so far) and has either had the transplant or
is undergoing immune suppression prior to transplant.  At our last contact on
1/18/96, mother was still pumping and giving some breastmilk by bottle and
doing some breastfeeding and was giving some infant formula by bottle.  She
was scheduled to meet with the baby's oncologist the following week (week of
1/22/96) to discuss the possiblity of being able to express and provide her
baby with holder pasteurized breastmilk.  However, she was not very hopeful
of achieving this goal and she was unsure whether she had the emotional
fortitude to advocate for this.  However, she continues to rent the breast
pump and I view that as a positive sign.

For your information, the reasons for caution in the situation where a
breastfeeding infant is scheduled for bone marrow transplant are:
1.  Breastfeeding is not a sterile process.  Breastmilk contains skin
bacteria and viruses that could compromise an infant during the immune
suppression treatment that must be done prior to transplant.  However, there
are precedents and protocols that have successfully allowed infants to
continue breastfeeding up to a point at which blood tests (absolute
neutrophil count) indicate that the immune system is too compromised to allow
actual breastfeeding to continue.  At this point, pre-transplant the baby can
be allowed to have expressed breastmilk that has been holder pasteurized.

2.  Post-transplant the concern is that the T-cells found in mother's milk
will set up a host vs. graft response in the infant and cause the infant to
reject the bone marrow transplant.  Again protocols have been established to
allow infants to receive holder pastuerized breastmilk after the transplant
since holder pasteurization (30 minutes in a water bath set to 62.5 degrees
C) destroys the T-cells in mother's milk.

Others of you have written and said you are aware of  other hospitals/doctors
that have established slightly different protocols that allow continued
breastmilk-feeding.  I would encourage those of you who wrote to do the same
thing that Kathleen Auerbach has urged me to do (and which I am doing).  That
is: contact those people that you know have established protocols for this
particular situation, mail them a copy of the Instruction to Authors page
from Journal of Human Lactation and invite/urge them to submit a paper for
publication so that this information can get into the literature and benefit
other lactation professionals and mothers and babies.

The reason I urge this approach is so as to avoid inundating my particular
resource with calls/request.  In the meantime, it is my intention to submit a
short FYI article to JHL so that other LCs will know that it is possible to
help mothers and babies continue breastfeeding in this situation.  You should
know that although it is possible, the protocol is somewhat complicated and
requires a great deal of cooperation from the hospital staff and a high
degree of motivation on the mother's part.

However, this particular mother/baby situation that I have been dealing with
turns out, it is gratifying to know that I have been able to provide the
mother with helpful and accurate information.  And, I have other Lactnetters
to thank for that.  THANK YOU, ONE AND ALL!!!

Please note:  For personal reasons, I will be setting Lactnet NO MAIL for the
next week or so.  If you wish to respond to my post, please write to my
e-mail address.  Thanks.

Anna Utter
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