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 [log in to unmask]