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Dr. Boelens and colleagues will study how the immune system recovers after a bone marrow transplant in children with leukemia. These transplants can cure cancer, but some children relapse or develop a serious complication called chronic graft-versus-host disease, where the donor immune system attacks the child's tissues. Dr. Boelens and team will focus on the thymus, an organ that trains new immune cells but is easily damaged by chemotherapy and radiation. Dr. Boelens and colleagues will measure how well the thymus works and how immune cells grow during the first year after transplant. Dr. Boelens will confirm their findings by working with many hospitals through a large pediatric transplant network. By finding early warning signs of poor recovery, Dr. Boelens and colleagues will help doctors identify children at high risk and guide more personalized care so that more children survive transplant and grow up healthy, with fewer long-term complications.