During the first few weeks after your transplant, you will wait for the transplanted stem cells to begin producing healthy blood cells. This is called engraftment.
If you had a transplant using your own cells (autologous transplant) your transplant team may give you drugs called growth factors, such as G-CSF, to speed the recovery of normal blood counts.
- If you were transplanted with bone marrow or peripheral blood stem cells, you can expect engraftment to take two to three weeks.
- If you were transplanted with cord blood, engraftment can take longer - typically three to five weeks
Infection after Transplant
Until the blood stem cells engraft, you will be at risk of developing an infection. This is because the preparative destroyed your white blood cells which are the backbone of your immune system.
If you had a reduced intensity transplant, the risk of developing a serious infection will be less.
Your transplant center will take many precautions to reduce the chance of a serious infection. These may include:
- antibiotics to prevent bacterial infections
- careful hand washing by visitors and hospital staff before touching you
- prohibiting live plants and dried flowers in your room
- eliminating fresh fruits and vegetables from your diet
- prohibiting visitors who are ill or have been exposed to someone with a contagious disease
- special air filtering equipment to remove infectious agents
Despite best efforts, it is possible that you will develop an infection during the first few weeks after transplant. You will be monitored daily for signs of infection and treatment will be started promptly if an infection occurs.
Blood and Platelet Transfusions after Transplant
The chemotherapy or radiation will also destroy the platelets in your blood which help blood clot. You may receive platelet transfusions during this time to prevent excessive bleeding.
You may also need blood transfusions, to replace the red blood cells destroyed by the preparative regimen, until your blood counts recover.
If you were transplanted with cells from a related donor, the transplant team may ask your donor to remain near the hospital to serve as your blood and/or platelet donor should the need arise.
Nausea, Vomiting, and Diarrhea after Transplant
Nausea, vomiting and diarrhea are common after transplant, but can be controlled with medication.
Drugs called antiemetics are used to control nausea. Antiemetics can cause temporary side effects such as anxiety, restlessness or drowsiness. Occasionally, muscle tightness, uncontrolled eye movement or shakiness occur. These reactions can be frightening to observe but are usually less serious than they appear and can be controlled with other medications.
Mouth and Throat Sores after Transplant
Mouth and throat sores are a common side effect of the preparative regimen and can make eating difficult. They are controlled with topical anesthetics or narcotics.
Mouth sores can affect your appetite and make it difficult to get enough calories, protein and fluids in the early weeks after transplant. The dietitian at the transplant center will monitor your caloric intake to ensure you are getting enough nutrients during your recovery period.
If necessary, you may be fed intravenously until you are able to eat on your own again comfortably.
Hair Loss and Skin Rash after Transplant
Temporary hair loss is a common side effect of the preparative regimen. In most cases, hair begins growing back in three to six months.
However, it may be a different thickness, curliness or texture.
Skin rash is also common after preparative regimens that include total body irradiation, busulfan, etoposide, carmustine or thiotepa. Less frequently, dark spots appear on the skin which usually fade in one to two months.
Muscle Spasms and Cramping after Transplant
Muscle spasms are common after transplant, and are usually caused by an imbalance of electrolytes in the body such as potassium, magnesium and calcium. The problem is usually resolved by taking electrolyte supplements.
Bladder Irritation after Transplant
Bladder irritation, evidenced by bloody or painful urination, sometimes occurs. Increasing the rate of intravenous fluids, using a catheter to irrigate the bladder or drug therapy usually resolves the problem.
Liver Problems after Transplant
Temporary liver damage can occur following high-dose chemotherapy or total body irradiation. It is usually mild and completely reversible.
Abnormal liver tests are seen in approximately 50 percent of patients after transplant, but only a small fraction of patients actually develop liver damage. Resting the liver and avoiding medications that are toxic to the liver usually resolve the problem.
Occasionally, patients develop a condition called sinusoidal obstruction syndrome or SOS (previously called veno-occlusive disease (VOD). Sinusoidal obstruction syndrome nterferes with the liver's ability to get rid of waste products in the bloodstream. If SOS occurs, your medical team may change your medications and/or reduce the amount of salt in your diet. A drug called called defibrotide is effective in treating patients who develop SOS.
Lungs and Heart
Breathing irregularities can occur after transplant. These may be caused by infection or damage from chemotherapy or total body irradiation. In most cases the problem is mild and temporary, but some patients do experience long-term breathing issues.
Irregular or rapid heartbeat can occur after transplant, particularly if the preparative regimen included cyclophosphamide or carmustine. These problems are usually temporary.
Confusion or altered thinking is an occasional, temporary side effect of the preparative regimen, or drugs used to control other side effects. Confusion can be frightening for both the patient and for loved ones who observe it. This problem is usually temporary and reversible, and is typically managed by changing the dosage or type of drug that is causing the problem.
During the early recovery period, expect to feel very fatigued. Moderate exercise can help you regain your strength and stamina.
At some transplant centers, patients are encouraged to walk the hallways to build up their strength. Other programs have stationary bikes patients can ride to improve stamina. Even a little bit of daily exercise is helpful for your recovery. Consult with your healthcare team about the appropriate amount of exercise for you.
Acute Graft-versus-Host Disease (GVHD)
Graft-versus-Host Disease is a common complication following a transplant using donor cells. GVHD is not an issue for patients who had a transplant using their own stem cells.
There are two forms of graft-versus-host disease: acute and chronic. Patients who develop acute GVHD usually do so during the first three months after transplant.
Transition to Outpatient Clinic after Transplant
Once your blood counts begin to recover and approach safe levels, you will be weaned off of antibiotics, and blood and platelet transfusions. If there are no major complications, you will be discharged from the hospital and followed for several weeks or months in the outpatient clinic.
During this time, you will need to remain close to the hospital so that any serious complications can be treated quickly.
- If you had an allogeneic transplant (a transplant using donor cells), you will need to remain close to the hospital for at least the first 100 days after transplant.
- If you had an autologous transplant (using your own cells) your follow-up at the outpatient clinic will be shorter.
It's common for a patient to be re-admitted to the hospital for a short period of time during the first year after transplant. Although this can feel like a setback, it is a normal part of the recovery process.
Eventually, the clinic visits will become more infrequent and you will be ready to return home, where your local physician will coordinate your care.
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