Recovering from a Bone Marrow and Stem Cell Transplant
If you received high-dose chemotherapy, the medication will cause all of your blood counts – white blood cell, red blood cell and platelet – to drop to very low levels.
A low white blood cell count puts you at greater risk for infections. You will receive prophylactic medications to prevent infections. It is essential that you practice good hygiene habits. The most effective measure is to wash your hands frequently, especially after using the bathroom and before you eat. You should also shower daily.
Your low red blood cell count will cause you to be very fatigued and possibly short of breath during activity. This is because you have fewer red blood cells to carry oxygen to the organs in your body. We will give you a transfusion of red blood cells if your count drops to a certain level. Keep in mind that this profound fatigue is common among transplant patients. Establishing reasonable expectations can help you deal with it more effectively. We will encourage you to stay out of bed and active as much as possible to prevent other complications.
Your platelet count will also be very low during this time period, putting you at risk for bleeding. You will need to avoid activities that can cause bleeding such as strenuous exercise, shaving (except with an electric razor), blowing your nose hard, or flossing your teeth. If your platelet count goes below a specified threshold, you will receive transfusions of platelets to minimize your risk for bleeding.
Other common complications and side effects from high-dose chemotherapy are gastrointestinal issues, including mouth sores, taste changes, nausea, vomiting, lack of appetite and diarrhea. We will give you medication for these symptoms as they occur. During the time your blood counts are low you will need to follow a certain diet to minimize the risk of bacterial contamination. Your transplant nurse will help you with nutritional recommendations during this time.
Engraftment and recovery
About 10 to 20 days following your transplant, we can begin to see signs that your stem cells are growing (engrafting) and beginning to produce blood cells. During this time, you may notice aching in your bones, especially your pelvis, lower back and thighs.
As your blood counts begin to rise, your white blood cells will start to fight and prevent infections. Fevers you had while your white blood count was low may get better now. You may no longer need to take antibiotics, and you should not need as many (or any) blood or platelet transfusions. You will notice that your other side effects will also start to get better.
If you have had an allogeneic stem cell transplant, you will stay on some of your antimicrobial medications even after discharge. You will also be monitored closely for graft vs. host disease which only occurs in patients who receive stem cells from a donor. This is a potentially serious complication. Your donor cells (the graft) see your cells (the host) as foreign and mount an attack against you, just as your immune system would normally attack an infection. You will be given medications to prevent or minimize this response and closely monitored. You will also have some additional long term restrictions that your transplant nurse coordinator will review with you. Once you are stable, you will be transferred back to your primary oncologist for long term monitoring. This occurs in about 30 days after an autologous transplant. Allogeneic transplant patients have a longer recovery period and will be followed indefinitely by the transplant team.
Your primary oncologist or transplant physician will let you know about follow-up tests to measure the effects of the chemotherapy and the results of the transplant, such as blood tests, X-rays, scans or bone marrow biopsies. You will continue to have regular check-ups by primary oncologist and the transplant team to monitor your disease and check for any long-term side effects.
Progress during this time may seem slow. Keep in mind that long-term recovery may take a few months for an autologous transplant. Recovery for an allogeneic transplant can take a year or longer. Although you may feel frustrated at the seemingly slow rate of recovery, we encourage you to stay engaged in your life and seek out others who can share their experiences with you.
Patients tell us they coped by taking one day at a time and setting simple, realistic goals for themselves. Community support groups such as those sponsored by Life with Cancer can be helpful. Other recipients of stem cell transplants are also a good source of support. Ask your transplant nurse coordinator or transplant physician for the names of transplant patients who are willing to speak to you.
Re-establishing your life after transplant varies from patient to patients. However, the great majority of patients report that the quality of their lives is now the same or better than before the transplant.