Day of bone marrow transplant

Your conditioning chemotherapy will destroy your cancer cells and bone marrow cells. This will make room for your new healthy cells. High-dose chemotherapy used in your conditioning regimen is more intense than most chemo treatments. So, you can expect to have more intensive side-effects from the conditioning chemotherapy.

There are several different conditioning regimens. Some of them can include radiation therapy. Your treatment will be based on the following:

• Your type of cancer
• Your medical history
• Your own transplant needs

Your transplant doctor and pharmacist will discuss your chemotherapy regimen with you. They will go over your treatment schedule and possible side-effects.

After conditioning

After conditioning, your blood counts will fall to below normal levels. This often happens one week after completion of your conditioning regimen. With low blood counts, it will be easy for you to get infections and to bleed. In order to keep you safe, we will watch your vital signs closely. We will also check your labs for signs of infection and risk for bleeding.

You may take antibiotics to prevent infection. Common ones are acyclovir, fluconazole, and levofloxacin. You must take these medicines as ordered. They will protect you from viral, fungal and bacterial infections.

You may need blood and platelet transfusions. It is common for transplant patients to receive several blood and platelet transfusions while in the hospital, and during transplant recovery. This will keep you from becoming anemic or bleeding while waiting for your blood counts to return to normal levels.

As you can see, this an important time in the transplant process. Our staff will keep a close watch on your health. You must stay in the hospital until your blood counts are back to normal. This will protect your from major health problems.

Chemo and radiation treatments can cause a variety of side-effects. The side-effects will depend on the type of drugs used in your treatment. These side-effects may include:

• Mouth sores.
• Nausea and vomiting.
• Diarrhea.
• Hair loss.
• Fatigue.

Within 24 to 48 hours after completion of your conditioning regimen, your new healthy cells will be infused. You will get the cells through your central line (similar to a blood transfusion). This is a very quick and simple process that takes place in your hospital room. Your loved ones may be with you during this time.

In each case you will be hooked up to a heart monitor for 24 hours after the infusion. For the first hour, your nurse will check vital signs every 15 minutes. After that, the nurse will check them every hour until the treatment is done. 

Your blood cell counts will be very low for about two weeks, depending on your type of transplant. You may need blood or platelet transfusions during this time. We will also take your vital signs every four hours – day and night – to check for signs of infection. The two types of transplant are listed below.

Autologous transplant

This is where you get cells you donated to yourself. A physician and nurse team will infuse your cells back into your blood through your central line. Your nurse will keep an eye on your vital signs. Autologous cells are preserved in a special liquid called DMSO (which is a preservative). When it goes into your body you may feel tickling in your throat. It may also cause a garlic-taste in your mouth. Sucking on hard candy will help relieve this.

If you receive an autologous transplant, you will begin to receive growth factor shots on the 5th day after your transplant. This is so your white blood cell counts can recover faster. You will receive growth factor shots until your blood counts reach a safe level determined by your doctor. These shots are the same as the shots you received during the apheresis phase of transplant.

Allogeneic transplant

This is where you get cells from another person. A physician and nurse team will infuse your cells back into your blood through your central line. Your nurse will keep an eye on your vital signs. 

How to count days after transplant

• Before the transplant, days count down as minus days (Day -7, -6, -5, etc.).
• The day of the transplant is Day 0.
• After the transplant, days count up as plus days (Day +1, +2, +3, etc.).

Engraftment is when your body accepts your new cells and your blood cell counts return to normal. This usually happens two weeks after infusion. This can vary based on the chemo treatment and the type of transplant. We will draw your blood daily to look for signs of engraftment. We will consider you fully engrafted when both of these are true:

• Your ANC is 500 or higher for three days in a row.
• Your platelet count is more than 20,000 without transfusion for three consecutive days.

If you want to know your blood cell counts, just ask and we will be sure to share the results as often as you like. Many patients use a chart or calendar to track cell count growth. There is a white board in your room to help you keep track.

Will I be at risk for infection?

While your white blood cell count is low, you will be at a high risk for infection. If you get an infection, having a fever is very common. Your nursing staff will check your temperature often to make sure you are not sick. If you have a fever, we will need to do these tests:

• The nurse will draw blood from your infusion catheter and from a vein in your arm.
• You will need to give a urine sample.
• You will have a chest X-ray.

These tests will help your doctor know why you are sick and how to treat you. Your nurse will give you antibiotics to treat the infection.

What can I do to prevent infection?

• Wear a mask outside of your hospital room.
• Shower daily with antibacterial soap, also called Hibiclens.
• Rinse your mouth with salt and soda rinse. Or brush your teeth at least four times a day.
• Wash your hands often. This is most important after using the bathroom and before eating. This is the #1 way to prevent infection.

What should I expect after engraftment?

As your new immune system grows stronger, we will monitor you for signs of infection or any complications. Think of your new immune system like that of a newborn baby. Until your immune system has fully matured, you will be at high risk for infection. It may take as long as six months or even longer after transplant until your immune system has fully matured.

Graft versus Host Disease (GVHD) is a common side effect of allogeneic transplant. This happens when the donated cells understand that your body is different from where they came from. They may cause your new immune system to attack your body’s cells. The size of the attack will vary. The symptoms can vary from mild to severe and life threatening.There are two types of GVHD.

Acute GVHD usually occurs in the first 100 days of transplant. It can affect your skin, stomach, gut and liver.

Chronic GVHD may occur months or even years after transplant. It may affect other areas in your body as well, like muscles and joints, eyes, mouth and skin.

During your transplant stay, we will check you daily for signs of GVHD. It is important for you to let us know about any changes in your body. Tell us if you have:

• Skin changes.
• Nausea that does not go away.
• Diarrhea that does not go away.

Your doctors will give you medicines to suppress your immune system. Tacrolimus, cyclosporine, methotrexate, antithymocyte globulin, mycophenolate and sirolimus are common medicines used to prevent GVHD. You must follow your doctors instructions carefully when you take them. Non-compliance with this treatment plan can result in severe and life-threatening outcomes. These drugs cause your immune system to be less active, putting you at even greater risk for infection.

For more information on blood and marrow transplants, your stay in the hospital, and more, please visit any of the pages below:

• Blood and Marrow Transplant homepage
• Before your transplant
• Your hospital stay
• After your transplant