Blood and Marrow Transplant

Recovery

When your blood and marrow transplant (BMT) is complete, your team at The University of Kansas Cancer Center will provide you with lifelong care and support that includes annual visits and checkups.

After your final stem cell transfusion, it usually takes 2-3 weeks for your transplanted cells to engraft and produce normal blood cells. We monitor your blood count production daily for 30 days. Your BMT nurse will give you a copy of our BMT manual, tailored to your type of transplant.

Follow-up care

If your blood count remains stable at the end of the initial 30-day period following your transplant, your BMT process is complete and you transition to follow-up care. The type of follow-up care depends on whether your transplant is autologous or allogeneic.

Autologous BMT

If you had autologous or syngeneic BMT, your blood counts are stable and you need no further transfusions, your care will transition to your primary doctor or oncologist 30 days after engraftment. We recommend you see your doctor within a week of discharge from our care. Your doctor will manage your follow-up care and report your condition to your cancer center care team. After 1 year, if there are no complications, you'll begin survivorship care.

Allogeneic BMT

For 100 days after engraftment, you'll have follow-up tests at our Westwood BMT clinic at least once a week. These include lab tests, scans and, if needed, a bone marrow biopsy. We will restage your condition at 100 days, 6 months, 1 year and 2 years after transplant.

Graft-versus-host disease

Graft-versus-host disease (GVHD) is the most serious, potentially life-threatening side effect of allogeneic BMT. Antibodies from your transplant donor cells can attack your own cells. The closer your donor cells match with yours, the lower your risk for GVHD. There are 2 types of GVHD, acute and chronic.

Acute GVHD usually occurs within the first 100 days after transplant and can affect the skin, liver or gastrointestinal tract. Symptoms include:

Constant nausea
Skin rash
Diarrhea
Jaundice

Chronic GVHD usually occurs 3-6 months after transplant and can affect the skin, nails, eyes, mouth, joints, lungs, digestive system, genitals or lungs. You are more likely to have chronic GVHD if you had acute GVHD. Symptoms include:

Unusual hair loss
Joint pain or stiffness
Dry eyes
Chronic cough
Mouth sores

Preventive measures include taking your medications and avoiding sun exposure. You can learn more about GVHD in the allogeneic BMT manual provided by your care team.

Scheduled visits

You'll have scheduled blood tests at 100 days, 180 days (6 months) and 1 year after engraftment. Although your oncologist can conduct these tests, we'll go over the results with you during your visit to our cancer center. We will call you to schedule your appointments.

At 180 days you can begin immunization for conditions such as measles, polio and mumps. Your doctor can provide these and notify us to ensure you are properly immunized.

Precautions after BMT

These precautions apply to all patients after a blood and marrow transplant. If you have any questions, refer to your transplant manual or ask your BMT nurse.

Your risk for infection is high until your immune system fully recovers. This can take up to a year after your transplant. During that time, continue to follow the infection prevention methods from your care team or your BMT manual. These include:
- Practice good hand washing techniques.
- Avoid crowds, especially during cold and flu season.
- Avoid sick people.
- Get yearly seasonal influenza vaccination for the rest of your life.
- Encourage family members and close contacts to get flu vaccination (not the nasal version).
Whether you had an autologous or allogeneic transplant, it's important to remain on a neutropenic diet – special diet for people who are immunosuppressed –for 100 days after your transplant. Follow the guidelines in your transplant manual, including:
- Avoid eating restaurant food for 100 days after transplant.
- When you return to a normal diet, take care when buying foods, preparing meals and dining out.
- Avoid situations where you can't control your food's cleanliness. These include salad bars, delis, bulk food bins and free food samples offered in stores. They can put you at greater risk for food-borne illness.
- Stay active to build and keep your strength.
- Going outside can help your mood. Ask your doctor or care team when you can start.
- Avoid exercising on windy or dusty days.
- Gradually increase the intensity of your activity and stop if you feel short of breath, dizzy or have chest pain. Notify your care team if you experience any of these symptoms.
Limit sun exposure during your first year after transplant. High-dose chemotherapy and/or radiation therapy makes your skin more sensitive to the effects of sun exposure. You are more likely to burn and are at an increased risk of developing skin cancers. A minimum SPF of 30 is recommended for the rest of your life. We recommend using sunscreen with zinc oxide or titanium dioxide.

Sun exposure also increases your chance of getting skin GVHD. Wear a hat, long sleeves, long pants, sunglasses and minimum SPF 30 sunscreen to help control skin GVHD caused by sun damage. Avoiding sun exposure is the best prevention.
Your immunity to diseases such as polio, measles, mumps and rubella declines up to 4 years after engraftment. You will get vaccinations in our BMT outpatient clinic during your long-term follow-up visits. This will allow us to know when you are ready to receive certain vaccinations based on your recovery and degree of immunosuppression.
It may take up to 1 year after engraftment before you are ready to return to your normal work or school routine.

One option is working at home or home tutoring until you are ready to resume normal activities. Be sure to discuss your type of work with your doctor or care team during your clinic visits. Depending on your energy level, you may need to gradually work up to a full-time schedule.
It may feel difficult to return to normal life after your transplant. This is common, and people can be affected in different ways. It is important to remember that it may take some time for you to feel like yourself again. You can always talk to your care team to help you coordinate support services, including counseling.
Sexuality is an important part of everyday life and includes the desire for comfort, closeness and touch. Thoughts and questions of sexuality happen at different times for everyone during the transplant process. It is important to find a member of your care team that you feel comfortable discussing this with.

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