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Waiting for Engraftment: Days 0-30

After your bone marrow or cord blood transplant (also called a BMT), you will have low blood counts. This means that you have fewer than normal numbers of red blood cells, white blood cells and platelets. Over time, the donated cells you received for your transplant start to grow and make new blood cells. This is called engraftment. Engraftment is an important milestone in your transplant recovery. For information about how doctors check your blood for signs of engraftment, see Measuring Engraftment.

Preparative regimen side effects

In the first 30 days after your transplant, you may also have some side effects from the preparative regimen you received before your transplant. Some of these side effects can be serious, and others are less serious, but can be painful or uncomfortable. For information about possible side effects you may have during this time and how your transplant team will treat them, see The Preparative Regimen.

TPN and feeding tubes

Some of side effects of the preparative regimen can make you feel less hungry or make eating hard. Some transplant patients are not able to eat and drink enough to get the nutrition, calories and fluids they need. If this happens to you, you may be given nutrients and fluids through an IV. This is called total parenteral nutrition (TPN). Patients can be given TPN until they are able to eat enough healthy foods on their own.

Another feeding method for patients who cannot eat because of mouth sores or other reasons is a feeding tube. A feeding tube is a catheter that goes through the nose and into the stomach (a nasogastric or NG tube) or the intestine (a nasojejunal or NJ tube). Some patients may be fed through an NG or NJ tube instead of getting TPN. Other patients may be given TPN until they are able to tolerate an NG or NJ tube. Then they are fed through an NG or NJ tube until they can eat on their own.

Transfusions and growth factors

Until your donated cells engraft, you may get red blood cell or platelet transfusions. On average, transplant recipients get one red blood cell transfusion a week, and two to three platelet transfusions a week.

You may also get growth factors — drugs that help the body make more blood cells. Growth factors may help donated cells engraft more quickly. A common growth factor is granulocyte-colony stimulating factor or G-CSF (also called filgrastim or Neupogen^®). G-CSF helps the body make white blood cells.

Preventing common complications

Infections

Until your donated cells engraft, you will have low counts of all types of blood cells. You will have very few white blood cells to fight infections. This means you can get an infection easily and infections during this time can be serious, even life-threatening. Your transplant team will take steps to protect you from infections. You will be at risk for infection for many months, but the period before engraftment is a time of especially high risk.

Infections can be caused by bacteria, by viruses or by fungi. You will probably be given drugs to prevent infection even if you do not have any signs of infection. (Drugs given to prevent infection are called infection prophylaxis.) If you get a high fever or other sign of infection, your doctors will give you drugs to treat the infection.

Bacterial infections — Bacterial infections are so common that most patients will have at least one during this time. They are most often caused by the bacteria normally in your mouth and gut. Infections around the place where the central line enters your body are also common.
Viral infections — The most common viral infection is herpes. If you have had herpes before, the herpes virus remains in your body and can become active when your white blood cell count is low. Another common viral infection is cytomegalovirus (CMV). Many people have this virus in their bodies without symptoms, but when your white blood cell count is low, CMV can develop into an active infection.
Fungal and yeast infections — The most common fungal or yeast infection is candida. The candida yeast lives in the mouth, intestines and vagina. Normally, bacteria in the body control candida, but the drugs that protect you from bacterial infections destroy these helpful bacteria. Candida can then grow into an active infection. Candida infections usually are fairly easy to treat. However, another common infection called aspergillus can be harder to treat. Aspergillus infections occur most often in the sinuses or lungs.

You can take some steps to avoid infections. You can take daily showers or baths to wash bacteria from your skin. Careful cleaning of your teeth and gums with a soft toothbrush or sponge is also important. You can also eat a low bacteria diet — avoid eating foods that are likely to carry bacteria. Foods you may need to avoid include raw foods, such as raw fruits and vegetables. Your transplant center will help you choose safe foods to eat. For more information about eating safely to avoid infection, see Healthy Eating.

After engraftment

Engraftment of neutrophil (a type of white blood cells) and platelets (blood cells that help control bleeding) are important milestones, but they are only one step in your recovery. To learn more about what to expect, see Early Recovery: Days 30-100.