After you receive a bone marrow or cord blood transplant (also called a BMT), your doctors will watch your health carefully. Especially during the first 100 days after your transplant, you are at risk for complications. You and your transplant team can take steps to prevent some of these problems. Your doctor will work quickly to treat complications that do occur.
Getting healthier and leaving the hospital
After your donated cells engraft (begin to grow and create new blood cells for your body), your blood cell counts will begin to go up and your immune system will become stronger, although it will be weaker than normal for many months. Your transplant team will still care for you and watch you closely for complications. Sometime during the first 100 days, you will probably be able to leave the hospital and receive your care as an outpatient.
Transplant centers have different plans for patient care and the stage of recovery at which transplant patients transfer from the hospital to outpatient care varies. In your first weeks or months after you leave the hospital, you will go to the outpatient clinic often, perhaps even daily, for care. If you travel to a transplant center far from home, you should plan to stay near your transplant center for treatment for at least the first 100 days and until any transplant complications are resolved.
When you do leave the hospital, you and your family will need to plan for your caregiving needs and prepare the place where you will stay (whether it is your home or an apartment near your transplant center). For more information, see:
There are some things you can do to rebuild your health and strength. It is important to get enough rest. You will probably be tired because your body will be working hard to recover from the intense treatment you received during your transplant. Try to be patient with yourself and with the time it may take for your body to heal.
It is also important to get some exercise every day, as you are able. Many people who have had a transplant say it helped them to get up and walk each day, even if they could only walk a short distance. Over time your strength will grow and you will be able to do more. For more information about ways you can help your body recover, see Staying Healthy.
After your transplant your immune system will be very weak. This is caused by the preparative regimen you receive before your transplant. It is also caused by some drugs you will take after your transplant, such as those used to prevent a complication called graft-versus-host disease (GVHD). Because your immune system is weak, your body may not be able to fight common viruses, bacteria and fungi that can cause infections.
Most infections happen in the first 100 days after transplant, but they remain a risk as long as your immune system is weak. Infections can be very serious, so your transplant team will watch you closely for signs of infections. Especially after you leave the hospital, you and your caregiver will also need to watch for signs of infection. If you do see signs of infection, tell your transplant team right away. It is important to treat infections quickly. Some common sites of infections are:
- The place where the central line (catheter) enters your body
- Urinary tract
- On or near the rectum
- In the blood
While you are in the hospital, your transplant team will check your body temperature at least 4 times a day, because fever is a strong sign of an infection. You may be given blood tests to check for signs of infections. You may also take infection-fighting drugs (antibiotics) even if you have no signs of infection. Drugs used to prevent infections are called infection prophylaxis.
Pneumonia is a serious infection risk in the first 100 days after transplant, so your doctors will watch for problems with your lungs. Pneumonia can be caused by bacteria or viruses. Pneumonia is a serious complication and can be life-threatening, but doctors have many drugs to treat it.
Even one to two years after your transplant, your immune system may not be at full strength. You may still need to take anti-infection drugs. Patients who get GVHD may have weak immune systems for even longer.
Acute graft-versus-host disease
Graft-versus-host disease (GVHD) is a common complication after an allogeneic transplant (which uses cells from a family member, unrelated donor or cord blood unit). In GVHD, the immune cells from the donated marrow or cord blood (the graft) attack the body of the transplant patient (the host).
GVHD that appears in the first 100 days after transplant is called acute GVHD. When GVHD occurs later, it is called chronic GVHD. To learn more about GVHD, including how doctors prevent and treat it, see Graft-Versus-Host Disease under the Treating Complications Tab in the "You and Survivorship" section.
Also see Coping with Chronic Graft versus Host Disease (cGVHD). An introduction to cGVHD. Explores self-management options and offers patients' perspectives on dealing with the disease. Self-management topics include health maintenance, nutrition, sexuality and intimacy, stress management and dealing with fatigue. An nmbtLINK Flash Presentation.
Graft failure or rejection
Doctors call the cells you get during your transplant a graft. Graft failure is when your body does not accept the donated cells. The donated cells do not make the new white blood cells, red blood cells and platelets you need. Generally, doctors define graft failure as no signs of engraftment by the 42nd day after transplant.
Graft failure is a serious complication, but the rate of graft failure is usually low (about 5%). However, a number of patient and disease-related factors can affect this risk. The most common treatment for graft failure is another transplant. The second transplant may use cells from the same donor or from a different donor. Patients who have graft failure after a cord blood transplant cannot get backup cells from the same cord blood unit. However, doctors may be able to use a different cord blood unit or a backup adult donor instead.