The goal of the Transplant Team is to provide consistent excellent care. This is achieved through continuous monitoring of your physical and emotional needs. Some patients may develop complications outside of what is listed below. You will be closely monitored for the development of any complications, and we ask you to immediately report any signs or symptoms you may be experiencing.

What to Expect

Depending on your type of transplant, engraftment (the sign of the stem cells growing) may take place in 2 to 5 weeks. As the body begins to heal, you can expect to see your blood counts recover, a reduction in chemotherapy and radiation therapy side effects, and a gradual return of your appetite and strength.  The Transplant Team will also address your need for pain management, physical therapy, occupational therapy, and/or dietary counseling.
To monitor your recovery, the Transplant Team will measure the following factors:

• Daily blood counts: One way to measure how well the stem cells are working is through daily blood counts. Bleeding can occur when the new stem cells cannot (as of yet) produce enough platelets to prevent bruising or bleeding. Your red cell count (hemogloblin/hematocrit) will also be monitored. Blood transfusions will be administered as needed.

• Temperature: An elevated temperature usually indicates the presence of infection; therefore, your temperature will be monitored frequently.

• Cultures: Cultures help determine the source of an infection in case of fever or other symptoms. The culture helps to determine if the problem is bacterial, fungal, or viral, and guides subsequent treatment. Cultures of the blood, stool, urine, central catheter, or other sites may need to be obtained.

Possible Complications

Some of the complications that can arise after transplantation may be due to the chemotherapy and/or radiation therapy prior to the infusion of the stem cells or the response of the immune system to the new stem cells. Despite the extensive prescreening and pre-transplant testing, some patients may develop complications. Most of these complications are reversible. They may include:

• Chemotherapy-related complications: Complications vary with each regimen, but often include nausea, vomiting, diarrhea, mouth sores, and poor appetite.  Sometimes more serious complications occur including kidney, liver, lung or heart problems. We attempt to prevent serious complications. If they occur, they are carefully followed and managed by the transplant team.

• Non-engraftment/graft rejection (allogeneic transplant only): There is a chance that the infused stem cells may not recover and your immune system may not function properly. This is called “non-engraftment” or graft failure. There is also a chance that the stem cells may begin to recover, then decline and become non-functional. In cases such as this, a “stem cell boost” may be necessary.  In other cases, a second transplant may be considered.

• Infections:  While you are in the hospital, precautions are taken to reduce the risk of infections. After discharge, some patients develop a late infection and require readmission into the hospital. It is important that you contact your transplant physician or go to the nearest emergency room if you have a temperature of 100.5°F (38°C) or higher.

• Graft-versus-host disease (allogeneic transplant only): One of the potential complications of receiving a donor’s stem cells or umbilical cord stem cells is graft-versus-host disease (GvHD). This is a common side effect that occurs in patients receiving stem cells that are not their own. Acute GvHD develops when the donated stem cells begin to grow and recognize the patient’s body as a foreign place. It may be mild or severe. Typically patients present with a skin rash and/or diarrhea. Laboratory tests sometimes show inflammation of the liver. It is believed that a mild case of acute GvHD has a beneficial antitumor effect. In order to prevent a severe reaction, you will be given medications to minimize GvHD risk. In some cases, you may require treatment with one or more immunosuppressive medications, which may include steroids. Chronic GVHD is another frequent complication of transplant. It tends to occur more than three months after the transplant and can take several months to recover from. It also mostly affects the skin, gut and liver. But other organs can be affected as well.

• Disease Relapse: Defined as the return of signs and symptoms of a disease after a patient has experienced a remission. Should the onset of relapse symptoms occur, your transplant physician will order specific tests to confirm disease relapse.

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