After the Transplant

Within hours of the transplant, the new bone marrow stem cells will find their way to the marrow space in the recipient’s bones where they will grow and start making red cells, white cells and platelets. It will take the new bone marrow about 2-4 weeks to grow (engraft) in the bones.

While waiting for the new marrow to engraft, the patient will continue to be at a very high risk for developing infections, including pneumonia, and must remain in isolation. During this time, especially if mucositis (mouth sores) develops, it is likely the patient will have fevers and will need additional antibiotics.

Healthy blood cells

In addition, multiple transfusions will be needed to support platelet and red blood cell counts. All blood products are tested as carefully and completely as possible by the Blood Bank to minimize transfusion reactions and infection. While it is not necessary, if you wish to establish a donor-designated transfusion program, our clinical nurse specialist or nurse coordinator can provide you with information as to how to create such a program. The need for transfusions will decrease as the new marrow stem cells begin working. Daily CBC (complete blood counts) and platelet counts will help the physicians keep track of how well the new marrow is growing.

The absolute neutrophil count (ANC) must be greater than 500 for three consecutive days before the attending physician will discontinue strict isolation.

Side effects and complications

Infection, anemia and bleeding are all potential problems post-transplant. These are expected side effects of the conditioning regimen. Other side effects that can be expected during this post-transplant period include mouth sores, sore throat, dry mouth, swollen glands, hair loss, darkening and dryness of the skin, and diarrhea. Some or all of these side effects may develop. The lungs, liver and kidney may also show the cumulative effects of chemotherapy, radiation and other drugs used post-transplant. Complications due to organ damage [for example, veno-occlusive disease (VOD) of the liver] may be mild and transient or severe and fatal.

The pre-transplant evaluations as well as careful monitoring while in the Transplant Unit are intended to minimize serious complications. However, 5-20% of all children receiving a BMT will die of a complication such as infection, bleeding, organ failure (for example, liver or heart), graft failure or graft vs. host disease, generally within the first 3 months following the transplant. The likelihood of a fatal complication varies depending upon the underlying disease, age of the recipient, conditioning regimen and type of transplant.

Most patients experience some nausea and vomiting during the conditioning regimen which often continues into the post-transplant period. The amount of nausea and vomiting varies among children and dependent upon the type of chemotherapy/radiation therapy received. To control the nausea and vomiting there are anti-nausea medications that can be given through the IV. There are several types of drugs that can be used alone or in combination. They include Granisetron (Kytril), Ondansatron (Zofran), Decadron, Ativan, Reglan, Benadryl, and a Scopalamine patch. If there is a specific medication that has worked in the past for you or your child please let us know. The patient's appetite will probably be very poor during the transplant period. Therefore, nutritional support will be provided using special IV fluids called total parenteral nutrition or TPN.

Mouth sores and skin breakdown may be a painful side effect of chemotherapy and radiation that can occur in many patients. To relieve the pain, intravenous pain medications such as Morphine or Dilaudid can be administered at intervals or as a continuous infusion.

Please refer to the sections on chemotherapy and radiation, on the conditioning page, for other potential side effects.