Print PDF

Waiting for Engraftment

During the time after the transplant, the stem cells make their way to the bone marrow, where they grow and mature into normal blood cells. This is called ‘engraftment’. Engraftment usually occurs within two to three weeks after the stem cell infusion. Often the first sign is a rise in your white blood cell count.
.

This rise can be unsteady, so do not worry if your count goes up and down a little during the early stages. While waiting for your white blood cell count to improve, your healthcare team will continue to monitor you carefully. You will have blood and platelet transfusions as you need them until you begin to make your own blood cells. These will help to combat side effects such as a low haemoglobin level (anaemia) and a low platelet count (thrombocytopenia) that treatment can cause. You may find the uncertainty of this waiting period quite unsettling, and it is normal to feel vulnerable.
.

You may also feel that the constant monitoring, medical procedures, infusions, and treatments can impose on your personal space. Working out a daily routine may help you to maintain some control. During this time, your immunity against infection is severely weakened. Therefore, you will need to be looked after in protective isolation.
.

Protective isolation, or reverse barrier nursing, is a way of reducing your risk of picking up infections. Protective isolation is when you are looked after in a single room with the door closed. There are often special air-filtration systems that make the air in your room cleaner, which reduces your risk of airborne infections. Activities outside the room are restricted to absolute essentials, such as CT scans, which cannot be adequately done in the unit.
.

However, this does not mean that you cannot move around inside your room. It is essential that you do try to get some exercise – walking to the toilet, rather than using urinals or the commode is an easy way of keeping yourself active.
.

There are other considerations with protective isolation. Visitor Isolation does not mean no human contact. The number of visitors you have at one time should be kept to two. The rooms are usually relatively small, and seeing many people can increase the risk of the spread of infections. Visits from anyone in contact with an infection are strictly out of the question until they are clear of the incubation period or they are ‘infection-free’. If in doubt, please ask our medical staff. Your visitors will be advised not to mix with other patients since this can increase your risk of catching infections.
.

Any visitors who have been in contact with any infectious diseases should not visit until they have received advice from our medical staff. If they have been in contact with, or have been suffering from, chickenpox, measles, flu, coughs or colds, or are in any doubt at all; they should contact the nursing staff before visiting.
.

The most crucial part of protective isolation is hand hygiene. Our nurses and doctors always wash their hands with antibacterial soap (in the dispensers that are usually outside the rooms) or with an alcoholic rub before they enter your room. Your visitors will be advised to do the same. When your white blood count is low, you may need to take antibiotics to protect you from infections caused by bacteria that occur naturally in your body. This is called prophylactic antibiotic therapy.
.
In a healthy person, these bacteria are harmless, but with a weakened immune system, they can cause infections. You will also need antiviral treatment to help prevent viral infections. These antibiotics and antivirals are a vital part of your treatment. Despite prophylactic or preventative medication, it is likely that at some point during your transplant, you will develop an infection. Infections are a common side effect of stem cell transplants. Your low white cell count and poorly functioning immune system mean you have a high risk of infection.
.

Fever is the most common sign of infection. Your temperature is checked regularly, along with your pulse and blood pressure, particularly while your white cell count remains low. Some people can feel cold and shiver (a rigor) before the fever appears. If you experience this, you should let your nurse know straight away. Sometimes, an infection can cause your blood pressure to drop. If this happens, you will be given extra fluid; on occasion, you may even need medication to help bring your blood pressure back up.
.

The medicines that are used to treat infections include antibiotics, antifungals and antivirals. Some of these drugs can cause issues with your liver or kidneys. For this reason, these organs will be monitored very closely, and your treatment can be adjusted if necessary. When you have a fever, the doctor will examine you and will usually give intravenous antibiotics. These are antibiotics that are given to you through your central venous catheter. The doctor may also order a chest X-ray and take a blood sample.
.

You may also be given a dose of paracetamol, which brings your temperature down and helps you to feel a little better while waiting for the antibiotics to work. Some other samples may also be taken to find out the cause of your infection, such as urine, stool or swabs. It is not unusual for the laboratory to receive a negative result from the cultures, despite you looking and feeling as though you have an infection. Therefore, a broad range of antibiotics is used to treat you for an infection.
.

These antibiotics can work against many types of organisms and bacteria. You will receive antibiotics until the cause of your infection is identified, or your temperature returns to normal. If you still have a temperature after 24 to 48 hours, the tests may be repeated, and the antibiotics may be changed. Once your fever and symptoms of infection have settled, the antibiotic treatment will be stopped. It is common for people to have several fevers and cycles of antibiotics during their transplant.
.

These are drugs that can be used to speed up engraftment (cell growth). Growth factors are naturally occurring hormones that control the production and function of white blood cells. They can increase the number of white blood cells in your blood, making infections less severe and speeding up your recovery time. Growth factors are received as an injection under the skin. The side effects are few, and they do not affect your risk of relapse.
.
It is normal for your white blood count to fall slightly when the growth factor support is stopped. Your white count will recover again after a short while.
.

.
Almost everyone who has had a transplant will experience changes in their mouths and gut. This happens because the chemotherapy drugs that are used attack and damage cells that divide quickly. This includes cancer cells, but also bone marrow cells, hair cells and those cells that line the mouth and the gut. This damage usually begins a couple of days after your transplant but can start earlier.
.

These changes to your mouth and gut are called mucositis and are caused by your conditioning therapy. Mucositis can also be caused by the treatment you may receive to suppress your immune system. The severity of your symptoms can depend on the type of conditioning therapy you receive and the type of transplant you are having; the stronger and more intense the treatment, the greater your chance of developing mucositis.
.

As a rough guide, mucositis tends to be mild to moderate in people who have transplants using their own stem cells or bone marrow (autologous transplants), or where conditioning therapy is given in lower doses (reduced-intensity conditioning). It is moderate to severe in people receiving higher doses of conditioning therapy (myeloablative conditioning) before a donor (allogeneic) transplant, or those receiving TBI (Total Body Irradiation).
.

When mucositis develops, your mouth may look whiter and feel rougher than usual. Your saliva may become thicker, less manageable, and more difficult to swallow. When it starts to become painful to swallow your saliva or fluid, make sure you inform our doctors, as they can offer pain relief. As your mouth continues to change, the surface may become red and inflamed; sometimes, painful ulcers can develop. The areas of your mouth that are usually affected include the insides of your cheeks, the sides and underneath of the tongue, and the back of the throat. Your throat may also become very sore, and you might find it difficult to swallow.
.

Mucositis in your oesophagus (the canal that connects the throat to the stomach, also called the gullet or foodpipe), in your digestive tract and bowel, can cause you discomfort, indigestion, pain and sometimes diarrhoea. Should this happen, please discuss your symptoms with your doctor so that you can receive medication. It is important to remember that your mouth pain is temporary, and it will heal once the effects of the conditioning therapy have gone, and your stem cells begin to work. However, it can be some time before your mouth feels ‘normal’ again.
.

Mouth care is essential and helps to make you feel more comfortable, reduces your risk of infection, and may help your mouth to heal more quickly.
.

VOD is a problem with the liver. It is a specific disease where the blood flow through the small veins of the liver is partly blocked. VOD can be life-threatening if severe. It can cause symptoms such as yellowing of the eyes and skin (jaundice), swelling of the stomach (abdomen) and a build-up of fluid. VOD can be caused by the high doses of conditioning therapy that you have before the transplant. The stronger the chemotherapy, the higher the risk of VOD.
.

While it aids in preparing for your transplant, chemotherapy can damage otherwise healthy tissues. When the liver is damaged, this can lead to VOD. It can happen at any time from after the start of the conditioning therapy, to the third week after your transplant; in very few cases, it can happen even later. VOD is more common in people having myeloablative conditioned donor transplants than in those receiving reduced-intensity conditioned transplants. It is usually very mild, disappears quickly, and often you may not even be aware of it. However, VOD can be a severe problem, and your treatment is aimed at minimising its effects. Your recovery is helped by your liver’s incredible ability to improve and restore itself from the effects of diseases like this.
.

Your kidneys perform many essential functions, such as:

  • Producing urine
  • Fluid balance
  • Regulating your blood pressure
  • Removing waste from your body
  • Processing medication
    .

To function normally, your kidneys also depend on your other organs working normally. Following a stem cell transplant, mild kidney problems are not unusual.
.

Our doctor will monitor your kidney function through:

  • Blood tests
  • Checking your urine output and quality
  • Daily weight checks
    .

Such monitoring will help your doctors understand how well your kidneys are working. These problems are generally treated aggressively with fluid, or by reducing your intake of any medicines that make your kidneys work hard. Careful monitoring is essential. Treatment usually resolves these problems, and your kidney function will return to normal.
.

Fatigue is a prevalent problem during this stage. People often find it difficult to concentrate on reading a book, watching television or even holding a conversation. This is normal, and it is crucial that you set yourself realistic goals and reasonable expectations of your abilities at this time. A balance of rest and light exercise is often helpful.
.

There are several reasons why you can feel tired. You are still having a lot of treatment, you may be anaemic, your sleep may be disturbed, and you may still be feeling anxious about your treatment. You may find that activities such as showering or bathing are exhausting. Try to conserve your energy by doing things for a shorter period, and then rest. A good night’s sleep is vital to prepare yourself for the day ahead.
.

Getting to sleep at night can be difficult while you are in hospital. You may find that earplugs and an eye-mask help to block out any sounds or overhead lighting that may stop you from getting a good night’s sleep. Remember the things that you do at home that help you to go to sleep – for example, reading, listening to the radio, warm and milky drinks. Try to recreate the same atmosphere while you’re in the hospital.
.

Please talk to our nurse or doctor if you’re having problems with sleeping.
.

Mobility is the ability to move freely and easily. You may experience issues associated with your mobility if you have had a long period of bed rest and illness.
.

Daily light exercise help:

  • Improve fatigue
  • Maintain muscle strength
  • Reduce muscle loss, which can happen with long periods of bed rest
  • Maintain balance and coordination
  • Boost feelings of wellbeing
  • Improve physical comfort
  • Prevent chest infections and blood clots (thrombosis), which are associated with long periods of bed rest.
    .

During recovery, there will be some days that are better and easier than others. Where possible, take advantage of these good days by getting up and moving around more.
.

In summary, the process of engraftment occurs during the first two to three weeks after the transplant. The transplanted cells will start to move into the bone marrow, grow and multiply, and produce healthy blood cells that appear in the blood. Frequent blood tests may be done by our doctors to monitor this process.
.

Total recovery of immune function may take up to several months for autologous transplants, and one to two years for allogeneic transplants.
.

FAQs

View All FAQs
 How long does it take to know if a bone marrow transplant is successful?
Read more

 How long does it take for a bone marrow transplant to engraft
Read more

 What is the recovery period for a bone marrow transplant?
Read more

 How long are you in the hospital for a bone marrow transplant?
Read more

 Can you live a normal life after a stem cell transplant?
Read more

 What are the possible complications of a stem cell transplant?
Read more

.

Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

Locations

Contact

WhatsApp : +65 6256 8836
Email : contact@cfch.com.sg

.

Consultation Hours

Monday to Friday : 8.30am – 5.30pm
Saturday : 8.30am – 12.30pm
Closed on Sunday & Public Holidays

 

Find us On Facebook

Drop a Line

If you have any questions about your condition or would like to make an appointment, simply fill up the form and we'll contact you as soon as we can

© Centre for Clinical Haematology | 2021

    Contact Us

Locations

Contact

WhatsApp : +65 6256 8836
Email : contact@cfch.com.sg
.

Consultation Hours

Monday to Friday : 8.30am – 5.30pm
Saturday : 8.30am – 12.30pm
Closed on Sunday & Public Holidays
.

Find us on Facebook

Drop a Line

If you have any questions about your condition or would like to make an appointment, simply fill up the form and we'll contact you as soon as we can

© Centre for Clinical Haematology | 2021