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Definition

You have had a bone marrow transplant. A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.

What to Expect at Home

It will take 6 months or more for your blood counts and immune system to fully recover. During this time, your risk for infection, bleeding, and skin problems is higher.

Your body is still weak. It may take up to a year to feel like you did before your transplant. You will likely get tired very easily. You may also have a poor appetite.

If you received bone marrow from someone else, you may develop signs of graft-versus-host disease (GVHD). Ask your health care provider to tell you what signs of GVHD you should watch for.

Mouth Care

Take good care of your mouth. Dry mouth or sores from medicines you need to take for the bone marrow transplant can lead to an increase in bacteria in your mouth. The bacteria can cause mouth infections, which can spread to other parts of your body.

• Brush your teeth and gums 2 to 3 times a day for 2 to 3 minutes each time. Use a toothbrush with soft bristles.
• Let your toothbrush air dry between brushings.
• Use a toothpaste with fluoride.
• Floss gently once a day.

Rinse your mouth 4 times a day with a salt and baking soda solution. (Mix one half teaspoon, or 2.5 grams, of salt and one half teaspoon or 2.5 grams, of baking soda in 8 ounces or 240 milliliters of water.)

Your provider may prescribe a mouth rinse. Do not use mouth rinses with alcohol in them.

Use your regular lip care products to keep your lips from drying and cracking. Tell your provider if you develop new mouth sores or pain.

Avoid foods and drinks that have a lot of sugar in them. Chew sugarless gums or suck on sugar-free popsicles or sugar-free hard candies.

Take care of your dentures, braces, or other dental products.

• If you wear dentures, put them in only when you are eating. Do this for the first 3 to 4 weeks after your transplant. Do not wear them at other times during the first 3 to 4 weeks.
• Brush your dentures 2 times a day. Rinse them well.
• To kill germs, soak your dentures in an antibacterial solution when you are not wearing them.

Preventing Infections

Take care not to get infections for up to 1 year or more after your transplant.

Practice safe eating and drinking during cancer treatment.

• Do not eat or drink anything that may be undercooked or spoiled.
• Make sure your water is safe.
• Know how to cook and store foods safely.
• Be careful when you eat out. Do not eat raw vegetables, meat, fish, or anything else you are not sure is safe.

Wash your hands with soap and water often, including:

• After being outdoors
• After touching body fluids, such as mucus or blood
• After changing a diaper
• Before handling food
• After using the telephone
• After doing housework
• After going to the bathroom

Keep your house clean. Stay away from crowds. Ask visitors who have a cold to wear a mask, or not to visit. Do not do yard work or handle flowers and plants.

Be careful with pets and animals.

• If you have a cat, keep it inside.
• Have someone else change your cat's litter box every day.
• Do not play rough with cats. Scratches and bites can get infected.
• Stay away from puppies, kittens, and other very young animals.

Ask your provider what vaccines you may need and when to get them.

Other Self-care

Other things you can do to stay healthy include:

• If you have a central venous line or a peripherally inserted central catheter (PICC) line, know how to take care of it.
• If your provider tells you your platelet count is low, learn how to prevent bleeding during cancer treatment.
• Stay active by walking. Slowly increase how far you go based on how much energy you have.
• Eat enough protein and calories to keep your weight up.
• Ask your provider about liquid food supplements that can help you get enough calories and nutrients.
• Be careful when you are in the sun. Wear a hat with a wide brim. Use sunscreen with SPF 50 or higher on any exposed skin.
• Do not smoke.

Follow-up

You will need close follow-up care from your transplant team for at least 3 months. Be sure to keep all your appointments.

When to Call the Doctor

Contact your provider if you have any of these symptoms:

• Diarrhea that does not go away or is bloody.
• Severe nausea, vomiting, or loss of appetite.
• Cannot eat or drink.
• Extreme weakness.
• Redness, swelling, or draining from any place where you have an IV line inserted.
• Pain in your abdomen.
• Fever, chills, or sweats. These may be signs of infection.
• A new skin rash or blisters.
• Jaundice (your skin or the white part of your eyes looks yellow).
• A very bad headache or a headache that does not go away.
• A cough that is getting worse.
• Trouble breathing when you are at rest or when you are doing simple tasks.
• Burning when you urinate.

References

Chhabra S, Hamadani M, Hari PN. Indications, outcomes, and donor selection for allogeneic hematopoietic cell transplantation for hematologic malignancies in adults. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 103.

Im A, Pavletic SZ. Hematopoietic stem cell transplantation. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 28.

National Comprehensive Cancer Network website. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Hematopoietic cell transplantation (HCT). Version 1. 2024. www.nccn.org/professionals/physician_gls/pdf/hct.pdf. Updated April 26, 2024. Accessed May 28, 2024.

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