Treatment Options > Bone Marrow Transplants > Overview

Autologous Stem Cell Transplant or Bone Marrow Transplant

Carolyn Vachani RN, MSN, AOCN
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: September 8, 2005

What happens while we wait?

This waiting period, also called the "nadir", is the most difficult time for the patient. The blood cell counts are very low, putting the patient at risk for infections, bleeding, and severe fatigue. The patient does not have any white blood cells to fight infections, so fevers and the need for antibiotics are to be expected. All visitors and healthcare personnel must wash their hands before entering the room. Anyone who is sick or lives with someone who is sick would be best to stay home and call on the phone. Low platelet counts can lead to bleeding, and platelet transfusions are common during this time. A low red blood cell count (called anemia) may be most distressing for the patient. The patient may look pale, feel tired, and require red blood cell transfusions. Many patients say the worst side effect is the extreme fatigue – they feel more tired and wiped out than you can even imagine. Just getting out of bed is a chore. When able, short walks in the halls can actually increase their energy – but this is often easier said than done.

On top of the low blood counts, the patient must deal with the side effects of the chemotherapy drugs used. These include, diarrhea, nausea and/or vomiting, hair loss, fever, chills, decreased appetite, and mouth sores (called mucositis). Every patient is different and it is difficult to predict which patients will have more side effects. The chemotherapy drugs used before the transplant can vary, and some medications are more likely to cause certain side effects than others.

What can a friend or family member do to help the patient during this time?

Be supportive, let the patient get a lot of rest, and understand that he or she just may not feel like eating much during this time. Make one family member the contact person for friends and family. Let the patient tell this contact person how he or she is feeling each day and whether or not he or she wants visitors or phone calls. It is important to respect the patient's wishes. Send a supportive note or a card. If the patient has children, knowing that friends or family are taking care of things like carpooling and school homework might be very comforting. Depending on the protocol for the transplant, the patient may be in the hospital, at an apartment near the cancer center, or at home.

What is engraftment?

Engraftment is a term the doctors use to describe the point when the stem cells start doing their job and blood cell counts start to come up. The first number we look for is the neutrophil count, which is the type of white blood cell that is most important in fighting infection. Generally, once the neutrophil count gets above 500, the patient can come off antibiotics, and in many cases can go home. The time until engraftment varies from patient to patient, but is usually between 7-12 days. The red blood cell and platelet counts can take several weeks to get back to a normal range, but the patient can usually go home once they are not regularly requiring blood or platelet transfusions.