Recovering from the Autologous Transplant
Engraftment generally occurs within 8 to 12 days after the stem cell infusion. The word “engraftment” refers to the return of red cells, white cells and platelets in the blood. The most important cell to return is a type of white blood cell known as the neutrophil. Neutrophils are important in fighting bacterial infections. It is important to get the neutrophil level close to normal.
The neutrophils are usually the first cells to return, especially if a growth factor, like G-CSF, is given. The platelets are next to return. Platelets are fragments of cells that live in the bone marrow. They play an important role in clotting – in other words, they help stop bleeding after a cut or other injury. Sometimes, if not enough stem cells could be collected, the platelets may take much longer to recover even though the neutrophils returned on time. The red cells usually start growing at this stage too, but because the red cell last so long compared to the other cells (120 days) it is not uncommon for patients to need a blood transfusion after going home.
When the white cell count returns the body’s immune system begins to return to normal – that is, it can begin to heal itself and fight off infection. Most fevers resolve at this point, so antibiotic use is generally stopped. Often, during the transplant procedure, patients find they have little appetite; at this stage, appetite generally starts to improve. Patients are sent home after antibiotics have been stopped and after they have started to eat and drink normally.