Allogeneic Bone Marrow Transplant — Recovery
Recovering from the transplant
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 bone marrow transplant procedure, patients find they have little appetite; at this stage, appetite generally starts to improve.
Once the bone marrow engrafts, we watch for signs of graft-versus-host disease. Occasionally graft-versus-host disease is seen before engraftment. Often it does not occur until sometime after the patient goes home from hospital. In addition to a skin rash, patients may develop diarrhea, mouth ulcers, nausea or jaundice (yellow skin from liver abnormalities). If graft-versus-host disease occurs before Day 100 it is called "acute," if it occurs after Day 100 is called "chronic." Chronic graft-versus-host disease involves the same problems as acute disease, but also can affect the joints, eyes and salivary glands.
If a patient develops graft-versus-host disease he or she may need to receive additional treatment to suppress the immune system. The first drug we use is the steroid Prednisone. Usually this is effective, but if the graft-versus-host disease persists it may be necessary to give more powerful immune-suppressing drugs.
Graft-versus-host disease is not entirely negative. The immune effects also act against any leftover cancer cells, and it is because of this that allogeneic bone marrow transplants are so effective at preventing relapse. In fact, it has been shown that patients who develop graft-versus-host disease are less likely to relapse than those who don't develop the condition.
When the bone marrow has engrafted, antibiotics have been stopped, the patient has started to eat and drink, and any graft-versus-host disease is under control, it is time for the patient to go home. Most people are more than ready to go home when the time comes. But it is also a time of anxiety. In the hospital there are always people around, checking on the patient several times a day. By contrast, the relative isolation of the home environment can be a little scary. This feeling doesn't usually last long once people have gone home. We always make sure that patients have a list of phone numbers to call if they have questions or don’t feel well. At the Rush Bone Marrow Transplant Center, there is someone on call 24 hours a day. Therefore, someone is available to answer questions or address concerns morning, noon and night.
Getting back to normal
After the transplant most people feel tired, especially if they do any activity or try to concentrate. Their stamina improves quite quickly over the first few weeks after returning home. However, it can take up to a year, sometimes longer, to feel 100 percent fit. Even after the white cells have engrafted, the immune system takes some time to recover fully. Patients are at risk of getting unusual infections and also tend to be more susceptible to coughs and the common cold. Viral infections that are mild in normal people can be severe, especially if the patient is taking immunosuppressive drugs for graft-versus-host disease. Patients who have had peripheral blood stem cell transplants tend to recover somewhat faster than those who have had bone marrow transplants, because more lymphocytes (a type of white cell) are given with the transplant, which speeds this recovery.
Patients who have had allogeneic transplants (received stem cells from a relative or unrelated donor) lose the immunity they previously acquired from childhood vaccinations as a result of the transplant. The Centers for Disease Control and Prevention (CDC) recommend a series of immunizations starting one year after the bone marrow transplant. Patients who have received immunosuppressive therapy must be off immunosuppressants for at least six months before immunization. For specific information about the immunization schedule, consult with your physician.