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Clinical Services at Rush Bone Marrow Transplant FAQs

Frequently Asked Questions

What can I eat following an allogeneic bone marrow transplant?

Patients often ask if there is a special diet that they must follow when they have had a bone marrow transplant. Our recommendation is that they should eat a normal healthy diet. This contains plenty of fresh fruit and vegetables, enough protein and not much fat. However, raw fruit and vegetables should be well washed. It is also best to avoid unpasteurized or raw milk and milk products including cheese and yogurt.
The following is a list of foods to avoid when immunosuppressed:

  • Raw and undercooked meat, fish, shellfish, hot dogs, tofu, sausage and bacon
  • Cold-smoked fish and lox; pickled fish
  • Unpasteurized or raw milk and milk products, including cheese and yogurt
  • Aged cheese (e.g. Brie, Camembert, blue, Roquefort, sharp cheddar, Stilton, etc)
  • Refrigerated cheese-based salad dressings (e.g., blue cheese) which are not shelf-stable
  • Mexican, farmer's cheese, and feta cheese
  • Unwashed raw fruits and vegetables and those with visible mold; imported raspberries
  • All miso products (e.g., miso soup); tempeh; Mat tea
  • All moldy and outdated food products
  • Unpasteurized beer(e.g., microbrewery beers and those not shelf stable)
  • Raw, uncooked Brewer's yeast
  • Well water, unless it is tested yearly and found to be safe
  • (From Fred Hutchinson Cancer Center, Seattle)

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What can I eat following an autologous bone marrow transplant?

Patients often ask if there is a special diet that they must follow when they have had a bone marrow transplant. Our recommendation is that they should eat a normal healthy diet. This contains plenty of fresh fruit and vegetables, enough protein and not much fat. However, raw fruit and vegetables should be well washed. It is also best to avoid unpasteurized or raw milk and milk products including cheese and yogurt. Keeping a strict diet is not critical immediately after going home if the patient's appetite is poor, where anything they eat is good.

 

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How soon after a bone marrow transplant can I have sex?

Hugging, kissing and touching may be resumed after discharge, although you should avoid sick people. We advise that you use a condom during intercourse for the first six months after your transplant to reduce the risk of viral transmissions. Generally we recommend that patients abstain from intercourse until their platelet count is above 50. With all of the emotional and physical strain of going through a transplant many patients find their desire and ability is low. Sometimes there are hormone changes after a transplant. Men can have a low testosterone level, especially if they receive total body irradiation, and this may need replacing. Women's periods often stop after a transplant and long term hormone replacement may be recommended. Although these physical problems can occur, and need to be checked for, most patients return to a normal sex life again.

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Is it better use marrow from my brother or sister for the bone marrow transplant than my own marrow?

If you use bone marrow from your brother or sister for a transplant it is called an allogeneic transplant. There are advantages and disadvantages to using allogeneic bone marrow.

Disadvantages
Allogeneic bone marrow transplants are associated with graft-versus-host disease or GVHD. GVHD is where the "graft" (the bone marrow you are given) reacts against the "host" (you!). This results in damage to the lining of the gut, the liver and the skin and increases the complication rate and mortality of undergoing an allogeneic transplant. While we can suppress the immune system to suppress GVHD this causes problems with increased chance of infections. This is not all bad as the graft also recognizes the cancer cells as foreign and tries to reject it.

Advantages
Your brother or sister's bone marrow is free of malignant cells, which are often present to some degree in your own bone marrow.
Because of the graft-versus-cancer effect the relapse rate is lower after receiving an allogeneic transplant.
 

The type of transplant we recommend depends on your disease and the availability of a donor. For example for patients with Hodgkin's disease we usually recommend an autologous transplant, unless the bone marrow is involved. In patients with CML we usually recommend an allogeneic transplant.

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What is the difference between stem cell transplants and bone marrow transplants?

In a bone marrow transplant, bone marrow is taken from the posterior hip of the donor and given to the patient after high-dose therapy. In a stem cell transplant, cells collected from the blood are used instead. The immature cells (stem cells) that normally reside in the bone marrow are made to circulate in the blood by giving chemotherapy, growth factors (such as G-CSF) or both. When circulating in the blood they are easy to collect by using an apheresis machine. Cells collected in this way are already primed by the growth factors and start growing in the patient sooner. It is also easier for the patient to donate stem cells this way than undergo an anesthetic and a bone marrow harvest. No one can agree on the name for these cells, the names used include: peripheral blood stem cells, (and because all blood is peripheral) blood stem cells, progenitor cells or just blood cells. Because the cells start in the bone marrow and end in the bone marrow they are really just a sub-type of bone marrow transplant. Most of the transplants we do use stem cell transplants.

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What is graft-versus-host disease?

Graft-versus-host disease or GVHD is where the "graft" (the bone marrow you are given) reacts against the "host" (the person receiving the transplant). If a person gets a kidney transplant they can recognize that the kidney is foreign and try to reject it. In a bone marrow transplant it is the bone marrow that has the immune system and the marrow "rejects" the person. There are two distinct clinical patterns to GVHD. The first occurs early (within 100 days) after a bone marrow transplant and is called acute GVHD. This results in damage to the lining of the gut, the liver and the skin. If GVHD occurs later than 100 days it is called chronic GVHD. This is characterized by more scarring. Mouth and skin changes are common as are liver lesions. The mouth may become very dry though lack of saliva and the eyes through lack of tears.

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Why is graft-versus-host disease sometimes a good thing to have?

Graft-versus-host disease is sometimes a good thing to have because as well as the immune system from the new bone marrow "rejecting the body" it also rejects the cancer cells. This is called the graft-versus-leukemia or GVL effect. There are a number of lines of evidence that support this concept. If you perform a bone marrow transplant using an identical twin as the donor, patients don't develop GVHD. However, the relapse rate after bone marrow transplant is much higher than when you use marrow from a brother or sister who is the same tissue type but not identical. It has also been shown that there is also a lower rate of relapse in people who develop GVHD. The strongest evidence is when someone relapses after an allogeneic transplant they can go into remission if you give back white cells from the original donor.

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What is my Tissue Type? Is it the same as blood type?

Your blood type reflects molecules that are on the surface of your red blood cells that are recognized by you immune system. (e.g. you might be A+). Your tissue type is determined by the molecules present on the surface of all the cells in your body. The other name for tissue type is the HLA type (Human Leukocyte Antigen). You inherit six of these molecules from each of your parents (6 pairs in total). Three of these pairs are more important in determining how you accept someone else's tissue or bone marrow. If you and you sister or brother inherit the same three pairs it is called a six out of six match. Even if you are a 6 out of 6 match you can have a different blood type but this is not important in determining whether someone will make a suitable bone marrow donor.

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Can I have visitors while I am in hospital?

Yes. Although your immune system is low and you are prone to getting infections during the bone marrow transplant, most infections are from bacteria that are present in your own body. We filter the air of your hospital room to remove any bacteria of fungus in the air. The chance of catching an infection from someone who is well is very low and the importance of having visitors when your spirits are low far outweighs this small risk.

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Tell me about bone marrow/stem cell transplant care at Rush.

For more information visit the Bone Marrow Transplant Center at Rush University Medical Center in Chicago, Illinois, home page.

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Contact Name
Bone Marrow Transplant Center
Contact Phone
(888) 352-RUSH
Contact E-mail
contact_rush@rush.edu


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