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Engraftment is when transplanted stem cells enter the bloodstream, make their way to the bone marrow and start making new blood cells. Engraftment occurs 10 days to 4 weeks after a stem cell transplant.
The time between when the conditioning therapy is given and engraftment takes place is very important. During this time, recipients can feel tired and generally unwell. Until their bone marrow starts to recover, recipients are at risk of fever, infection, bleeding, anemia, damage to the vital organs (such as the heart, lungs, liver and kidneys) and nutritional problems. Most of these problems are worse when the blood count is at its lowest, usually 2–3 weeks after the transplant. The healthcare team will monitor the recipient very closely during this time.
The recipient may be kept in isolation to reduce the chance of infection. The healthcare team will do daily blood tests and regular temperature checks. They will also monitor the recipient for bleeding, nausea, vomiting, diarrhea and any other problems.
When necessary, the recipient will receive blood transfusions and medicines for infection. Nutritional supplements may be given, or in more severe situations, special nutritional fluid is given through the central venous catheter (parenteral nutritionparenteral nutritionGiving nutrients and other substances directly into a vein (intravenously).).
Until engraftment takes place, colony-stimulating factors, such as filgrastim (Neupogen), may be given to:
Engraftment can be confirmed with blood tests and a bone marrow sample. Gradually, the blood cell counts begin to rise as new blood cells are made. When this happens, and if there are no complications, recipients may be allowed to go home or move into accommodation close to the transplant centre. They must remain nearby in case they have a problem and need to go back to the hospital.
Before recipients can leave the hospital, they must:
An allogeneic transplant uses stem cells from a donor. It is a more intensive procedure than an autologous transplant, which uses the recipient’s own stem cells. It may take longer for the bone marrow to recover after allogeneic transplant, so the recipient is at risk for problems, such as infection, for a longer period of time. The recipient may be in the hospital for 4–6 weeks (an average of about 5 weeks for an allogeneic transplant). People who have an autologous transplant may need to spend less time in the hospital.
Recovery time varies from person to person. Some people may need to stay in the hospital longer if problems develop. Recipients may still tire easily and feel weak for months because it can take 6–12 months, or longer, for the immune system to recover.
The recipient will have frequent checkups after discharge. Daily assessment and treatment may be needed until:
Follow-up schedules may vary from person to person, but they usually follow the same general schedule.
For the first 3 months after leaving the hospital, recipients are usually assessed at least once a week.
Until blood cell counts return to normal, recipients are encouraged to:
Any infections will usually need to be treated. Recipients continue to take drugs to lower the risk of infection and graft-versus-host disease.
After 3 months, the doctor will decide how often follow-up needs to be done. If there are no serious problems, follow-up may be done less frequently, such as every 3–6 months.
Follow-up is done to assess:
If there are no problems or complications, follow-up visits will happen once a year with the family doctor or hematologist (a doctor who specializes in treating blood disorders). Sometimes a return visit to the transplant centre may be needed.
Checkups can include:
One hundred days after the transplant (Day 100) is an important milestone for people who have had a stem cell transplant. They may undergo restaging tests to determine the status of the disease and its response to treatment.
Recovery depends on the person’s physical condition before the transplant and the side effects they experienced. Many people will not have any major problems after leaving the hospital, but recovery occurs gradually. Talk to the doctor about when to return to school or work and to resume exercise and sexual activity.
By the end of the first year, the immune system usually returns to normal and the bone marrow produces blood cells normally again. It may take longer for some people, especially if they are on immune-suppressing drugs. About 1–2 years after stem cell transplant, most people need to be immunized with vaccines that are commonly given in childhood (such as polio and measles vaccines). Talk to the doctor about which vaccines should be given to help restore the immune system
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.