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Follow-up after stem cell transplant
A standard follow-up schedule after a stem cell transplant would not work for everyone with leukemia. There will be frequent checkups after discharge. Daily assessment and treatment may be needed until:
- the new bone marrow is working properly
- there are no serious problems
- it looks like the leukemia is under control
First 3 months
For the first 3 months after leaving the hospital, the person is usually assessed at least once or twice a week.
- Frequent blood tests are done to check blood cell counts.
- People take antibiotics and antiviral drugs to reduce the risk of infection.
- If donated stem cells were used, doctors may prescribe drugs to suppress the immune system and reduce the risk of graft-versus-host disease.
- Blood or platelet transfusions may be needed.
- The recipient may need to go back to the hospital if they feel unwell. They should always carry a 24-hour hospital contact number and get in touch with the hospital right away if they develop:
- a fever over 38°C
- infection of the skin or teeth
- skin rashes
- severe diarrhea
- shortness of breath or trouble breathing
Until blood cell counts return to normal, the recipient is encouraged to:
- Eat a healthy diet and avoid possible risks of infection from foods. Alcohol use during this time can increase the risk of bleeding or interfere with medicines.
- Avoid crowded places, such as shopping malls, to reduce the risk of coming in contact with infections.
- Avoid contact with children who have recently been exposed to infectious diseases (such as chicken pox) or immunized with live viruses (such as a certain polio vaccine).
- Follow the doctor's instructions to reduce the risk of infection.
- Carry or wear a medical alert card, bracelet or necklace.
After 3 months
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:
- the person's health
- any problems or concerns
- whether any medicines or activities need to be adjusted
- how well the bone marrow is working
- whether the cancer has come back (recurred)
- The risk of recurrence (relapse) depends on the status of the cancer at the time of transplant.
- If a relapse does occur, it's usually within the first 2 years after the transplant, but it can also happen several years later.
If there are no problems or complications, follow-up visits will happen once a year with the family doctor or hematologist. Sometimes a return visit to the transplant centre may be needed.
Checkups can include:
- physical examination
- blood tests
- periodic bone marrow aspiration and biopsy
- imaging tests, such as computed tomography (CT) scan or possibly a positron emission tomography (PET) scan
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. Discuss with the doctor about when to return to school or work, resuming exercise, and sexual activity.
By the end of the first year, the immune system will have returned to normal and the bone marrow will be producing blood cells normally again. It may take longer for some people to recover, especially if they are on immune-suppressing drugs. To help restore the immune system, transplant recipients should talk to their doctor about being vaccinated again 1–2 years after the transplant.