Transplant & Beyond
Engraftment
Approximately 10-14 days following your transplant, signs that your stem cells are growing (engrafting) and beginning to produce new blood cells are expected. As this starts to occur, you may notice aching in your bones, especially your pelvis, lower back and thighs. As your blood counts begin to rise, your white blood cells will start to fight and prevent infections. Any fevers you may have experienced while your white blood count was low will start to resolve. Other side effects of the chemotherapy will also start to improve.
Your transplant physician or nurse will let you know when you may stop taking the antibiotics and when other restrictions may be lifted. Remember, however, that it is a good idea to always practice good hand washing no matter what your white blood count is. As your blood counts improve, you will no longer need blood and platelet transfusions and will notice that you do not bruise or bleed as easily. Your fatigue will also start to improve, but keep in mind that your energy levels may take weeks or months to return to normal.
Recovery
Progress during this phase of treatment may seem slow. Keep in mind that the long-term recovery phase may take a year or longer. You may feel frustrated because you want to get well rapidly, but it takes time to recover. Many patients feel depressed at some point during this period. Patients tell us they cope best by taking one day at a time and setting simple, realistic goals for themselves. Community support groups such as the Leukemia Lymphoma Society and Life with Cancer may help. Other recipients of stem cell transplants are also a good source of support. Ask your transplant nurse or physician for names of recipients who are willing to speak with you.
It is common to continue to feel some fatigue in the later months of your recovery. Despite feeling fatigued, it is important to stay as active as possible. You will need to identify the most important activities for you (in other words, pace yourself). Low impact exercise such as walking may help you regain your energy level. Your primary oncologist will let you know when tests will be done to measure the effects of the chemotherapy and the results of the transplant. Some tests are done on the blood and others will be x-rays or scans. You will have regularly scheduled checkups with your primary oncologist as well as the transplant team to monitor your disease and check for any longterm side effects.
Re-establishing your life after transplant varies from difficult and rough to relatively easy and smooth. However, the great majority of patients report that the quality of their lives is now the same or better than before transplant. Despite the intensity of the transplant experience, most patients are able to make adjustments in their life and maintain an optimistic outlook for the future.
Types of Stem Cell Transplants
Autologous Transplants
Use your own stem cells. It is safer for patients to use their own stem cells in a transplant rather than someone else’s because their body will not reject its own stem cells. But it also means that these patients are more likely to have a relapse because their own marrow or blood may still contain some of the cancer cells they are trying to get rid of. Cells from another donor may work better at attacking any leftover cancer cells still in their body.
Allogeneic Transplants
Related Donors-Use stem cells from a matched sibling. Many factors determine how the immune system knows the difference between ”self” and “non-self”, but the most important for transplants is the human leukocyte antigen (HLA) system. Human leukocyte antigens are proteins found on the surface of most cells. They determine a person’s tissue type. (This is different from a person’s blood type.)
How well the donor’s and recipient’s HLA tissue types match plays a large part in determining whether the transplant will be successful. The best matches are where all of the HLA antigens are the same. Because HLA antigens are inherited, the search for a donor usually starts with the patient’s brothers and sisters, if possible. The chance that any sibling would be a perfect match (that is, that you both received the same set of HLA antigens from each of your parents) is 1 out of 4.
Matched Unrelated Donors (MUD)
Stem cells can be matched from an unrelated donor. If a good match is not found in a sibling, the search may then move on to a donor search pool of 10 million registered donors or to other relatives.