Stem Cell and Bone Marrow Transplant Recovery
May 6, 2024
This page was reviewed under our medical and editorial policy by Leslie Popplewell, M.D., Hematologist and Medical Director of Hematology and Blood and Bone Marrow Transplant, City of Hope Atlanta
Stem cell or bone marrow transplants may save the lives of people with blood cancers, also called hematologic malignancies. A bone marrow transplant procedure replaces stem cells or bone marrow with healthy cells from a patient’s own body (autologous transplant) or from a donor (allogeneic transplant). These transplants are also known as hematopoietic cell transplants (HCT) to reflect the fact that they use various cell types to treat a patient.
Life After a Stem Cell or Bone Marrow Transplant
After a stem cell or bone marrow transplant, patients must take steps to stay as healthy as possible, including by eating well, taking medications as directed and reducing any and all risks for infection. Patients should follow their cancer care team’s guidelines on what they may and may not do — and when in doubt, ask.
It’s also important to be patient. Transplant recipients have an all-new immune system, and the body needs time to embrace it. Recovery from a stem cell or bone marrow transplant is a journey.
Prepping Your Home for Return
About two to four weeks after a transplant, new cells typically engraft and start producing new blood cells. This is most likely when the patient goes home. The home should be thoroughly cleaned beforehand to reduce the risk for infections. Someone else should do the cleaning.
Here’s an example of a to-do list that may be useful:
- Shampoo rugs and wash floors.
- Scrub bathroom and kitchen tile floors to get rid of any mold and mildew.
- Use a disinfectant, such as bleach or ammonia, to clean areas in kitchens and bathrooms where infection-causing bacteria may lurk.
- Thoroughly clean drapes, blinds and upholstered furniture, along with furnace and air conditioning filters.
- Keep doors and windows closed as much as possible.
- Get rid of any live indoor plants and avoid gardening and contact with plants and soil during recovery.
Patients are probably eager to see beloved pets after weeks in the hospital, but some may pose risks to people with compromised immune systems. Infections may spread while cleaning up after a pet, from bites, scratches or even cuddling. Patients may reduce these risks by keeping pets as clean as possible and making sure they’re up to date on key vaccines. Some may want to consider having them tested for parasites or toxoplasmosis. Patients shouldn’t sleep with a pet during recovery. Litter boxes and pet beds should be placed in a different part of the house. Patients should avoid cleaning up after pets as well.
Certain pets may pose greater risk than others during cancer treatment. These may include:
- Reptiles
- Chickens
- Ducks
- Rodents and pocket pets (such as guinea pigs, gerbils or hamsters)
- Chinchillas
- Exotic animals
It may be necessary to find a temporary home for pets until patients get the all-clear from their care team.
Dietary Restrictions
Eating a healthy, well-balanced diet is an important part of a patient’s recovery from a bone marrow or stem cell transplant. Patients need to get the appropriate amount of calories and protein to fight infection and recover. However, certain treatment side effects and complications — such as mouth sores, nausea and vomiting, dry mouth, taste changes and fatigue — often pose obstacles. Working with a dietitian is one way to ensure patients get needed nutrients.
It’s also just as important to avoid foods that may contain infection-causing organisms, especially in the first three months after a transplant, including:
- Raw or undercooked meat
- Raw or undercooked eggs
- Raw or undercooked seafood
- Raw or unshelled nuts
- Miso- and tempeh-based products
- Non-pasteurized milk products and juices
- Moldy or soft cheeses
- Meats and cheeses from a deli
- Smoked, uncooked, refrigerated fish, such as lox
- Pickled seafood
- Raw honey
- Salad bars and buffets
Another key to infection prevention is paying close attention to food safety and storage. This includes washing hands before handling any food and cleaning cutting boards and countertops with hot soapy water and a weak bleach solution. Raw meat and poultry should be kept away from foods that won’t be cooked, and foods should always be cooked to a safe temperature. A food thermometer may help eliminate guesswork.
Patients should avoid eating any cooked foods left at room temperature for more than two hours. Leftovers should be refrigerated and then reheated thoroughly before serving. Takeout food is OK if temperatures don’t cause concerns.
Self-Care and Hygiene
Practicing good self-care and hygiene is essential to reducing risk of infection during recovery from a bone marrow or stem cell transplant. Proper oral care includes brushing teeth after each meal and at bedtime with a soft toothbrush or swab and soaking dentures daily in a denture cleaner. Patients may use tap water and any toothpaste they prefer, but it’s wise to avoid mouthwashes with alcohol, which may be irritating. Patients should report any oral symptoms, such as dryness, bleeding or sores, to their doctor.
Both showering and bathing are OK during recovery, but patients should use only mild soaps and shampoos. Makeup, aftershave or perfumes are OK in small amounts. Patients should buy all new products after their transplant.
After a bone marrow or stem cell transplant, skin may be especially sensitive to the sun’s ultraviolet (UV) rays. Patients should avoid direct sun for at least one year. When outdoors, it’s important to use sunscreen greater than SPF 30 daily and cover up with a hat and long-sleeved shirt.
While the immune system recovers, patients should avoid getting a manicure or pedicure in a salon and instead groom their nails at home using their own tools. Body piercings and tattoos should wait, as they pose a risk of hepatitis and other infections. Patients should also tell their doctor about any rashes or blisters that develop.
In the case of cuts or injuries that bleed, patients should put a clean, dry gauze pad, towel or cloth over the cut and apply pressure until the bleeding stops. If this doesn’t work, they should elevate the wound, apply ice and call their care team. Patients who have a nosebleed should sit up and lean forward, squeezing the bridge of the nose firmly for at least 10 minutes. If the nosebleed continues, they should keep squeezing, apply ice and call their care team.
How Long Will the Patient Stay in Isolation After a Stem Cell Transplant?
Patients will be isolated for 100 days after a bone marrow or stem cell transplant as the new immune system starts working, avoiding public spaces and crowds.
Patients should also be very careful about having guests. Meeting people outdoors is considered safer than indoor get-togethers. Transplant patients should wear an N95 mask or an equivalent when around others, and ask visitors to do the same.
Stem Cell and Bone Marrow Transplant Recovery Timeline
Recovery from bone marrow and stem cell transplant takes time. The days before transplant are considered minus days, while the day of the transplant is known as Day Zero. Recovery officially starts on Day +1.
For the first week after Day +1, blood counts will be low and a patient’s risk of developing an infection will be high. Patients will also take antibiotics to ward off infection. Over time, the patient’s new cells will start to grow and produce new blood cells (in a process known as engraftment), and blood counts will gradually return to normal. As a result, patients may start to feel more normal, and infection risk will decrease. From Day +12 to +30 of recovery, patients may be sent home on medications to prevent infections. Day +30 to six months will involve active monitoring by the transplant team.
First 100 Days
For the first 100 days after a bone marrow or stem cell transplant, patients may expect to have frequent visits with their doctor to make sure the recovery is going smoothly. The treatment team will monitor for infections and other potential complications.
During this time, the engraftment process occurs. In patients who had an allogeneic transplant, the team will watch for graft-versus-host disease (GVHD), which may occur if the donor cells think the transplant recipient’s stem cells are a threat and go on the attack.
Patients may expect lab tests, physical exams and discussions of how to manage complications. Many experts suggest avoiding travel during the first 100 days after a transplant and avoiding air travel or public transport for nine to 12 months, if possible.
Patients won’t feel like themselves in the first few weeks. They may expect side effects from the chemotherapy administered before the transplant, including:
- Nausea
- Vomiting
- Decreased appetite
- Taste changes
- Hair loss
- Fatigue
- Weakness
- Mouth sores
- Diarrhea
- They may also develop a fever or infection.
Most of these symptoms improve two to three weeks after the transplant. The first 100 days is the time for patients to strictly adhere to all guidelines from their care team on cleaning their home, self-care and hygiene, crowd avoidance and all other measures that may lower any risk for infection. Each day, the risk of infection declines.
100 Days After Stem Cell or Bone Marrow Transplant
Reaching the 100-day mark after a stem cell or bone marrow transplant is a major milestone. It means that engraftment is well underway and the risk for serious complications, including infection and GVHD, is subsiding.
One Year
It takes up to one year after transplant for the immune system to work as well as it should. Patients will need to receive vaccines again once their immune system has recovered.
- Autologous transplant patients typically receive inactivated vaccines six months after their transplant and live vaccines at 24 months.
- Patients who have had allogeneic transplants may be told to wait until 12 months to start vaccination.
Patients should ask their doctor what they may and may not do as they enter this important next chapter. Many restrictions will likely be lifted.
Spiritual and Mental Health
It’s normal to experience a lot of emotions after a bone marrow or stem cell transplant. Patients may feel grateful, angry, stressed and anxious about the future, and they may feel all these emotions in the same afternoon.
City of Hope offers spiritual counselors, psychologists/psychiatrists, social workers, grief counselors and support groups to help patients work through these feelings and learn ways to cope.
Learn more about the bone marrow transplant support services City of Hope offers
For additional details on recovery from a bone marrow or stem cell transplant, see our guides on:
City of Hope. The Basics About Blood and Marrow Stem Cell Transplantation: A patient’s and caregiver’s guide for an allogeneic transplant.
https://www.cityofhope.org/sites/www/files/2022-05/bmt-allogeneic-transplant-patient-and-caregiver-guide.pdfAmerican Cancer Society (2023, February 9). Caring for Pets During Cancer Treatment.
https://www.cancer.org/cancer/managing-cancer/side-effects/low-blood-counts/infections/safety.htmlBlood & Marrow Transplant Information Network (2023, August). Nutrition After Transplant.
https://www.bmtinfonet.org/transplant-article/nutrition-after-transplantLymphoma Research Foundation. Understanding The Stem Cell Transplantation Process.
https://lymphoma.org/wp-content/uploads/2020/11/LRF-Transplant-Guide-2018.pdfNational Cancer Institute (2023, October 5). Stem Cell Transplants in Cancer Treatment.
https://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant#how-long-it-takes-to-have-a-stem-cell-transplantAmerican Society of Clinical Oncology (2023, June 20). What to Expect During Recovery From a Bone Marrow Transplant: An Expert Q&A.
https://www.cancer.net/blog/2023-06/what-expect-during-recovery-bone-marrow-transplant-expert-qaAmerican Cancer Society (2020, March 20). Stem Cell or Bone Marrow Transplant Side Effects.
https://www.cancer.org/cancer/managing-cancer/treatment-types/stem-cell-transplant/transplant-side-effects.html