Bone Marrow Transplant

Autologous Transplant Guide: Outpatient Care After Chemotherapy

Routine Outpatient Visits

Your bone marrow transplant (BMT) doctor and nurse practitioner will follow you throughout your BMT procedure and experience at UCSF Medical Center. You will have blood work done and, if necessary, will be given intravenous medications or fluids.

Problems That Should Be Reported Immediately

• Temperature over 100.3 degrees Fahrenheit or 38 degrees Celsius
• Chills, sweating
• Redness, swelling, pain or discharge around the central line
• Bleeding
• Coughing, shortness of breath or chest pain
• Persistent nausea or vomiting
• Frequent or painful urination, blood in the urine
• Weight loss greater than 5 pounds
• Painful blisters on the skin
• Skin rash, diarrhea, abdominal cramping or pain, yellowing of skin or whites of eyes
• Inability to keep medications or fluids down due to nausea

Keeping Healthy

Your risk of infection will remain higher than normal for at least three months after autologous BMT even though your body is again producing white blood cells. The highest risk is within the first month of leaving the hospital and during this period you should spend most of your time at home and away from people (this is called house arrest). You should not go to the supermarket, church, movie theater or any place where there may be large crowds of people. You may have visitors, but people who are ill should not visit. If there are family members or household members, including kids, who are ill, you must do your best to keep away from them, either by staying in separate rooms or keeping them at a distance. To help prevent infection, do the following:

• Stay away from anyone that is ill or is coughing
• Wash your hands after using the bathroom, before eating and every time you return home
• If you feel you may have a fever, take your temperature and if you have a fever, call the clinic
• Do not have any immunizations until one year after BMT and avoid children who have been immunized with live virus vaccines within the previous four weeks
• Wash your hands carefully after handling pets, and do not clean up animal feces. This includes cat litter boxes, your dog's excrement in the yard, etc.
• Avoid swimming in lakes, rivers, swimming pools or hot tubs (both public and private)
• Avoid flossing your teeth until your platelet count is over 50,000. Use a soft toothbrush to clean your teeth.
• When near a construction site, wear a mask
• Avoid activities with exposure to dust or dirt that may be a source of infection
• Contact lenses can be worn only after your counts have returned to normal
• Do not smoke

Bleeding Precautions

Your platelet count may not be back to normal levels when you are discharged. If it is low, take the following precautions:

• Use an electric razor instead of a straight edge razor
• Do not blow your nose forcefully
• If you tend to be constipated, use a stool softener so that you will not have to strain when having a bowel movement
• Do not use rectal thermometers or suppositories, enemas, tampons or douches
• Avoid strenuous forms of exercise or activities which have potential for injury

If you have an injury which bleeds, apply pressure over the injured area. Keep applying pressure until the bleeding stops, which may take several minutes. If the bleeding does not stop, apply ice, maintain the pressure and call your clinic doctor or go to the emergency center.

Good Nutrition Habits

Your appetite may not have returned by the time you leave the hospital, so you may have to try harder to get the calories you need. Your dietician can help you to plan for meals before you are discharged. The guidelines listed below may help you to maintain or improve your nutritional status.

• Eat small snacks and five or six small meals a day instead of three large meals
• Eat high-calorie, high-protein snacks such as milk shakes, cheese and crackers, nuts, high-calorie supplements, etc. Add gravies and margarine to foods you already eat
• Drink eight large glasses of fluid daily. Try to include fluids with calories (instant breakfast, sports drinks, etc.) and avoid excessive amounts of caffeine (i.e. colas, coffee, tea)
• Avoid alcoholic beverages, as they can interact with medications and injure your liver
• Do not eat from salad bars or buy foods from bulk containers in the grocery store, as the food may contain bacteria that can cause infection
• Do not eat raw meat or raw seafood (including raw oysters, fish or sushi)
• Do not eat raw fruits or vegetables until your neutrophil count is over 1000
• Watch for stomach cramps, diarrhea or gas after eating or drinking milk or milk products, which could indicate an inability to digest lactose

Caring for Your Skin

Your skin will be drier than usual after treatment. Use a soap that contains a moisturizer and also use a moisturizing lotion, especially after bathing or showering. Use a crȿme rinse or conditioner after shampooing to moisturize your hair and scalp. Wear a hat, long sleeves and long pants when outdoors during the day whenever possible. Always apply sunscreen (SPF 15 or higher) and limit the amount of time spent in the sun.

Resuming Sexual Activity

You may have questions regarding issues of intimacy and sexual activity after bone marrow transplantation and should feel free to ask your doctor or nurse. Your partner also may have questions and want to be involved in any discussion.

You may feel free to hold, kiss, hug and sleep in the same bed as your partner unless your partner is ill. You may resume intercourse once your platelet count and neutrophil counts are high enough, such as a platelet count of about 50,000 and neutrophil count of about 1500. Anal and oral intercourse may increase the risk of infection.

Many people notice a change in desire or interest in sexual activity, which is usually related to hormonal changes as a result of the chemotherapy. This is a temporary situation and not a reflection of a change in your feelings of love or need for closeness.

The American Cancer Society (ACS) has a booklet called "Sexuality and Cancer" (one for men and his partner and one for women and her partner) which may be helpful and can be obtained either on 11 Long, through the outpatient social worker or by calling the ACS at 800-ACS-2345.

Infertility generally follows high-dose chemotherapy or TBI treatment. Sperm or egg banking should be done well before admission for transplantation if this is a concern. An interruption in the menstrual cycle is common in women, and long-term estrogen replacement may be recommended for some women. However, fertility may occur in a small percentage of both men and women. You should discuss hormone replacement with your family doctor or gynecologist. Fertility may occur in a small percentage of both men and women after transplant and contraception should be used to protect against unwanted pregnancy.

After BMT

The appropriate time to return to work varies from patient to patient. In general, it is advised to not expect to return to work for the first year post transplant. However, some patients are able to return to work at least part time if the work place is secluded. Check with your doctor about your expected return to work.

If you live in the San Francisco area, you may continue your follow-up and care here at UCSF Medical Center. If you are from outside the area, be prepared to return to UCSF within the first seven to 10 days after discharge following transplant and then again at three months post-transplant. These visits will be used to evaluate how your recovery is progressing. At three months you will likely have an evaluation of your cancer. This may include X-rays, CAT scans, PET scans, blood tests, urine tests and possibly a bone marrow biopsy. After three months time, you will likely be followed by your local oncologist and will return to UCSF at one year post-transplant and then yearly after that. You will be scheduled to start vaccines at one year, just like a newborn child. Although you will be followed by your local doctor, you will always be able to reach your UCSF health care provider for any questions by calling the clinic at (415) 353-2421.

• Autologous Transplant Guide
• Bone Marrow Transplant
• Blood Disorders

Reviewed by health care specialists at UCSF Medical Center.
Last updated May 8, 2007

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.