Side effects of stem cell or bone marrow transplant

You have fewer white blood cells in your bloodstream after your treatment. This means you are more at risk of getting an infection. You are most likely to get an infection from the normally harmless bacteria we all have in our digestive systems and on our skin.

To help prevent infection from body bacteria, you might have mouthwashes and tablets known as gut sterilisers (these are antibiotics). And your nurse will encourage you to have a shower each day.

You are also at risk of infection from food. The nurses on the ward will tell you and your relatives about the food you can and can't eat. Advice might include:

• hot meals must be thoroughly cooked and eaten fresh
• fruit must be washed and peeled
• salads must be carefully washed (but are usually not allowed)
• you can't have lightly cooked or raw eggs
• you can't have fresh cream or soft cheese

You are at risk of getting an infection called cytomegalovirus (CMV) which can affect the lungs. Let your doctor or nurse know if you feel breathless.

The domestic staff clean your room every day. Your visitors have to wash their hands before they come into your room. And they might have to wear disposable gloves and aprons. Visitors with coughs and colds are not allowed. Some hospitals don't allow you to have flowers in your room, because germs can grow in the water.

Even with all these precautions, most people do get an infection at some point and have to have antibiotics. You can help yourself by trying to take care of your mouth properly, getting up to shower and having your bed changed each day. It is important to try to do this even on the days when you really don't feel like it.

Your platelet levels in the blood will fall after your treatment. Platelets help the blood to clot. A low platelet level means you are at risk of bleeding. Tell your nurse or doctor straight away if you have any of the following signs:

• blood in your urine
• blood when you have your bowels open
• bruises or tiny red spots on your skin
• nosebleeds
• bleeding gums

You might need a platelet transfusion. 

Some people have a reaction to the platelets. This can make you feel hot, itchy and shivery when you are having the transfusion. Tell your doctor or nurse if you have this. They will give you medicines to reduce the reaction.

Your platelet count can take quite a while to get back to normal after a bone marrow or stem cell transplant. After having your own stem cells (an autologous transplant) it can take a few months to really recover. 

Mouth ulcers are very common after a transplant. They can develop as a reaction to chemotherapy or radiotherapy or from a mouth infection.

Your nurse can give you mouthwashes and sometimes lozenges or pastilles to suck to try to prevent infection. You must be very careful not to damage the lining of your mouth. It can be very delicate just after a transplant. If your mouth is very sore, tell your nurse. They can give you painkillers.

You can expect to feel very tired and run down after your transplant. The tiredness is usually at its worst during the second and third weeks, when your blood counts are at their lowest.

When your blood counts start to pick up, you start to feel better. You have less risk of getting infections. And you don't need blood and platelet transfusions so often. As side effects wear off, your appetite usually begins to come back.

Slowly you start to feel that you have more energy. But you do feel more tired than usual for quite a long time after your transplant. You might tire more easily than usual for several months.