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Patient Instructions

You have had a bone marrow transplant. It will take 6 months or more for your bone marrow to recover fully. During this time, your risk for infections, bleeding, and skin problems is higher.

Your body is still weak. It will take up to a year to feel like you did before your bone marrow transplant. It is likely that you will get tired very easily. And, you will likely have a poor appetite.

Brush your teeth and gums 2 to 3 times a day for 2 to 3 minutes each time. Use only a soft bristle brush for now.

• Let your toothbrush air dry between brushings.
• Use a toothpaste with fluoride.

Floss gently one time a day.

Rinse your mouth 6 times a day with a salt-and-baking-soda solution (mix one half teaspoon of salt and one half teaspoon of baking soda in 8 ounces or 1 cup of water).

Chew sugarless gums or suck on sugar-free popsicles or sugar-free hard candies. Avoid mouth rinses that have alcohol in them. Do not eat foods and drinks that have a lot of sugar in them.

Use your regular lip-care products to keep your lips from drying and cracking.

Take care of your dentures, braces, or other dental products.

• If you wear dentures, put them in only when you are eating. Do this for the first 3 to 4 weeks after your transplant. Do not wear them at other times during the first 3 to 4 weeks.
• Brush your dentures 2 times a day. Rinse them well.
• Soak your dentures in an antibacterial solution (a solution to kill germs) when you are not wearing them.

You need to take care not to get infections for up to 1 year after your transplant.

Practice safe eating and drinking.

• Be careful what you eat. Do not eat or drink anything that may be undercooked or spoiled.
• Make sure your water is safe.
• Know how to cook and store foods safely.
• Be careful when you eat out. Do not eat raw meat or fish, or anything else you are not sure is safe.

See also:

• Safe eating during cancer treatment
• Safe drinking during cancer treatment

Wash your hands with soap and water often:

• After being outdoors
• After touching body fluids, such as mucus or blood
• After changing a diaper
• Before handling food
• After using the telephone
• After doing housework
• After going to the bathroom

Keep your house clean. Stay away from crowds. Ask visitors who have a cold to wear a mask, or to not visit. Do not do yard work or handle flowers and plants.

Be careful with pets and animals.

• If you have a cat, keep it inside.
• Have someone else change the litter box every day.
• Do not play rough with cats. Scratches and bites can get infected.
• Stay away from puppies, kittens, and other very young animals.

Ask your doctor what vaccines you may need and when to get them.

Know how to care for your central venous line or PICC line.

If your doctor or nurse tells you your platelets are still low, learn how to prevent bleeding. See also: Bleeding during cancer treatment

Start to walk. Slowly increase how far you go based on how much energy you have.

You need to eat enough protein and calories to keep your weight up.

See also: Eating extra calories when you are sick - adults

Ask your doctor about liquid food supplements. These can help you get enough calories and nutrition.

Be very careful about being in the sun. Wear a hat with a wide brim. Use sunscreen with SPF 30 or higher on any exposed skin. Do not smoke.

You will need close follow-up care from your transplant doctor and nurse for at least 3 months.

If you have any of these symptoms, call your doctor:

• Fever, chills, or sweats. These may be signs of infection.
• Redness or drainage from any place where you have a line inserted into your body
• A new skin rash or blisters
• Jaundice (the white part of eyes or skin looks yellow)
• Pain in your stomach area
• A very bad headache or a headache that does not go away
• A cough that is getting worse
• Trouble breathing when you are at rest or when you are doing simple tasks
• Burning when you urinate

If you have had an allogeneic transplant (bone marrow cells from someone else) and are having any of these signs of graft-versus-host disease (GVHD):

• Diarrhea, stomach cramps, nausea, vomiting, or loss of appetite
• New skin rash
• Jaundice (white part of eyes or skin looks yellow)

Transplant - bone marrow - discharge; Stem cell transplant - discharge; Hematopoietic stem cell transplant - discharge; Reduced intensity, non-myeloablative transplant - discharge; Mini transplant - discharge; Allogenic bone marrow transplant - discharge; Autologous bone marrow transplant - discharge; Umbilical cord blood transplant - discharge

Bishop MR, Pavletic SZ. Hematopoietic stem cell transplantation. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 32.

Vose JM, Pavletic SZ. Hematopoietic stem cell transplantation. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 184.

Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.