Step seven: Awaiting engraftment

High-dose therapy can cause a variety of side effects as it destroys normal cells in addition to cancer cells. Some of these side effects may be apparent during the chemotherapy or immediately afterward. Other side effects may not occur until days, weeks or even months later.

Your body will begin to repair the damage from the high-dose therapy as soon as it occurs, but the repair efforts will be more effective once your blood counts have recovered. You and your caregiver will be taught how to treat and relieve these side effects.

You will need careful monitoring until you recover from most of the side effects of the high-dose therapy and your stem cells begin to grow. You will have lab work done and will be seen by a doctor daily.

The most common side effect of the high-dose therapy is low blood cell counts. You will be supported with red blood cell transfusions and platelet transfusions until your body makes enough of these cells on its own. You also may receive injections of a growth factor to stimulate the growth of your stem cells.

Because your white blood cells will be low, you will be at risk for infections and will be given antibiotics to prevent or control these. While your white blood cell count is low, it is very important for you and your caregiver to practice good hygiene habits.

About 10 to 12 days after your transplant, we expect to see signs that your stem cells are growing (engrafting) and beginning to produce blood cells. 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. If you have had fevers while your white blood count was low, they may get better now.

Your doctor or nurse will let you know when you can stop taking antibiotics and relax some other restrictions. Remember, it is a good idea to wash your hands often regardless of your white blood count. Transfusions will no longer be needed, and other side effects you may have experienced will resolve.