Always follow the advice of your care team.
General Precautions
Follow these guidelines for 100 days after your stem cell infusion (Day 0) unless noted or directed otherwise by your care team. Speak with your care team about any specific questions you have.
You are at highest risk of infection during the first year post-transplant. It can take 12 to 18 months for your immune system to recover from your transplant. Your immune system is your body’s infection-fighting system. The best way to prevent infection is to prevent germs from entering your body in the first place. The most common ways germs enter your body are through your:
Skin/Hand Hygiene
One of the best ways to prevent infection is hand hygiene. Hand hygiene includes washing your hands (with soap and water) and hand sanitizer (using an alcohol-based hand rub such as Purell®). Wash your hands frequently (and have family/friends do so as well) with soap and warm water. Carry a small bottle of hand sanitizer (such as Purell®) to make hand sanitizing easy wherever you go.
Handwashing: Wash your hands with soap and water:
Handrubbing: Use hand sanitizer:
Gloves
Gloves work as a barrier for your hands. Gloves are only effective if they are clean. Once your gloves are dirty, remove them, use hand sanitizer, and replace with a new pair of gloves if needed. Do not eat while wearing gloves and avoid touching your eyes, nose, or your mouth. Wash your hands when you take off your gloves.
Wear gloves when you are:
Carry clean gloves with you to use in case you come in contact with someone who is ill or has been exposed to an infection, or if they become dirty or wet. Replace your gloves if they become soiled or wet, and after each use.
Respiratory Hygiene
Many infections can happen through breathing in germs from other people or your surrounding environment. Germs spread by coughing and sneezing are examples. Construction sites or places that are damp are another risk because mold/fungus can be carried in the air.
The best way to prevent the spread of respiratory infections is by:
Masks
Avoiding people who are sick or public places is the best way to prevent the spread of infection, but if you cannot avoid it, wear a clean, surgical or simple mask to reduce your risk to exposure. Like gloves, the mask only works if it is clean. If the mask gets soiled or wet, replace it with a new one. Carry a clean mask with you in case you need to replace one that becomes dirty or wet.
You should wear a mask when you are:
Others around you should wear a mask if they have:
Gastrointestinal Hygiene
Gastrointestinal hygiene includes safe food handling, preparation, and intake. Foodborne illness can be reduced significantly by following these guidelines.
High-Risk Activities
Activities or situations that can put you at high risk of infection include:
Personal Hygiene
Mouth Care
Maintaining a good dental care routine will help prevent infection as you recover from your transplant. One of the most important things to remember is to be gentle when brushing or flossing. Your platelet count may still be low as you recover from your transplant, which may cause your gums to bleed a little in the beginning. Follow the guidelines here and in the comprehensive guide to help you maintain a healthy mouth. Tell your care team if you develop any soreness or pain in your mouth.
Going to the Dentist
If you have dental problems at any time during your recovery, consult your care team about seeing your dentist. Try to schedule your appointment at a time when the dentist has few patients (for example, early in the morning) to avoid contact with people who may have infections or may be sick.
You should make a dental appointment for a routine dental examination generally six to 12 months after your transplant. At your visit, you should have bite wing x-rays taken. This is especially important if the pre-transplant dental evaluation showed that you needed elective procedures that were not performed prior to the transplant, or if you have dry mouth. After this initial visit, see your dentist regularly (i.e., every six months).
Tell your dentist about your medical condition and that you have received a stem cell/bone marrow transplant. They can contact your oncologist and/or primary care physician as necessary.
Dry Mouth
If you have cGVHD, your mouth may become very dry. This makes you more likely to develop cavities or a mouth infection called thrush. Often, the dryness will lessen over time. The following steps may help provide oral comfort.
Mouth Infections
One of the most common infections in the mouth after transplantation is yeast infection, also known as thrush. This appears as white and sometimes red patches in the mouth, which cause soreness.
Another common infection is caused by the herpes simplex virus, the cause of cold sores around the lips. These can occur inside your mouth and resemble canker sores.
These conditions are treatable. If you see red or white patches in your mouth or develop any mouth sores, contact your care team, who will diagnose your condition and prescribe a treatment.
Graft-Versus-Host Disease (GVHD) and Allogeneic Transplant
One of the most common complications after an allogeneic transplant is graft-versus-host disease (GVHD). GVHD is caused when your immune system recognizes your donor's immune system as something foreign. It may occur early (acute) or late (chronic) after the transplant.
Usually, acute GVHD occurs within the first 100 days after your transplant. Acute GVHD can affect the skin, gastrointestinal tract, and liver. Chronic GVHD (cGVHD) may occur later. It affects the same systems as acute GVHD, but may also affect the eyes, mouth, lungs, joints, and vagina. The symptoms of GVHD may be mild or severe.
Management and treatment of these symptoms is controlled with medication. The treatment process for GVHD is long and recovery is slow.
If you experience any of the following symptoms, call a member of your care team:
Pneumonia (and other lung problems)
Because of your risk of developing pneumonia (or other lung infections) after transplant, you will start to take preventive medicine early in your treatment and continue to take this medication for at least one year after transplant. Despite taking medication, you may still develop pneumonia. Smoking or vaping of marijuana or tobacco products can also cause a life-threatening fungal infection. It is therefore extremely important to be completely honest and straightforward with your care team about any smoking.
If you experience any of the following symptoms, call a member of your transplant team:
Please refer to the comprehensive guide - Stem Cell Transplantation: An Information Guide for Patients and Caregivers - for more information.
You are at highest risk of infection during the first year post-transplant. It can take 12 to 18 months for your immune system to recover from your transplant. Your immune system is your body’s infection-fighting system. The best way to prevent infection is to prevent germs from entering your body in the first place. The most common ways germs enter your body are through your:
- Skin (touching things, wounds)
- Respiratory tract (breathing)
- Gastrointestinal (GI) tract (eating)
Skin/Hand Hygiene
One of the best ways to prevent infection is hand hygiene. Hand hygiene includes washing your hands (with soap and water) and hand sanitizer (using an alcohol-based hand rub such as Purell®). Wash your hands frequently (and have family/friends do so as well) with soap and warm water. Carry a small bottle of hand sanitizer (such as Purell®) to make hand sanitizing easy wherever you go.
Handwashing: Wash your hands with soap and water:
- When hands have visible soiling (you can see the thing that has come in contact with your hand)
- Before eating or preparing food
- After using the bathroom
- After touching a pet
- After you sneeze or cough
- If you are around others who are sneezing or coughing
- Before touching your eyes, nose, and/or mouth
Handrubbing: Use hand sanitizer:
- No visible soiling
- After you come into contact with things other than yourself
- Other people
- Objects outside your own environment (Elevator buttons, handrails, car doors)
Gloves
Gloves work as a barrier for your hands. Gloves are only effective if they are clean. Once your gloves are dirty, remove them, use hand sanitizer, and replace with a new pair of gloves if needed. Do not eat while wearing gloves and avoid touching your eyes, nose, or your mouth. Wash your hands when you take off your gloves.
Wear gloves when you are:
- In places that are exposed to many people
- Touching things that have likely been touched by many people.
- Traveling to and from Dana-Farber Cancer Institute (especially if using Uber® or Lyft®)
- Handling anything high risk (e.g., changing a dirty diaper)
Carry clean gloves with you to use in case you come in contact with someone who is ill or has been exposed to an infection, or if they become dirty or wet. Replace your gloves if they become soiled or wet, and after each use.
Respiratory Hygiene
Many infections can happen through breathing in germs from other people or your surrounding environment. Germs spread by coughing and sneezing are examples. Construction sites or places that are damp are another risk because mold/fungus can be carried in the air.
The best way to prevent the spread of respiratory infections is by:
- Avoiding crowds of people
- Avoiding anyone who is or may be sick, or is high risk of being sick
- Do not bring a sick child into your bed.
- Avoid settings where you are likely to come in contact with people who are sick or ill (shopping malls, supermarkets, and enclosed spaces).
- Avoid people who have been ill within the last few days.
- Staying away from construction areas
Masks
Avoiding people who are sick or public places is the best way to prevent the spread of infection, but if you cannot avoid it, wear a clean, surgical or simple mask to reduce your risk to exposure. Like gloves, the mask only works if it is clean. If the mask gets soiled or wet, replace it with a new one. Carry a clean mask with you in case you need to replace one that becomes dirty or wet.
You should wear a mask when you are:
- Traveling to and from the clinic and in public areas of the clinic
- Out in public and there is a risk of contact with many people
- In all enclosed (indoor) public places
- At areas of construction or dusty areas
- Damp or moldy areas
- Walking outdoors and passing areas where lawns are being mowed or past a construction site where dust and dirt are blown.
Others around you should wear a mask if they have:
- An active cough or sneezing
- A recent respiratory infection, cold, or flu
- Allergies that cause a runny nose or cough
Gastrointestinal Hygiene
Gastrointestinal hygiene includes safe food handling, preparation, and intake. Foodborne illness can be reduced significantly by following these guidelines.
- Wash hands with soap and water before touching any food or eating.
- Start with a clean cooking area
- Prepare raw meat or poultry on a separate dish away from other food. Cook meat thoroughly.
- Wash all produce under warm water before cooking or eating (even thick-skinned fruit).
- Keep cold food cold and warm food warm.
- Cook food thoroughly (no medium or rare meat, no runny eggs, no raw fish).
- See the “Eating Safely at Home After Stem Cell Transplant” booklet for more information.
High-Risk Activities
Activities or situations that can put you at high risk of infection include:
- Crowds of people
- Professional sporting events, grocery stores, shopping malls, gyms, large gatherings, parties, or events
- Sick people
- Infants and young children
- Construction areas
- Damp or moldy areas (basements, garages)
- Animals
- Farm animals, exotic animals, stray animals
Personal Hygiene
- Toiletry items: Always use your own clean towel, washcloth, soap, toothbrush, and toothpaste. Do NOT share these or other toiletries with family or friends.
- Bathing: Take a bath or shower every day. Wash and dry your head, face, underarms completely. If daily showers are not possible, wash at a sink or use a basin. Avoid very hot water and use only small amounts of very mild soap.
- Hygiene products: Throw away any personal hygiene products from before your transplant (including hairbrush, comb, toothbrush, makeup, deodorant, etc.), and buy new products.
- Make-up/Creams/Lotions: Replace makeup, creams, lotions, etc. with new products. Use the same brand you used before transplant but buy new products.
- Do not share these items with anyone.
- Apply eye makeup with special care because your lashes and tears may not yet be effective in protecting your eyes.
- Watch for any skin changes after using these products and notify your care team of any rashes or changes.
- Skin Checks: Check your skin daily for rashes or changes. Use a mirror or have someone check your shoulders and back. New skin rashes or skin changes may indicate infection or graft-versus-host-disease. Report any new findings or worsening conditions to your care team immediately. Your care team can provide treatment if necessary.
- Shaving: Nicks and cuts caused by shaving can become sites of infection or bleeding. Shave with an electric razor until your platelet count is higher than 20,000, and your neutrophil count and ANC is over 500. If irritations occur, clean the area with soap and water and apply a small bandage or piece of gauze.
- Contact Lenses: Talk with your care team before wearing contact lenses again. When you begin wearing them again, your eyes may be dry and irritated. New lens fittings may be necessary, or you may need a new prescription. Tell your care team right away if you have any pain in or on the eye.
Mouth Care
Maintaining a good dental care routine will help prevent infection as you recover from your transplant. One of the most important things to remember is to be gentle when brushing or flossing. Your platelet count may still be low as you recover from your transplant, which may cause your gums to bleed a little in the beginning. Follow the guidelines here and in the comprehensive guide to help you maintain a healthy mouth. Tell your care team if you develop any soreness or pain in your mouth.
Going to the Dentist
If you have dental problems at any time during your recovery, consult your care team about seeing your dentist. Try to schedule your appointment at a time when the dentist has few patients (for example, early in the morning) to avoid contact with people who may have infections or may be sick.
You should make a dental appointment for a routine dental examination generally six to 12 months after your transplant. At your visit, you should have bite wing x-rays taken. This is especially important if the pre-transplant dental evaluation showed that you needed elective procedures that were not performed prior to the transplant, or if you have dry mouth. After this initial visit, see your dentist regularly (i.e., every six months).
Tell your dentist about your medical condition and that you have received a stem cell/bone marrow transplant. They can contact your oncologist and/or primary care physician as necessary.
Dry Mouth
If you have cGVHD, your mouth may become very dry. This makes you more likely to develop cavities or a mouth infection called thrush. Often, the dryness will lessen over time. The following steps may help provide oral comfort.
- Stay hydrated. Always keep drinking water nearby.
- Use sugar-free gum to stimulate the production of saliva. Sugar-free hard candies are also ok if you are careful. These candies develop sharp edges and may cut the inside of your mouth and gums.
- Consider using over the counter dry mouth rinses, sprays and gels.
- Ask your doctor for a prescription for saliva-stimulating medications (pilocarpine and cevimeline). You can request a prescription for this from your care team.
- Apply petroleum jelly (such as Vaseline) to dry lips.
- Use prescription fluoride toothpaste, gel and/or rinse every night. You can request a prescription for this from your care team.
- Visit your dentist every 6 months so any cavities can be treated immediately.
Mouth Infections
One of the most common infections in the mouth after transplantation is yeast infection, also known as thrush. This appears as white and sometimes red patches in the mouth, which cause soreness.
Another common infection is caused by the herpes simplex virus, the cause of cold sores around the lips. These can occur inside your mouth and resemble canker sores.
These conditions are treatable. If you see red or white patches in your mouth or develop any mouth sores, contact your care team, who will diagnose your condition and prescribe a treatment.
Graft-Versus-Host Disease (GVHD) and Allogeneic Transplant
One of the most common complications after an allogeneic transplant is graft-versus-host disease (GVHD). GVHD is caused when your immune system recognizes your donor's immune system as something foreign. It may occur early (acute) or late (chronic) after the transplant.
Usually, acute GVHD occurs within the first 100 days after your transplant. Acute GVHD can affect the skin, gastrointestinal tract, and liver. Chronic GVHD (cGVHD) may occur later. It affects the same systems as acute GVHD, but may also affect the eyes, mouth, lungs, joints, and vagina. The symptoms of GVHD may be mild or severe.
Management and treatment of these symptoms is controlled with medication. The treatment process for GVHD is long and recovery is slow.
If you experience any of the following symptoms, call a member of your care team:
- Rash
- Skin changes, including hypersensitivity, pigmentation, or thickening or crusty lesions
- Loss of joint mobility
- Difficulty swallowing, nausea, vomiting, or diarrhea
- Shortness of breath
- Excessive dryness, pain, sores, or burning mouth
- Burning in the eyes, blurring, photophobia (sensitivity to light), or “gritty feeling”
- Frequent, watery stools that may be painful, diarrhea (with or without cramping)
- Yellowing of the skin or eyes
- Significant vaginal dryness, pain, or narrowing of the vaginal canal
Pneumonia (and other lung problems)
Because of your risk of developing pneumonia (or other lung infections) after transplant, you will start to take preventive medicine early in your treatment and continue to take this medication for at least one year after transplant. Despite taking medication, you may still develop pneumonia. Smoking or vaping of marijuana or tobacco products can also cause a life-threatening fungal infection. It is therefore extremely important to be completely honest and straightforward with your care team about any smoking.
If you experience any of the following symptoms, call a member of your transplant team:
- Fever
- Shortness of breath during your normal activities
- Coughing
Please refer to the comprehensive guide - Stem Cell Transplantation: An Information Guide for Patients and Caregivers - for more information.