Inpatient Transplant
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What to Expect
Watch Inpatient Overview VideoWhat to Expect
Get an overview of the inpatient experience from pre-transplant therapy and stem cell infusion to how to prepare for your hospital stay.
For your transplant, you will be admitted either to Brigham and Women’s Hospital (BWH) or Dana-Farber’s Inpatient Hospital (located within BWH). You will stay on a specialized oncology unit (called a "pod"), which is specially equipped and staffed to meet your needs. The specialized environments will help protect you from infection while your immune system starts to recover. For your added protection:
- Everyone who goes into your room must first wash their hands and put on gloves and a mask.
- You will need to wear gloves and a mask when you leave your hospital room.
- Though you will not be allowed to leave the unit, you are able to walk outside your room within the doors of your unit.
Every situation is unique and the length of your inpatient stay will be determined by how you are feeling and your blood counts. Your care team will keep you updated as the discharge date approaches so that you can make arrangements for cleaning at home and arrange for a ride on the morning of discharge.
Resource
Planning Checklist for Your Hospitalization for Stem Cell Transplant (PDF)
Preparing For Your Hospital Stay
Preparing For Your Hospital Stay
Your Inpatient Care Team
During your first days at the hospital, you will meet your care team, which includes your:
- Inpatient attending physician(s), who will visit you daily during your stay
- Inpatient physician assistant, who will manage your daily medical care
- Inpatient nurses, who will be mainly responsible for your nursing care
Your Room
All patient rooms on the stem cell transplant units are private and have special filtration systems to protect you while your immune system starts to recover.
Patient rooms have a closet, television, telephone, small refrigerator, and a bathroom (with a shower). Some rooms are also equipped with a DVD player.
What to Bring to the Hospital and What to Leave at Home
- Hospital gowns, pants, socks
- Towels
- Bed linens
- Toiletries, including: soap, lotion/cream, toothpaste, shampoo
Although you will have limited space in your room, there are a number of things that you can bring to make your stay more comfortable, including:
- Hangers for your clothes
- Light reading materials (books, magazines, newspapers)
- Images/items that help remind you of your goal of getting well
- Printed photos
- Music player or radio, musical instruments
- Headphones or headset
- Laptop or notebook computer, e-reader, tablet, and chargers (wireless Internet access is available)
- Cell phone, pre-paid phone card, or calling card (for long-distance calls)
- DVDs, portable streaming devices such as a Roku Streaming Stick, and gaming devices (every room has a TV, and some have DVD players)
- Sound machine
- CPAP machine (your ONN will discuss maintenance during hospitalization)
For your protection, any items brought to you during your stay will be wiped with cleaning wipes before they are brought into your room. If you are not sure whether an item is allowed, ask your care team.
| Items Allowed | Items NOT Allowed |
| Prepackaged food items | Medications (unless approved by your care team) |
| New and unopened toothpaste | Money or other valuables |
| New and unopened unscented lotions or deodorant | Live plants or flower arrangements |
| New and unopened cosmetics | Homemade food items |
| Electric razors | Used and open toothbrushes or toothpaste |
| Emery boards | Perfumes and scented soaps or lotions |
| Credit or debit card for prescriptions | Used and open cosmetics |
| Razors or razor blades | |
| Nail clippers | |
| Edible or vaping products (nicotine or marijuana) |
Washing Clothing and Personal Items
You may bring your own clothing to wear (pajamas, sweats, etc.) during your stay, following these instructions to decrease your risk of infection:
- Your clothes must be freshly washed, dried, and put in a clean, washable tote bag or hard suitcase that can be wiped out with a cleaning wipe.
- Clothes that touch your skin must be changed every day.
- Bring enough items so you can send clothing home for washing.
The hospital does not provide laundry service for your personal clothing. Your family may bring your clothes home to be laundered, following the directions above.
Hair Care
Hair loss is a common side effect of chemotherapy and radiation. While this side effect is usually temporary, your hair may begin to fall out at some point after your chemotherapy treatment. To prepare for this, many patients cut their hair short prior to admission. You may wear washable turbans or caps. Wigs are not recommended because they are difficult to keep clean and uncomfortable while in the hospital.
Communicating from the Hospital
We understand the need to keep loved ones connected during a lengthy hospital stay. From the hospital, you can communicate with family and friends in the following ways:
- Computer/internet access: All patient rooms have wireless internet so you can use your smartphone or tablet. Family members and friends can also use computer workstations in the resource rooms at Dana-Farber and BWH.
- Hospital room phone: All local calls are free. Long-distance calls can be charged to your calling card or a prepaid phone card. Cell phones are permitted in the transplant unit rooms.
- CaringBridge website: CaringBridge is a free, secure website you can use to set up a personal web page to keep family and friends connected when you are receiving care. You can post updates and photographs, or list tasks you may need help with (which can be a helpful way to let your friends and loved ones know how they can help after transplant). Visitors to your page can read updates posted by you or someone you designate and write messages of encouragement. Learn more at www.caringbridge.org.
Visitor Guidelines
We encourage you to have visitors throughout your hospital stay. Although the hospital does have regular visiting hours, the best time for visitors on the transplant units is from lunchtime to early evening. No one – including your caregiver and any other family member or friend – is allowed to stay in your room overnight.
Because you will be at risk of infection, we require special precautions for visitors to the transplant unit. These policies are subject to change. Ask your care team if you have questions.
Resource
Pre-Transplant Conditioning Therapy
Pre-Transplant Conditioning Therapy
In preparation for your stem cell transplant, you will receive conditioning (or pre-transplant therapy) to prepare your body to receive the new blood stem cells. Your treatment plan or protocol will determine which pre-transplant therapy you will receive.
Chemotherapy
The type of chemotherapy you receive will depend on your disease and your transplantation protocol. The goal of this chemotherapy is to prepare your body for your stem cell transplant. Chemotherapy prior to transplant can kill cancer cells in your body as well as make space for your stem cells to grow and help your body mount an immune response to your cancer. You will receive your chemotherapy treatment in your room by IV infusion.
The normal cells most likely to be affected are the bone marrow, hair follicles, cells of the mouth, intestinal lining, and reproductive systems.
Common Chemotherapy Side Effects
- Bone marrow suppression (decreased red and white blood cells and platelets)
- Hair loss
- Nausea and vomiting
- Diarrhea
- Dry mouth
- Sore throat
- Mouth sores
- Taste changes
- Sterility and/or interruption of the menstrual cycle
- Fatigue (feeling tired/lack of energy)
- Loss of appetite
Talk with your care team about ways to manage or reduce the impact of these side effects.
Radiation Therapy
Radiation therapy uses high-energy x-rays or beams to prepare your body for your transplant. Radiation may be used alone or with other types of treatment. Stem cell transplant patients may receive total body irradiation (TBI) treatment. Unlike radiation that targets a specific area of the body, TBI treats your entire (total) body with radiation to kill cancer cells. If your treatment plan includes radiation, you will go to the Radiation Therapy department in the lower level of BWH.
Common Radiation Side Effects
- Hair loss
- Dry mouth and/or mouth sores
- Sore throat
- Swollen neck glands
- Nausea, vomiting, and/or diarrhea
- Fever
- Skin color changes and/or skin sensitivities
- Sterility or early menopause
- Fatigue (feeling tired/lack of energy)
Talk with your care team about ways to manage or reduce the impact of these side effects.
During Stem Cell Infusion
During Stem Cell Infusion
Stem Cell Infusion Process
Stem cell infusion is a very similar process to a blood transfusion. In fact, many patients are surprised by how fast and uneventful the stem cell infusion is. The stem cells come in the same bag that blood comes in and can appear clear, yellow, or pink in color.
The stem cells will be infused through an IV or catheter. The infusion generally lasts from 15 minutes to 2 hours.
Your nurse will be present throughout the infusion process, and will monitor your blood pressure, heart rate, temperature, and breathing. Your nurse may give you medication to prevent any minor reactions.
Common Infusion Side Effects
- Fever
- Headache
- Chills
- Full body flushing/facial flushing, hives, itching
- Nausea/vomiting, abdominal cramps
- Trouble breathing, shortness of breath, coughing, chest pain/tightness
- Light headedness
These reactions may occur up to two hours after the infusion procedure is completed.
Day Zero
The day you receive your new stem cells is referred to as day zero. Your post-transplant tests will be scheduled based on your day zero date.
During Your Hospitalization
During Your Hospitalization
Learn more about how to prepare for your hospitalization, what to expect while in the hospital, your inpatient care team, and discharge planning.
Resource
What to Expect While in the Hospital for Stem Cell Transplant (video)
View this video in Arabic.
View this video in Spanish.
Undergoing stem cell transplantation is a challenging, lengthy process. Your care team will do everything possible to make you comfortable during your time in the hospital. For your protection:
- Everyone who goes into your room must first wash their hands and put on gloves and a mask.
- You will need to wear gloves and a mask when you leave your hospital room. You do not need to wear a mask while you are in your room.
Though you will not be allowed to leave the unit, you are able to walk outside your room within the doors of your unit.
Daily Routine
A responding clinician will manage your daily care. This is usually a physician assistant (PA). An intern or resident who is a member of our house staff will cover care on weekends and holidays.
- Morning Rounds: Your inpatient transplant attending physician will conduct rounds each morning.
- Afternoon Rounds: Based on patient needs, the PA team may do a visit in the afternoon rounds to follow up on specific issues or concerns.
- Vital Signs: We will check your vital signs every 4 hours, including several times during the night.
We will closely monitor your blood and platelet counts through daily blood draws to see how you are responding to your treatment and transplant. Blood counts are often low after transplant.
How You May Feel
From the time you receive your stem cells until engraftment, you may experience several side effects. These may include:
- Fever
- Nausea
- Fatigue
- Difficulty sleeping
- Skin rashes
- Mucositis and esophagitis, which are mouth and throat sores and can make it difficult to eat or drink
- Diarrhea. This may persist even after you return home.
- Lack of appetite
What You Can Do
Try to be involved in your own care while in the hospital, including personal hygiene, mouth care, eating, and light exercise. Work with hospital staff to improve your own well-being. You may walk outside your room within the doors of the unit. You may also be able to get a stationary bicycle for your room, depending on availability and whether you are clinically stable to ride it. This can be requested by your inpatient care team if you qualify.
- Take a sponge bath or shower every day to decrease the bacteria on your skin and help prevent infection.
- Use the chlorohexidine wipes provided to prevent central line infection.
- Wash your hands frequently, especially after bathroom use.
- Use the lotions and creams provided to help prevent your skin from itching and drying out.
You will be shown a new way to care for your teeth. It is used because the “usual” way of brushing your teeth can irritate or scratch your gums. Gum injuries can invite bacteria. One of the most important things to remember is to be gentle when brushing or flossing.
While in the hospital, you can request a referral to meet with an inpatient clinical social worker to help you and your family cope with and manage the emotional, psychological, and other cancer-related issues that may arise, and help you find resources.
Palliative care specialists can also be helpful through all stages of illness. Early on, it can help make medical treatments more tolerable; at later stages, it can reduce suffering, help you carry on with daily life, assist you in planning for future medical care, and provide support for living with a life-threatening illness.
While in the hospital, it is important for you to follow our program’s guidelines for a special, low-bacteria diet while your immune system is compromised, and infection is a major concern. The dietitian on your care team can answer your questions, make sure that you receive the proper nutrition, and help you with your food choices. This is especially important when you may not feel like eating.
- Most foods that are cooked or have been commercially processed are permitted.
- Certain foods or methods of preparation may pose a risk of infection.
- If you follow a specialized diet at home (e.g., gluten free, kosher, vegan, specific ethnic foods, etc.), let your care team know. We can connect you with a dietitian to help you with food options while you are in the hospital.
- The nursing staff or dietitian must approve any food brought by visitors. No homemade food, restaurant food, takeout food, or fruit baskets are allowed.
Most patients do not eat very much while they are in the hospital. This is common. We encourage you to eat when you can, and we will support you with fluids or other care as needed.
Nutrition Resources
How to Eat Safely After Transplant (video)
Foods/Drinks That Are Safe (PDF)
Food Preparation and Storage Safety Guidelines (PDF)
Food Safety in Special Situations (PDF)
Foods from Outside the Hospital (PDF)
During your hospital stay, activity is an important part of your treatment so you can maintain strength, endurance, and be as independent as possible when you go home. A physical therapist may evaluate and follow your progress during your hospitalization to help maximize your physical abilities. We encourage you to maintain everyday activities, such as bathing, dressing, and walking as able, as well as a regular exercise program as outlined below.
Physical activity will help offset the effects of treatment and/or prolonged hospitalization that may include muscle weakness and physical decline, fatigue, stiff joints, swollen extremities, and balance problems. Staying active is important and will aid your recovery after discharge. You may want to track or record your activity levels.
Although activities can be tailored to meet your individual needs, most programs include:
- Daily walks on the transplant unit, with assistance if needed
- An appropriate and progressive exercise program including arm, leg, and back muscle exercises
- Stationary biking (a limited number of bikes are available)
- Balance activities
- Building stamina and energy
- Education about energy saving techniques, platelet precautions with activity, and the overall importance of daily mobility to prevent fatigue/deconditioning (physical decline or weakness)
General Exercise Guidelines
- Ask your nurse daily whether your blood and platelet counts are at a level appropriate for exercise and resistance.
- Try to perform three activities per day, with any combination of biking, walking, and strengthening exercises.
- Monitor how you feel during the activity.
- Include a warm-up and cool down. This can be 1-2 minutes of seated exercises or leisurely walking.
- Wear shoes during exercise.
- The amount and intensity of exercise or physical activity you do will depend on how you feel and your blood counts for the day. Make the activity somewhat challenging so that it benefits you, but not so much that you will be too tired afterwards or have difficulty recovering.
Discharge Planning
Discharge Planning
Every situation is unique and the length of your inpatient stay will depend upon how you feel and your blood counts. Your care team will keep you updated about your discharge date so you can arrange for cleaning at home and ride on the morning of discharge. You will know your expected discharge date 48-72 hours in advance.
Prior to leaving the hospital, you will meet with care team members to review instructions pertaining to life after a stem cell transplant. Your caregiver should attend these sessions with you (or listen by phone if they cannot be in person). These sessions will be scheduled in the days prior to discharge.
1. Food choices after discharge
The nutritionist will review any food restrictions that apply to you and provide you with recommendations for a healthy, safe diet.
Resource
How to Eat Safely After Transplant (video)
Quick Reference Sheet: Foods/Drinks That Are Safe (PDF)
Food Preparation and Storage Safety Guidelines (PDF)
Food Safety in Special Situations (PDF)
2. Medications after transplant
The pharmacist, physician assistant, or nurse will review all of your discharge medications. If your discharge prescriptions are not being delivered directly to the hospital, a caregiver will need to pick them up at your pharmacy and bring them to the hospital review.
Resource
Tacrolimus: How to Take Tacrolimus (video)
Tacrolimus Quick Guide (PDF)
Sirolimus: How to Take Sirolimus (video)
Sirolimus Quick Guide (PDF)
3. General discharge information
Your nurse will review general post-transplant guidelines, including use of mask and gloves, visitor guidelines and more.
Important Things to Remember
- Our goal is to have you ready for discharge by 11 a.m. on your discharge day. Your ride home should arrive before this time. Please let your caregivers know this well in advance.
- Your central line will be removed prior to your discharge day. Your care team will plan this for you.
- Your medications will be delivered to your room within a few days of your discharge. In order for this to happen, you will need to take care of any co-pays prior to delivery. Please make sure you have a payment option available to you while you are in the hospital (i.e., credit or debit card). In some cases, insurance may require that your medications be filled at a specific pharmacy that may not have a delivery service. These medications will need to be picked up at that pharmacy and brought in to the hospital prior to the discharge medication session.
- We will schedule your first follow up appointment. This will be either at Dana-Farber or at your local oncologist’s office, if appropriate for your care. This is generally within the first week of your discharge.
This website is for informational purposes only. Always follow the advice of your care team.
The information on this site is an abbreviated version of the printed guide — Stem Cell Transplantation: An Information Guide for Patients and Caregivers. We encourage you to check the printed guide or contact your care team if you have any questions or concerns.
In an emergency, page any member of your care team by calling the Dana-Farber page operator at 617-632-3352.
Clinical care provided by Dana-Farber Brigham Cancer Center
