Recovery from Transplant

What to expect after your child’s bone marrow transplant

To help you and your family navigate the transplant process, we assign numbers the days involved in the lead-up to transplant, transplant day and recovery. The day of your child’s transplant is “day zero.” Days of preparation before the transplant are numbered with negative numbers. Find out more about preparing for bone marrow transplant.

Your child’s recovery starts on day +1. This method helps your family understand the process, including predicted changes and possible complications.

The goal of BMT is for the donated cells to enter your child’s bone marrow and start making new blood cells. This process is called engraftment. Engraftment typically happens around day +15 or +30.

During this time (and longer if necessary) your child will be isolated to prevent the transmission of germs. This time can be difficult for both your child and the rest of your family. That’s why UCLA Health offers a variety of options for emotional support for patients, parents and siblings.

Your child’s hospital discharge date will depend on how quickly he or she responds to the transplant. When doctors feel the new immune system is strong enough, your child will be able to leave the hospital and continue recovering at home.

Bone marrow transplant side effects

After pediatric BMT, your child’s doctors will stay on the alert for early signs of complications. Side effects from BMT can range from mild to extremely serious.

Rest assured that our skilled care team will work to minimize risks and optimize your child’s bone marrow transplant recovery. We will observe your child for possible side effects including:

• Risk of infection: Your child’s body will rebuild an immune system from scratch with the new, transplanted stem cells. During this process (which can take months), your child is highly susceptible to infection. Your child’s doctor may prescribe antibiotics or other medications to help prevent infection. You will need to be very careful about interactions with others. Avoiding outside germs until his or her immune system is functioning again is the key to recovery.
• Physical weakness: People often feel very weak after treatment. Your child might experience extreme fatigue, nausea or vomiting. Encourage your child to be patient and let his or her body rest. Children usually start gaining strength in a week or so.
• Pain: The high doses of chemotherapy used during conditioning may cause painful mouth sores and stomach irritation. If your child experiences these symptoms, the pediatric comfort care specialist can help manage your child’s discomfort.
• Fluid overload: During recovery, your child will receive a large amount of fluid intravenously (directly into their veins). This fluid helps keep your child hydrated and delivers medications, nutrition and blood. But if your child’s kidneys can’t keep up with the fluid coming in, the overload can lead to pneumonia or high blood pressure. We watch carefully for early signs of too much fluid, such as swelling or trouble breathing.
• Respiratory distress: Several side effects of treatment can affect the lungs, leading to difficulties breathing. If your child feels short of breath, a doctor or nurse may give them supplemental oxygen while their lungs continue to recover.
• Graft-versus-host disease (GVHD): The newly transplanted stem cells are replacing your child’s immune system. Sometimes, that transplanted immune system can react against your child’s body, attacking its organs. GVHD can range from mild to life-threatening. Your child’s doctors will watch for any early signs and prescribe medications to control the reaction if it occurs.

In some cases, the transplanted cells don’t take hold in the marrow. This event is called graft failure. If graft failure occurs, your child’s doctors will discuss possible next steps and treatments.

Improving quality of life during recovery and beyond

We understand that your child’s emotional needs after BMT are just as important as the physical ones. That’s why our pediatric transplant team helps manage expectations and improve your child’s quality of life. Services include:

• Educational support: Our Child Life Team includes an education specialist who can work with your child’s school to help keep up with studies as much as possible.
• Counseling and play therapy: The Child Life Team is also available to your child — and the rest of your family — to offer emotional support during the recovery process. The counselors can meet with your child and his or her siblings individually to discuss their feelings, fears and anxieties. For the youngest patients, our counselors use play therapy to help them express their emotions.
• Pet therapy: Once your child’s immune system has recovered enough to interact safely with animals, we encourage them to play with the dogs that visit the hospital as part of our pet therapy program.
• Long-term care: Our care for your child doesn’t stop when he or she leaves our hospital or outpatient clinic. Your child’s continued recovery and quality of life is important. The dedicated experts at our Pediatric and Young Adult Bone Marrow Transplant Survivorship Program will continue to monitor your child’s condition for years after BMT. They can help manage any late effects from treatment, consult on fertility issues as your child enters adulthood, and offer continued social and emotional support.

Contact us

To make an appointment with our Pediatric Blood and Bone Marrow Transplant & Cellular Therapies Program, please call 310-825-6708.