What is Hematopoietic stem cell transplantation (HSCT)?
A hematopoietic stem cell transplant (HSCT) is a transfusion procedure transplanting normal hematopoietic stem cells to a patient. Hematopoietic stem cell transplantation can come from bone marrow, peripheral blood, or umbilical cord blood. Currently, the majority of adult receive peripheral blood of transplantation. HSCT can be autologous or allogeneic. In an allogeneic transplant, stem cell come from family members or donors. High-dose chemotherapy or a combination of chemotherapy and radiation therapy is given before the transplant. This therapy kills the cancer cells, rebuild the patient’s hematopoietic and immune system.
 
Home Care Instructions:
After receiving hematopoietic stem cell transplantation, it takes half to one year to reestablish immune system. In order to go through this recovery period smoothly, self-care is critical.
  1. Medications
    1. Antibiotics and antifungal agents: make sure to take as prescribed, stick to your medication routine.
    2. Immunosuppressive agents: take as prescribed. DO NOT adjust doses or stop by yourself. If you’re under medication, grapefruit or pomelo are prohibited.
  2. Diets 
    1. Eat high-calorie and high-protein foods, and avoid stimulus and irritating foods.
    2. Have frequent small meals, and avoid raw food.
    3. Have peeled fresh fruits, do not eat foods which are left overnight.
    4. Have your own eating utensils, keep the cutting board dry, to avoid mold and mildew.
  3. Home environment 
    1. Frequent wash and sun-dry the bedding linens, quilt, underwear and socks.
    2. Bedrooms should be ventilated, dry and sunny. Air purifiers are recommended. Please change the filter regularly.
    3. In order to avoid fungus infection, do not place any plants, flowers or artificial flowers indoor. 
    4. Avoid contact with people who have cold or contagious diseases.
    5. Before your immune system recover, hold off keeping a pet.
  4. Personal hygiene
    1. Shower and change clothes every day. Choose cotton fabric to reduce skin irritation, apply moisturizing lotion, to reduce dry skin.
    2. Keep the perineum and anal area clean and dry. Call your doctor if you have any redness, swelling, or pain in your perineum or anal area. 
    3. Wash hands with soap often, especially before meals, after using the restroom and when returning home.
    4. Rinse your mouth with saline or boiled water. Brush your teeth after meals and before bedtime to keep your mouth clean. Check the mucous membranes of your mouth daily.
  5. Outdoor activities
    1. Mild activities such as taking a stroll is okay. Sudden movement can lead to dizziness and falling.
    2. Wear a hygiene mask, while outdoor activities. If the mask is wet after sneezing, please change a new one immediately.
    3. Please wear long sleeve clothes and trousers. Carry an umbrella or put on a hat to prevent exposure to the sunlight.
    4. Avoid taking crowed public transportation.
    5. Avoid going to any public places before immune system recover.
  6. Others
    1. Must change Hickman dressing with skin protectant every 7 days, or gauze dressing every 2 days. When it becomes loose, wet or dirty, it must be changed right away. Call your doctor if you see redness, swelling, drainage or the site is sore.
    2. Must attend follow up clinics.
    3. Within half a year of HSCT, do not take any vaccination (such as rubella, measles, mumps and influenza). Discuss with your doctors before vaccination.
    4. Consult with the doctor before returning to work or school.
    5. Please visit the ER immediately if suffering from persistent fever, skin rash, and diarrhea, yellowing skin and eyes, dark urine and tarry stool.
 
Reference
  1. Chao, N., Negrin, R., & Rosmarin, A. (2018). Treatment of chronic graft-versus-host disease. UpToDate, Waltham, MA. Accessed May, 3. http://doi.org/10.1097/01.COT.0000534134.03023.2f
  2. Rodrigues, K. S., Oliveira-Ribeiro, C., Gomes, S. D. A. F., & Knobler, R. (2018). Cutaneous graft-versus-host disease: diagnosis and treatment. American journal of clinical dermatology, 19(1), 33-50. http://doi.org/10.1007/s40257-017-0306-9
  3. Wallhult E., Quinn B. (2018). Early and Acute Complications and the Principles of HSCT Nursing Care. In: Kenyon M., Babic A. (eds) The European Blood and Marrow Transplantation Textbook for Nurses(pp.163-195). Springer, Cham. doi:10.1007/978-3-319-50026-3_9
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