HSC engraftment and production of normal blood cells occur approximately 7-20 days post transplantation.10,30 During this period the recipient requires comprehensive assessment and monitoring, physical care, and psychosocial and spiritual support.
Successful engraftment of transplanted stem cells depends on the quality and quantity of stem cells and the integrity of the marrow's microenvironment.6
Haematopoietic and immunological recovery occur at variable speeds and are influenced by a number of factors:7
- the nature and status of the primary disease
- previously administered chemotherapy and radiation
- the type of preparative regimen
- the type of GVHD prophylaxis
- viral complications
- the use of antiviral agents.
Lack of initial engraftment of donor cells, or loss of donor cells after initial engraftment, is termed graft failure or graft rejection.31 These conditions occur in less than 5% of recipients and are rare after matched-sibling transplants.31
Learning activities
Access Mixed chimerism in SCT: conflict or peaceful coexistence?(PDF, 242KB)32 and:
- Define the term chimerism
- Summarise the implications of an individual's chimeric state following HSCT.
For each of the following drugs commonly used in the acute transplant period:
- Cyclosporine
- Tacrolimus
- Fluconazole
- Acyclovir
- Methotrexate
- Cotrimoxazole
- Intragam
- G-CSF
- identify the classification of the drug
- describe the indication for the drug
- discuss potential short and long term effects associated with the drug
- explain the nursing interventions to prevent, detect early, and manage these effects
- identify other nursing considerations associated with administering these drugs.
Access a current text and identify the average length of time to engraftment for:
- Autologous transplants
- Allogeneic transplants
- Non-myeloablative allogeneic transplants.
Access Graft failure after allogeneic hematopoietic cell transplantation(PDF, 38KB)31 and:
- Summarise the risk factors for graft failure
- Outline methods to prevent and manage graft failure.
Discuss common psychosocial concerns in the immediate post-transplant period and nursing responses to these.