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After your bone marrow or cord blood transplant, your new cells will start to grow and make new blood cells. This is called engraftment. Engraftment is an important milestone in your transplant recovery.

Risk of infection

You will be at highest risk of infection until your new cells engraft. This is because you will have fewer than normal numbers of white blood cells. White blood cells are the part of the immune system that help prevent or fight infections. Your health care team will take steps to protect you from infections and treat any infections that develop. If you experience any symptoms of infection tell your doctor right away. For tips on how to minimize the risk infections, see Infection prevention.

Managing side effects after a bone marrow transplant

Some important medications you will take after your transplant, such as those used to prevent graft-versus-host disease (GVHD) or infection may cause side effects with different degrees of severity. Tell your health care team about any side effects you experience. Often there are ways to reduce side effects or make medications more tolerable.

Transfusions and growth factors

Until your new cells engraft, you may get red blood cell or platelet transfusions. The number of blood and platelet transfusions you will need will vary greatly between patients and even at different times for the same patient.

After an autologous transplant, when you receive your own cells for the transplant, some patients also receive growth factors. Growth factors are medications that stimulate the marrow to make more blood cells, and help transplanted cells engraft more quickly. A common growth factor for white blood cells is granulocyte-colony stimulating factor or G-CSF. Some patients may also receive growth factors to stimulate the marrow to make more red blood cells or platelets.

Waiting for engraftment

After you receive your transplant, your care team will watch you closely for signs of engraftment. Engraftment is when the new blood-forming cells start to grow and make healthy blood stem cells that show up in your blood.

You will have daily blood samples taken while you are waiting for your cells to engraft. A laboratory will perform a CBC, or complete blood count test. The CBC test shows the numbers of and kinds of cells in your blood.

Neutrophil engraftment

Neutrophils are a type of white blood that are important for fighting bacterial infections. Neutrophils are also an important measure of engraftment.

Neutrophils in your bloodstream will be counted in your CBC. An absolute neutrophil count (ANC) of 500 or more for 3 days in a row is a sign of engraftment.

For patients who receive marrow or peripheral blood stem cells (PBSC), neutrophil engraftment can occur as early as 10 days after transplant but is more common around 14-20 days. Patients who receive cord blood may need more time to engraft (typically about 25 days but sometimes as long as 42 days).

Platelet engraftment

Platelets help control bleeding. Your CBC test will show the number of platelets in your bloodstream. A platelet count of 20,000 to 50,000 is a sign of platelet engraftment.

For patients who receive marrow or PBSC (peripheral blood stem cells), platelet engraftment often happens a little bit after neutrophil engraftment. For patients who receive cord blood, it may be 8 weeks or longer after transplant before platelets engraft.