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Survivors' Guide for Bone Marrow/Stem Cell Transplant
What to Expect and How to Get Through It

Physical Preparation

Exercise
Many people undertake some kind of regular exercise routine to improve their physical conditioning in preparation for the transplant. The extent and rigor of the exercise you choose will depend in part on your general activity level and physical condition. Some people will be able to exercise vigorously whereas others may choose very moderate exercise routines involving just short walks or stretches in bed. One survivor writes:

Physically, I felt like I was in training for a marathon. I thought that the better physical condition I was in when I went in for my transplant, the better chance I had for survival. I walked several miles every day and in the summer I swam laps at the pool.

Another person writes:

I was determined to be in the best possible shape for the transplant. I exercised religiously, going on long hikes in nature. I undertook several long back packing trips as I love to be outside and wanted to get as much of the outdoors as I could before I was going to be enclosed in a hospital room.

Others said that exercise became important “even if it was just a walk or fifteen minutes on a treadmill.” Ideally, you should find some kind of exercise you enjoy. Joining a gym or finding friends who enjoy similar physical activities may be helpful. In addition to conferring physical benefits, exercise may be a helpful way to channel stress and promote general well-being.

If your medical condition does not allow you to undertake a rigorous exercise routine, be aware that many people enter the transplant in poor physical shape and do extremely well. To the extent that exercise is an option for you, consider doing some mode of exercise suited to your medical condition.

Nutrition
Eating a healthy diet and meeting your basic nutritional needs is important prior to transplant. Intuitively, we all know that a well-nourished body fights infection, aids healing and deals with the demands of very aggressive treatment protocols better than a poorly nourished one. It is beyond the scope of this guide to discuss in detail the different alternative nutritional therapies. The recommendations vary from that of the American Cancer Society which is described below, to the macrobiotic diet which entails eating primarily cooked foods, to diets using nutritional supplements, etc. When considering an alternative diet, do some research to ensure that it provides all the necessary nutrients and then discuss it with your physician. Unless you are severely obese, it is not advisable to undergo rapid weight loss immediately prior to treatment. Generally the guidelines for maintaining good health, as recommended by the National Academy of Sciences and the American Cancer Society are as follows:

• Reduce dietary fats to less than 30% of total caloric intake.
• Eat plenty of fresh fruits and vegetables daily, particularly citrus fruits, green leafy vegetables, and carotene rich vegetables such as carrots and squash.
• Increase intake of certain fibers such as wheat bran.
• Consume alcohol in moderation, if at all, and completely refrain from smoking.
• Maintain your weight within normal range.
• Minimize your consumption of salt-cured, salt-pickled, and smoked foods.
• Cut your consumption of red meat. Protein alternatives include seafood, skinless poultry, legumes, tofu and low fat dairy products.

For some, the transition to a healthier diet is relatively easy; for others, it may require significant changes in eating patterns. If you are unfamiliar with a low fat diet, read some of the excellent vegetarian cookbooks that are widely available, consult with a dietitian, or ask your friends for good recipes. Taking time to find restaurants in your area that cater to customers interested in a low fat healthy diet may also be helpful.

Dental Care
Good dental care prior to transplant is an essential part of your overall preparation for transplant. Healthy gums and teeth prior to transplant can eliminate potential infections and some of the painful mouth sores that may develop during transplant. Meticulous mouth care prior to and during transplant can also provide protection against infections by limiting the number of open sores in the mouth. Taking care of lingering gum and tooth problems is also important because it is strongly advised that you refrain from any routine dental care for some time after your transplant until your immune system is fully functional again.

Ideally, mouth care should start at least two or three months prior to the transplant. When you visit your local dentist, explain the reason for your visit and the importance of getting your teeth and gums in the best possible shape prior to the transplant. Before initiating treatment, your dentist should contact your oncologist to discuss your medical condition and to determine whether you will need antibiotics or other precautionary measures before treatment. During this time, broken or problematic teeth should be removed or repaired. If you have braces, they should be removed and loose or poorly fitting dentures should be adjusted. To have your mouth in the best shape possible before the transplant, you will need to adopt good personal oral hygiene. This may entail regular flossing and brushing as well as utilizing antiseptic mouth rinses. Before taking on a rigorous dental regimen of your own, however, it is a good idea to consult your dentist, to review the correct way to floss and brush your teeth, and to request a recommendation for a good toothbrush and mouth rinse.

Fertility
People undergoing treatment with total body irradiation and some forms of chemotherapy have a high risk of becoming infertile. If you are considering having children after the transplant, you may consider undergoing fertility treatment prior to receiving chemotherapy. For males, sperm banking is a possibility. This entails contacting a sperm bank in your area and freezing and storing sperm for use post-transplant. For women the process is more complicated. It requires them to freeze their fertilized eggs. In this process, women undergo hormonal treatment to induce ovulation. Once the eggs mature, they are surgically removed, fertilized in a test tube with sperm, and then frozen for later implantation. Since the procedure is time consuming, it should be undertaken well before the transplant date. Before undertaking these procedures, anyone should make sure that their medical condition allows for the procedures involved.

At the time of this writing, new techniques are being developed that may allow women to freeze their eggs, and later thaw and fertilize them. There is also a new and still experimental option for women to freeze their ovary or a portion of it prior to transplant and to have it reimplanted post-transplant. It is possible that such a procedure may allow women who do this to regain ovarian function post-transplant and thus avoid the risks associated with early menopause. For more information about fertility clinics, please see the Resource Listing. Although the majority of people undergoing a transplant will lose their fertility, some patients may in rare instances regain fertility.

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