Safe Living After a Bone Marrow Transplant

Hematopoietic Cell Transplantation (HCT), more commonly known as bone marrow transplantation, is a procedure for used for some patients with cancer, immune deficiencies, or other genetic diseases. In short, we take stem cells from one person (donor) and give them to a patient (recipient). Those stem cells help repopulate all the blood cells of the body (white blood cells, red blood cells, platelets) and eventually become the patient’s new immune system.

During HCT, there are two major challenges that the patient may face – infection and graft-versus-host disease (GvHD), where the new immune system attacks parts of the patient’s body (skin, intestines, etc). Medications are often given to help prevent GvHD. A delicate balance exists after HCT – managing the needs for preventing both GvHD and infections

• A weak immune system makes a patient more vulnerable to infection.
• Taking away medications early to boost the immune system may help prevent/treat infections, but may also raise the risk of GVHD.

This is why “Safe Living,” a part of infection prevention, is so important – it is one major factor that can be controlled. If we can minimize infections, we can do our best to minimize risks of GVHD. There are several ways we can acquire infections:

What We Breathe In

People can transmit illnesses through droplets when they cough or sneeze. These droplets can hang around long enough to be breathed in, causing infection in the patient or their household contacts. Our environment may also contain particles like mold spores. To a person with a typical immune system, mold spores are unlikely to cause any harm. However, when the immune system is weakened, those moulds can cause some serious problems.

Prevention:

• Avoid close contact with people who are coughing, sneezing, or have a runny nose or red eyes. Discourage any family or friends from visiting if they are ill.
• Avoid large crowds, especially during influenza and other respiratory virus seasons (generally September through March).
• Avoid smoking and exposure to smoke, including from tobacco, fireplace, and bonfires
• Avoid e-cigarette and tobacco exposure, and avoid marijuana use or exposure completely. Smoking marijuana can contain fungal spores (Aspergillus) and cause a very serious lung infection.
• Avoid breathing in air from dusty environments. These activities include gardening/landscaping, farming, construction, old buildings, wood piles, caves, and chicken coops and bird droppings. These activities can contain fungal spores that can make a patient ill.
• Avoid exposure to molding food, plants, wood, and hay.
• If the above can’t be avoided, wear a mask during higher-risk activities to reduce the risk of infection. If at-home family members are ill, try to separate living environments as much as possible until they have improved.

What We Eat

Nutrition is extremely important to our health. Fortunately, we have access to safe food and water supplies, but there are still ways one can acquire infection by what is eaten.

Prevention:

• Always wash fruits and vegetables thoroughly with clean water.
• Look at the dates on products before eating – do NOT use if the expiration date has passed.
• Do not share utensils, glasses/cups, or food with other people.
• Avoid eating soft cheeses (or cheeses with molds like bleu cheese, feta or queso blanco fresco) and unpasteurized/raw milk products.
• Avoid unpasteurized juices.
• Avoid foods containing raw or undercooked eggs.
• Avoid eating raw or undercooked meat, poultry, seafood, fish, and tofu. Beef and pork should be cooked to an internal temperature of ≥ 165°F; poultry should be cooked to an internal temperature of ≥ 180°F and seafood to ≥ 145°F.
• Practice good food preparation and avoid cross contamination of raw foods, utensils, cutting boards/surfaces, washing hands and utensils/boards frequently.
• Avoid raw alfalfa sprouts, raw honey, and miso products; avoid loose leaf teas (teas that are commercially packaged can be used).
• Avoid street food vending stands.
• Avoid public salad bars, standing buffets, or other foods that may be sitting out at room temperature for some time. Avoid deli salads, pates, and cold cuts.
• Avoid salad dressings that contain raw eggs or cheeses (generally in the refrigerated section of grocery store).
• Prepackaged foods such as hot dogs or sausages should be thoroughly re-cooked.
• Refrigerate food made at home within 2 hours of cooking at temperatures < 40°F in the refrigerator and 0°F or below in freezer. Refrigerated leftovers should be consumed within 2 days and reheated to steaming hot temperatures (>165°F).
• Make your transplant team aware of any food outbreaks in your local area that you may have been exposed to.

What We Touch

Skin is an extremely important barrier that protects us from the outside environment. Keeping it healthy helps your child when going through a transplant.

Prevention:

• If you have a catheter, PICC, or port, avoid touching altogether; if necessary, wash your hands before and after touching it.
• Wash your hands frequently, particularly after touching other people and animals or possible fluids that may have come in contact with human or animal feces. Wash your hands after changing diapers.
• Do not go barefoot.
• Avoid body piercings and tattoos.
• Keep finger and toenails clean and trim. Avoid putting your fingers in your mouth. Avoid artificial nails.
• Avoid any injection drug use.
• Wash any open cuts or wounds immediately with soap and water.
• Wash hands after touching any plant or soil/dirt.
• Avoid uncovered and community sandboxes; avoid litterboxes.

In addition to “Safe Living,” we also give medications and vaccinations to help prevent infection. To learn more about it, click here.

These steps for Safe Living are some of the most important things you can do to help keep your child safe and healthy after a bone marrow transplant. For more information about the Host Defense Program at Nationwide Children's Hospital, click here.