Potential early effects of HSCT, requiring astute nursing assessment and management, include:7, 11
- veno-occlusive disease
- ongoing effects of the conditioning regimen (nausea, vomiting, diarrhoea, haemorrhagic cystitis).
Complications that may occur 30 to 100 days post allogeneic transplant include:7
- acute GVHD
- interstitial pneumonia (CMV and idiopathic)
- varicella zoster virus
- herpes simplex virus
- restrictive lung disease
- disseminated fungal infection.
Care requirements of the recipient during the acute phase include:7
- thorough assessments
- blood tests
- blood product transfusion
- nutritional, antibiotic, immunoglobulin, and intravenous fluid support
- symptom management
- skin biopsies
- bone marrow biopsies and aspirations
- close monitoring of medication administration and drug levels
- care of the central venous access device
- psychosocial support.
There are significant risks to day 100 post-transplant. The cumulative incidence of transplant related mortality (i.e. deaths other than those from relapse or persistent disease) for allogeneic transplant recipients in Australia and New Zealand in 2011 was 9.3% at 100 days post-transplant.2 In autologous transplant recipients, this figure was 1.8% mortality at 100 days post-transplant.2
Access a current text and Nausea and vomiting with high-dose chemotherapy and stem cell rescue therapy: a review of antiemetic regimens(PDF, 158KB)33 and summarise the assessment and management of nausea and vomiting in people during HSCT.
Access a current evidence based guidelines and Palifermin reduces incidence and severity of oral mucositis in allogeneic stem-cell transplant recipients(PDF, 118KB)34 and summarise the assessment and management of oral mucositis in people following HSCT.
Access a current text and Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: update on defibrotide and other current investigational therapies(PDF, 185KB)35 and:
- Define hepatic veno-occlusive disease
- Identify risk factors for VOD
- Identify signs and symptoms of VOD
- Identify nursing and medical interventions to prevent and manage VOD.
Access a current text and the following resources:
- Graft-versus-host disease in oncology nursing practice(PDF, 60KB)36
- GVHD: a continuing barrier to the safety of allogeneic transplantation(PDF, 60KB)37
- Corticosteroids for preventing graft-versus-host disease after allogeneic myeloablative stem cell transplantation38 (free resource, but you must register and login to access it) and:
- Describe the pathology of acute graft-versus-host disease
- Identify the clinical manifestations of acute graft-versus-host disease
- Summarise approaches to prevent and manage acute GVHD.
- Summarise the pain syndromes experienced by the people following HSCT
- Discuss implications of HSCT on pain management.
Summarise the indications for blood product support in the post-transplant period.
Outline the rationale for the following associated with blood product administration following HSCT:
- Leukocyte reduction
- CMV assessment.