Catholic University Catholic Hematology Hospital

As your white blood cell count increases and you begin to recover following a hematopoietic stem cell transplant, it's time to prepare for discharge. About a week prior to leaving the hospital, a thorough cleaning of your home should be conducted using a solution of bleach diluted 200 times(5cc of bleach in 1 liter of water) and a disposable mop. If carpets are present, they should be removed. Old curtains should be laundered or replaced. Use a mold remover and dehumidifier to clean all corners of your home, especially in between furniture and under beds, to eliminate dust. Going forward, a comprehensive cleaning should be conducted about once a week, with regular ventilation.

Avoiding Pets and Plants After a Hematopoietic Stem Cell Transplant. For at least one year following a hematopoietic stem cell transplant, you should avoid having pets in your home. Similarly, ornamental plants, flower vases, and fish tanks should not be kept in your home for at least six months.

The floors of the patient's room, living room, and kitchen should be cleaned daily using commercially available disinfection wipes or ethanol disinfection tissues that are safe for human use. Once a week, a more thorough cleaning should be performed, reaching every nook and cranny. During this time, avoid using vacuum cleaners or steam cleaners.

The floors of the bathroom, bathtub, and utility room should be regularly cleaned using commercially available disinfection wipes or ethanol disinfection tissues that are safe for human use.

Bedding should be washed regularly, about once a week, and the inside of the covers should be aired out in the sun. If you are using a bed, be sure to wipe down the mattress during your weekly thorough cleaning.

If the indoor air becomes dry, you can maintain appropriate humidity levels by air-drying laundry or hanging a clean, wet towel on a clothes rack. However, avoid using humidifiers as they can easily foster microbial growth.

Regular filter replacements and cleaning, as per the product manual, are necessary when using air purifiers, air conditioners, and heaters.

During cleaning, the patient should avoid the area and should not handle garbage directly.

It's necessary to monitor daily for symptoms such as skin rash, bruising, swelling, or erythema.

Both the patient and family members must wash their hands with soap before and after meals, after using the restroom, after returning from outside, and after contact with others.

Use a mild soap to shower every day or every other day. (Use pump soap; solid soap should not be used due to the risk of infection from the soap itself.)

You should thoroughly dry joint creases, axillae, perineum, and under the breasts with a soft bath towel.

Avoid causing skin damage due to excessive friction; do not scrub or rub hard with a rough towel.

Avoid saunas, public baths, steam rooms, full baths, and half baths for at least a year.

Use a personal bath towel.

If your skin is dry, make sure to apply an oil or moisturizing lotion generously after showering.

Alcohol-based lotions should be avoided as they can further dry out your skin.

Wear comfortable clothing and shoes, and report any issues to the medical staff.

Sun Protection : Skin is very sensitive to sunlight after high-dose chemotherapy and radiation therapy, so direct sun exposure should be avoided. Therefore, when going out, wear a hat, mask, long-sleeved clothes, and long pants, and always apply sunscreen (SPF 15 or higher) to exposed parts of your body.

Nails : Chemotherapy and radiation therapy can bring changes to your fingernails and toenails. Damaged nails may fall off, and as your body recovers, new healthy nails will grow. When trimming your nails, be careful not to tear your nails or cut your skin, and avoid applying manicure to prevent excessive dryness.

Hair : A few weeks after the transplant, new hair will start to grow, but it will be weak, slightly curly, and somewhat brown. At this time, use a mild shampoo to moisturize your hair and scalp, and always wear a hat when going out. Perms and hair coloring can be done at least a year later, but only after consulting with your primary care physician.

Other : Contact lenses should not be worn until instructed by medical personnel.

Oral hygiene is very important for maintaining healthy gums and teeth after a hematopoietic stem cell transplant. You should brush your teeth more than three times a day, and you can use a special mouthwash as prescribed by your medical team.

Until your platelet count recovers to 70,000 /mm³ or higher, you should use a soft toothbrush and avoid using dental floss.

Following a transplant, radiation or chemotherapy can cause dry mouth. Consuming foods with high water content and drinking plenty of water can be helpful in these situations.

If your lips are dry, apply a non-irritating product like Vaseline.

If you have a dental problem, consult your primary care physician and obtain a dental consultation. Generally, dental treatments are prohibited for a year after the transplant.

Start with simple exercises that don't strain your body, such as calisthenics, walking, strolling, and climbing stairs, and gradually increase the amount of exercise.

Sports involving collisions, skiing, swimming, and ball sports should be avoided until your platelet count is 70,000 /mm³ or higher.

Instead of vigorous exercise, adjust the level of physical activity to match your personal health and fitness levels.

Start with about three times a week at first, and when you go for a walk, have a guardian accompany you.

Initially, start with 10 minutes of exercise, followed by 10 minutes of rest, and on the next day, increase to 20 minutes of exercise, followed by 20 minutes of rest. Gradually increase the time in this manner.

Exercise should be performed one hour after a meal. Avoid intense workouts in a short amount of time, and ensure you are well hydrated before and after exercise.

If you experience excessive fatigue, pain, dizziness, or vomiting, stop exercising.

To avoid direct sunlight exposure, wear a hat when you go outside, along with long-sleeved clothes and long pants.

Driving should be limited in the initial period after discharge due to the potential risk of accidents associated with muscle weakness and slowed reaction times from long-term hospitalization.

For at least 6 months following an allogeneic transplant, or for the duration of immunosuppressant use, and for about 3 months following an autologous transplant (or 1 month for multiple myeloma), it's advisable to avoid places like supermarkets, markets, theaters, schools, restaurants, department stores, large stores, churches, or any crowded or enclosed space, including swimming pools. This is to prevent infection from bacteria or viruses in the air. If it's necessary to visit these places, such as for an outpatient appointment, wear a mask and take a thorough shower upon returning home.

It's advisable to avoid public transportation such as buses, subways, trains, and airplanes, where large numbers of people are present.

When at home with healthy family members you regularly interact with, it is not necessary to wear a mask.

If a family member catches a cold, avoid close contact with them and ensure they wear a mask. Besides the common cold, it's also important to avoid contact with anyone who has contagious diseases such as the flu, chickenpox, shingles, or measles.

Family members living with the patient should always maintain cleanliness to reduce the risk of infection, and wash their hands after returning from outside.

Limit visitors to 2-3 people at a time, and ensure they wash their hands thoroughly before meeting the patient. Preferably, the meeting should take place in the living room rather than the patient's room. However, visits from people infected with viruses such as the common cold, chickenpox, shingles, or measles are strictly prohibited.

Avoid paint, benzene, gasoline, or any products that contain these, as they can potentially decrease your blood cell count.

Typically, returning to school or work is possible about 3 months after an autologous transplant (or 1 month for multiple myeloma) and upon the cessation of immunosuppressant therapy for allogeneic transplants. However, the precise timeline for return should be discussed with your primary physician during outpatient visits.

Avoid consuming grapefruit or grapefruit juice while taking the medication.

Be sure to take your medication at the designated times without missing any doses, and always check the dosage before taking it.

Be aware that absorption rates can increase when taking the medication with high-fat meals or fat-soluble vitamins.

Always take the medication with water. (Do not take it with other beverages.)

If you vomit within 1 hour after taking the medication, take it again.