As your blood counts fall to near zero over the week after the high-dose chemotherapy, your stem cells will be circulating and getting instructions on what they need to build: white cells, red cells, platelets. It takes 5-7 days for the stem cells to start to build what is called engraftment.

Engraftment is the period when the infused bone marrow or peripheral blood stem cells “take” and begin producing blood cells. It may take 10 – 16 days for engraftment to occur. 

During this waiting period, your blood counts will be very low. You may need transfusions of red blood cells and platelets. Red blood cells carry oxygen to all the cells of your body, and platelets help blood to clot and prevent bleeding.

Medications may be given to speed up the production of blood cells, particularly the white blood cells needed to fight off infections. These drugs may cause bone pain, like you had during the mobilization process. Be sure to tell your nurse at the first twinge or pain. 

Moist heat, acetaminophen, or other pain medications can help. Daily blood tests and, possibly, periodic bone marrow aspirations will be done to determine if engraftment has occurred.

Once your white blood cell count is high enough to fight infection, you will be discharged from the inpatient unit and seen frequently in the outpatient clinic.