Leukaemia, lymphoma and stem-cell transplant: nursing care and graft-versus-host warning signs
- Safe practice
Blood cancers and transplant mean long periods of low counts: the nurse prevents infection and bleeding, cares for the line and spots graft-versus-host disease.
What it is
People with leukaemia or lymphoma, and those who receive a stem-cell or bone-marrow transplant, spend long periods with low blood counts, a central line and intensive treatment. After a transplant, blood counts and immunity can take six months or more to recover and full energy up to a year. After a transplant from a donor (allogeneic), the donor's cells can attack the recipient's body: graft-versus-host disease (GVHD), which affects mainly the skin, liver and gut. Nursing care combines infection and bleeding precautions, central-line care, mouth care, nutrition, emotional support and teaching the early signs of GVHD and infection. Each of those has its own page; this one joins them for these patients.
What it requires
- Infection and bleeding precautions while counts are low.
- Central-line care by the institutional bundle.
- Daily mouth, skin and stool checks for infection and GVHD.
- Nutrition and weight followed closely.
- Teaching for home: food and water safety, hand washing, pets, plants, vaccines and when to call.
How it is applied (and why)
- Apply the neutropenia and low-platelet precautions while counts are low — infection and bleeding are the main early dangers.
- Care for the central line by the institutional bundle and inspect the site each shift — the line is a common source of bloodstream infection.
- Check the mouth daily and help with mouth care: soft brush, salt or baking-soda rinses, no alcohol rinses — mucositis is painful and can become infected.
- Look at the skin every day and report a new rash or blisters — an itchy red rash is a sign of acute GVHD.
- Record the number and type of stools and report diarrhoea — it may be infection or GVHD of the gut.
- Watch for yellowing of the skin or eyes and ask about abdominal pain — the liver can be affected by GVHD or by medicines.
- Weigh the person and track intake, and ask about nutrition support early — weight loss slows recovery.
- Teach food and water safety, hand washing, avoiding crowds, gardening and litter boxes, and the warning signs — risk continues for a year or more.
- If the person goes home with a central line, teach its care and the signs to report — redness, swelling or drainage at the site need a call.
In nursing practice
- Report fever, chills or sweats, a new rash or blisters, diarrhoea that does not stop, jaundice, a worsening cough or trouble breathing.
- Report redness, swelling or drainage at any IV or central-line site.
- Fatigue and poor appetite are common for months; regular walking and enough protein and calories help.
- Treatment of fast-growing blood cancers can cause tumour lysis; see the cancer-emergencies page.
- Which vaccines are needed, and when, is decided by the transplant team.
Common mistakes
- Thinking a rash after transplant is only a drug allergy and not reporting it.
- Counting diarrhoea as a simple side effect without recording volume and frequency.
- Accessing the central line without following the bundle.
- Assuming autologous transplant patients can get GVHD, or forgetting that allogeneic ones can.
- Stopping the teaching at discharge, when the infection risk continues for months.
Test yourself
Think of the answer, then tap the question to see it.
Which patients can develop graft-versus-host disease?
Those who received stem cells or marrow from a donor (allogeneic transplant); it does not occur after an autologous transplant.
What are the signs of acute GVHD?
An itchy red skin rash, diarrhoea, abdominal cramps, nausea or vomiting, and yellowing of the skin or eyes.
How long can immunity take to recover after a stem-cell transplant?
Six months or more, and the person should stay alert to infection for a year or more.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Bone marrow transplant - discharge: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Graft-versus-host disease: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Preventing Infections in Cancer Patients: Know the Signs and Symptoms of Infection (Centers for Disease Control and Prevention (CDC), 2025).
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