[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Leukaemia, lymphoma and stem-cell transplant: nursing care and graft-versus-host warning signs # 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. Updated Nov 13, 2026 ## Key points - Fever, chills or sweats are reported at once: infection risk stays high for a year or more after transplant. - Acute GVHD (usually in the first months): itchy red skin rash, diarrhoea, abdominal cramps, nausea and yellowing of the skin or eyes. - GVHD happens only after a donor transplant (allogeneic), not when the person receives their own cells (autologous). - Chronic GVHD (usually after three months): dry eyes and mouth, mouth patches, skin tightening, joint stiffness, breathlessness and weight loss. - Medicines that suppress immunity to prevent GVHD are continued until the transplant team decides, and need regular blood tests. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/nursing/leukaemia-lymphoma-and-stem-cell-transplant-nursing-care-and-graft-versus-host-w/) ## Elsewhere in DurgiPedia - [Immunosuppressants by mechanism (classes)](https://durgical.com/en/immunology/immunosuppressants-by-mechanism/) ## Connections ## Related 4 - [Neutropenia and low platelets: infection and bleeding precautions, and fever as an emergency](https://durgical.com/en/nursing/neutropenia-and-low-platelets-infection-and-bleeding-precautions-and-fever-as-an/) - [Central venous catheter care](https://durgical.com/en/nursing/central-venous-catheter-care/) - [Cancer emergencies on the ward: cord compression, SVC syndrome, high calcium and tumour lysis](https://durgical.com/en/nursing/cancer-emergencies-on-the-ward-cord-compression-svc-syndrome-high-calcium-and-tu/) - [Nursing care of the dying patient](https://durgical.com/en/nursing/nursing-care-of-the-dying-patient/) ## Related conditions 5 - [Acute leukaemia (AML and ALL)](https://durgical.com/en/conditions/acute-leukaemia/) - [Chronic lymphocytic leukaemia](https://durgical.com/en/conditions/chronic-lymphocytic-leukaemia/) - [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/) - [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/) - [Graft-versus-host disease](https://durgical.com/en/conditions/graft-versus-host-disease/) [← All of nursing](https://durgical.com/en/nursing/) 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](https://medlineplus.gov/ency/patientinstructions/000010.htm) (MedlinePlus, US National Library of Medicine, 2026); [Graft-versus-host disease: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001309.htm) (MedlinePlus, US National Library of Medicine, 2026); [Preventing Infections in Cancer Patients: Know the Signs and Symptoms of Infection](https://www.cdc.gov/cancer-preventing-infections/patients/symptoms.html) (Centers for Disease Control and Prevention (CDC), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/leukaemia-lymphoma-and-stem-cell-transplant-nursing-care-and-graft-versus-host-w/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/leukaemia-lymphoma-and-stem-cell-transplant-nursing-care-and-graft-versus-host-w/