Nutrition After Blood And Marrow Transplant

Blood and marrow transplant (BMT) is a very intense procedure, which involves the replacement of a person's abnormal stem cells with healthy ones ^[1] . The healthy stem cells are from another person, called a donor. A blood and marrow transplant is carried out in patients with blood cancer or any blood disorders. The procedure helps the patient in gaining new stem cells that work properly, thereby improving their quality of living.

A blood and marrow transplant is not only carried out on adults but also on children. Studies reveal that in comparison to adults, children receive the treatment in large numbers.

The three main types of blood and marrow transplant are ^[2]

• Autologous transplant
• Allogeneic related donor transplant
• Allogeneic unrelated donor transplant

What To Expect After A Blood And Marrow Transplant

As the procedure is complex, there are several side effects associated with it. Some of the most common side effects are the following: ^[3]

• Nausea and vomiting
• Mouth Sores
• Fatigue
• Low levels of platelets
• Low levels of red blood cells
• Diarrhoea

Apart from these, the patients may also develop infertility and cataracts as part of the long-term side effects. Some of the other long-term side effects are as follows: ^[4]

• Early menopause for women
• Thyroid problems
• Lung or bone damage
• Risk of developing another cancer

Among all these side effects or adverse impact the procedure can have on an individual, the most difficult one is on one's eating habits and daily diet. After the transplant, the individual will need to face various challenges in order to cope with the changes the blood and marrow transplant will impose on your body. Your body's requirements will change over time - in the initial phase you will be required to focus on maintaining your current weight and exploring the different types of foods that you can consume without causing any adverse impact on your body and system ^[5] .

During this phase, your body will require plenty of nutrients and energy so as to help repair, create and maintain the new cells. However, you will not be able to experience the taste of food as you used to. Loss of appetite and taste are common after a transplant. And as aforementioned the problems such as dry mouth, change in taste, depression, constipation etc., can make it difficult to get the necessary amount of protein, calories and fluids into your body^[6] .

Eating Habits To Follow

After receiving a blood and marrow transplant, you may find it difficult to eat food on a regular basis. However, it is highly important that you not lose the relationship with food simply because it is highly critical that you eat regularly to keep your body healthy and functioning. It is the most important part of your journey towards recovery ^[7] .

Eat little and eat often - There is no need to eat your meals three times a day. You may not be able to eat a full meal at a time, so it is best to eat smaller portions more often. This way, you will be able to eat food without having to finish it one go.

Give in to your cravings - Yes! Eat what you want. If your tastebuds restrict you to eat a specific type of food, go ahead. However, make sure the food you are craving for is suitable for your health at the moment.

Eat calories - Choose to eat food with high amounts of calorie because, as you may not be able to eat food that often, eating calories will help maintain a healthy balance and provide you with energy.

Quick eats - Plan out meals that are quick to prepare and do not take much preparation time. Because longer hours of preparations may kill your appetite.

Avoid distraction - Concentrate on your meals while eating them. Avoid sitting in front of a television or anything that would cause a distraction.

Aid digestion - Eat food that can be easily chewed. You can also add gravy or sauce to ease the digestion process. Once after eating, sit straight for at least 15 minutes so that there is no chance of indigestion^[8] .

Foods To Eat After Blood And Marrow Transplant

• Consume nutrition supplements such as Boost ^[9] .
• Dairy products rich in phosphorus and calcium ^[10] such as cream (pasteurised), milk (skim, low-fat, whole), natural cheese, processed cheese (pre-packaged), cottage cheese, ricotta cheese, yoghurt (regular, frozen or Greek), custard pudding, ice cream or ice milk, cream soup, buttermilk, milkshakes, evaporated milk, powdered milk and soy milk.
• Non-dairy products that are rich in calcium such as calcium-enriched fruit juice, roasted almonds, dried peas and beans, tofu, kale, collard, mustard, turnip, canned salmon with soft bones, bok choy, calcium-fortified cereal, spinach, sardines.
• Phosphorus-rich foods ^[11] such as biscuits, lean beef, bran cereal, chicken, fish like pollock, walleye, swordfish, cod, halibut, salmon, tuna, granola, nuts - most varieties, oatmeal, peanut/nut butters, pork loin, potato/baked with skin, seeds (sunflower or pumpkin), soybeans, tortillas, turkey, vegetable or soy patty and waffle or pancake.
• Fruits such as apricots, avocados, bananas, dates, figs, honeydew or cantaloupe, kiwi, nectarines, oranges, peaches, prunes, raisins.
• Vegetables ^{[12] [13]} such as artichokes, bamboo shoots, beets, Brussels sprouts, chard, chickpeas, parsnips, pumpkin, spinach, squash, sweet potatoes, tomatoes, white potatoes.

Foods To Avoid After Blood And Marrow Transplant

• Do not eat fresh raspberries, fresh strawberries, raw broccoli, raw cauliflower or sprouts.
• Avoid rare and medium-rare meats ^[14] .
• Avoid juices, honey and dairy products that are unpasteurized or gently pasteurised.
• It is best to avoid uncooked fruits or vegetables that cannot be peeled before eating.
• Avoid deli salads not prepared at home.
• Limit red and processed meat.
• Avoid fast food and processed foods including those high in fats, sugars and salt.
• Say no to sugary or sweetened drinks.
• Avoid alcohol ^[15] .
• Avoid spicy foods.
• Avoid foods that are overly sweet.
• Avoid strong smelling foods.
• Avoid foods that are high in fat.
• Do not have hot liquids with meals.
• Avoid drinking liquids on an empty stomach.
• Do not consume raw honey.
• Avoid pickled seafood.
• Avoid soft cheese.
• Avoid raw nuts.
• Avoid herbs such as alfalfa, apricot pits, rhubarb root, Chinese herbs, liquorice root ^[10] .

Specific Foods To Eat & Avoid To Deal With The Side Effects

Apart from the aforementioned types of what to eat and what not to eat, the following suggestions can be taken into consideration to manage the common side effects that arise after the blood and marrow transplantation.

1. For mouth and throat sores

Foods to eat - Lukewarm or cold food, foods that are cooked until tender and soft (you can add sauces to moisten them), high-protein, high-calorie foods, soft foods such as creamed soups, pasteurized cheeses, mashed potatoes, cooked eggs, custards, puddings, gelatin, soft canned fruit, cooked cereals, milkshakes, ice cream, cottage cheese, yogurt, slushes and watermelon ^[16] .

Foods to avoid - Tart or acidic foods such as citrus fruits and juices, pineapple juice and some tomato products, salty foods, strong spices (pepper, chilli powder, cloves), coarse foods (grainy cereals, crunchy snacks), alcoholic beverages.

2. For dry mouth

Foods to eat - Ice chips, popsicles, sugarless gum or hard candies, citric food (in case of no mouth sore) ^[17] .

Foods to avoid - Bread products, crackers and dry cakes, very hot food, alcohol.

3. For taste changes

Foods to eat - Strongly flavoured foods such as chocolate, lasagna, spaghetti or barbecued foods, tart or spicy foods, cranberry sauce, jelly or applesauce.

4. For thick saliva

Foods to eat - Club soda, hot lemon tea, soft, tender foods such as cooked fish and chicken, eggs, noodles, thinned cereals, and blenderized fruits and vegetables.

Foods to avoid - Meats that require chewing, bread products, oily foods, thick cream soups, thick hot cereals, nectars ^[18] .

5. For nausea & vomiting

Foods to eat - Pretzels, vanilla wafers, low-fat foods like cooked vegetables, canned fruit, baked skinless chicken, sherbet, fruit ice, popsicles, gelatin.

Foods to avoid - Spicy foods, foods that are overly sweet, strong smelling foods, high-fat foods.

6. For diarrhoea

Foods to eat - Ripe bananas, potatoes without the skin, tomato juice, pasteurised peach and pear nectar, baked fish, chicken and ground beef, well-cooked eggs and vegetables (but not beans, broccoli, cauliflower or cabbage), canned fruit, white rice, white bread ^[19] .

Foods to avoid - Bran or whole grain cereals and breads, raw vegetables, fruits with skin and seeds, popcorn, seeds and nuts, carbonated beverages, beans, broccoli, cauliflower and cabbage, chewing gum, spicy foods, foods with rich gravies or sauces, foods and drinks with caffeine such as coffee, tea, chocolate, colas etc.

Steps To Follow While Preparing Your Food

It is necessary that you take utmost care while preparing your food because after the transplant your body will be weak and can contract various infections ^[20] .

• Always wash fresh produce thoroughly with water. Scrub the vegetables and fruits to get rid of the dirt.
• All meats, poultry and seafood must be thoroughly cooked.
• Eggs should be cooked until both white and yolk are set (not runny).
• Do not use a microwave to cook poultry, meat, fish or egg.
• Eat meals within one hour of preparation.

General Food Guidelines To Be Followed

As your immune system needs the utmost care during this phase, you will be required to follow certain steps and guidelines to maintain a healthy body and system^{[20] [21]} .

• Check expiration dates on perishable food.
• Check for mould or insect contamination.
• Do not keep leftovers longer than two days.
• Keep foods at the proper temperature.
• Keep cold foods such as milk and dairy products, in the refrigerator.
• Keep hot foods hot, not served at room temperature.
• Portion food into individual servings in a tightly sealed container and cool in the refrigerator or freezer.
• Thaw frozen foods appropriately either in the microwave or refrigerator on defrosting the refrigerator or by running cold water continuously over meal until thawed and not at room temperature.
• Drink fresh water, use a water filter.
• Fruits and vegetables must be washed thoroughly and cut off the bruised areas.
• Do not share eating or drinking utensils.
• In the case of children, they should take a daily multivitamin supplement until the appetite returns to normal. It is not necessary to take large doses of vitamins and minerals, as this may be dangerous as well as expensive. Select a simple, inexpensive, daily multivitamin without iron, unless advised by the doctor.
• Notify the doctor if your child develops difficulties eating, swallowing or tolerating food.