Which of the following is a common gastrointestinal toxicity observed in the first 2-3 weeks after stem cell transplant that often precludes enteral feeding?

• A. Headache
• B. Rash
• C. Nausea/vomiting
• D. Cough

Answer: (C)

The event being tested is the high frequency of nausea and vomiting after the conditioning therapy used for stem cell transplantation. This regimen—often very intense chemotherapy with or without total body irradiation—has strong emetogenic potential, so patients commonly experience significant nausea and vomiting in the first couple of weeks. When vomiting is severe, it makes it hard to keep or advance enteral nutrition because the risk of aspiration rises and tolerance to oral intake is poor. That is why nausea/vomiting is the most likely reason enteral feeding is precluded early after transplant.

Headache, rash, and cough are not primarily GI toxicities seen as barriers to enteral feeding in this setting; they may occur but do not typically prevent GI nourishment to the degree that nausea and vomiting do in the immediate post-transplant period.