Purpose <p>The aims of this investigation within the Orastem study were to describe the prevalence of subjective taste change, levels of patient-reported distress associated with taste change, and factors predicting taste change after hematopoietic cell transplantation (HCT) with a particular focus on factors predictive of severe and/or persistent (present at 12 months) taste change.</p> Methods <p>Altogether, 238 patients at five cancer centers were followed during HCT hospitalization and up to 12 months post-HCT. Patients with taste change were compared to non-affected patients with respect to gender, age, transplant type, previous chemotherapy, conditioning regimen(s), oral mucositis, pre-HCT salivary flow, oral hygiene status and, in allogeneic HCT recipients, chronic oral graft-versus-host disease (GVHD). Distress from taste change was also evaluated.</p> Results <p>During hospitalization, taste change was reported by over one-third (81/238) of patients to an open question on oral symptoms; of these, 41% reported taste change as their worst/most bothersome oral symptom. To a specific question on distress due to taste change, 76% of all patients reported some level of distress. Taste change from previous chemotherapy and full intensity conditioning were risk factors for severe taste change during hospitalization. At three months, allogeneic transplant patients reported a higher rate of severe taste change compared to autologous transplant patients. Increased age predicted severe taste change at 6 and 12-month follow-up. At twelve months, 13.1% of patients reported distress from taste change.</p> Conclusion <p>This study confirmed taste change as a common clinical complaint post-HCT. Taste change remained a significant issue for a small subset of patients at 12 months. Further research is required to develop effective preventive and management strategies for this common oral side-effect post-HCT.</p>