This study examined the course of adaptation as indicated by the level of emotional distress for family caregivers of adult BM recipients across the acute phase of the transplant trajectory. Factors influencing caregivers' adaptation that could be potential markers of vulnerability to psychological and social morbidity were identified. The sample included 192 caregivers of either an autologous or allogeneic BMT recipient. Data were collected by self-report questionnaires at three time points in the trajectory: pre-transplant/pre-hospitalization (T1); during hospitalization, post-infusion (T2); 1 month post-discharge (T3). There was a decline in emotional distress from T1 to T3, and bivariate correlations indicated significant association of distress with variables hypothesized to be theoretically relevant. Specifically, greater personal control, a greater sense of spiritual connectedness, less disruption in the life of the caregiver and less use of avoidance coping were the strongest factors associated with lower emotional distress. In conclusion (1) levels of personal control and spirituality remained stable across time and were negatively associated with emotional distress. Therefore, they may provide an indication of caregiver resilience pre-transplant; (2) level of recipient symptomatology rather than BMT type appears to influence caregiver distress; (3) there are indications of the need for post-hospitalization follow-up with caregivers by the BMT team.