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Side effects of bone marrow and stem cell transplants

Find out about the possible side effects of having a bone marrow or stem cell transplant.

The side effects of bone marrow transplants and stem cell transplants are caused by high dose chemotherapy. You might have extra side effects if you also have whole body radiotherapy (total body irradiation) as part of the treatment.

All the side effects are at their worst when you have just had your high dose treatment and for a few weeks afterwards. When your blood counts start to rise (engraftment) you will start to feel better. Let your team know if you have any side effects. They can do a lot to help you.

In the longer term, these treatments often cause infertility, although some people who have had a transplant do go on to have children.

Risk of infection

You have a low white blood cell count after your intensive treatment. So you are at more risk of getting an infection. This can be from normally harmless bacteria that we have in our digestive system and on our skin.

To try and stop this from happening your nurse might give you:

  • antibiotics
  • anti-fungal medicines
  • mouthwashes

You need to have a shower every day to reduce the risk of infection. If you are finding it hard to shower, let your nurse know and they can help.

You are also at risk of infection from some foods. The rules about what you can eat are different in different hospitals.

Talk to your nurse and dietitian about getting a good balance between what you fancy eating and what might cause an infection.

Tips

  • Heat all hot meals thoroughly and eat them fresh.
  • Wash and peel all fruit.
  • Carefully wash all salad leaves.
  • Avoid lightly cooked eggs.
  • Avoid soft cheese.

Your room is cleaned and your bedsheets are changed every day.

Your visitors should wash their hands before they come into your room. They might need to wear gloves and aprons like the nurses and doctors. They shouldn't visit if they have coughs or colds.

Even with these precautions you are very likely to get an infection at some point that you will need to have antibiotics for.

After a transplant you lose immunity to diseases you were vaccinated against as a child. Your transplant team will let you know which vaccinations you need to have again after your treatment. It's important that all your family have the flu vaccine and any children in your close family have their childhood immunisations.

Low red blood cell count (anaemia)

Your red blood cell count will fall after treatment. Your transplant team will check your red blood cell count every day.

If it gets too low you might feel:

  • tired
  • lacking in energy
  • breathless

You will need a blood transfusion to top up your red blood cells. This will make you feel better almost straight away.

Sometimes people have an allergic reaction to a blood transfusion. Let your nurse or doctor know as soon as possible if you feel:

  • hot
  • shivery
  • itchy

They will give you some medicines to stop the reaction. They may also slow down the transfusion rate.

More rarely, some people have:

  • chest or kidney pain (pain in your back or side)
  • a flushed face
  • chills
  • burning along the vein that your drip goes into

Tell your doctor or nurse straight away if you feel any of the above because they might need to stop the infusion.

Risk of bleeding

Your platelet level will fall after your treatment. Platelets help the blood to clot. A low platelet level means you are at risk of bleeding. You might find you are bruising more easily than normal.

Tell your nurse or doctor straight away if you notice:

  • nosebleeds
  • bleeding gums when you clean your teeth
  • very heavy periods
  • blood in your urine or poo
  • bruises or small dark red spots on your skin

Your treatment team will arrange for you to have a platelet transfusion. You have the platelets as a drip into your vein. It takes about half an hour.

Sometimes people have a reaction to platelets. This is uncomfortable at the time but soon passes. Let your nurse or doctor know as soon as possible if you feel:

  • hot
  • shivery
  • itchy

Your platelet count can take a while to get back to normal after a bone marrow or stem cell transplant. It might take longer to recover after you have had your own bone marrow or stem cells.

Sickness and diarrhoea

You might feel sick after your chemotherapy and radiotherapy, but should start to feel better after a couple weeks. Unfortunately other treatments you have can make you feel sick, such as antibiotics. You can have anti sickness medicines for as long as you need them.

You might have diarrhoea as a reaction to the radiotherapy or chemotherapy. You might also have it due to an infection or because you have graft versus host disease. Tell your nurse or doctor if the diarrhoea is severe. They will give you medicine that will help. You will also need treatment for the underlying cause of the diarrhoea.

A sore mouth

A sore mouth and mouth ulcers are very common after a transplant. They can develop because of:

  • chemotherapy
  • radiotherapy
  • a mouth infection

Your nurse will give you mouthwashes and lozenges to suck to try to prevent infection.

Ask for painkillers if you need them. Sucking on ice-cubes can sometimes help to reduce the pain.

Difficulty eating and drinking

You won't have much appetite just after your transplant. Try small meals throughout the day and eat whenever you feel like it. Your dietitian will give you high calorie drinks, if you can't eat much. Or you might have liquid nutrition through your central line.

Feeling tired and run down

You will feel very tired and run down after your transplant. This will be at its worst during the second and third weeks when your blood cell counts are at their lowest.

Slowly you will feel that you have more energy. But you will feel more tired than usual for quite a long time after your transplant. This could be up to a couple of years.

Loss of fertility

A longer term side effect of this type of treatment is infertility. This means you will no longer be able to have children. Bone marrow and stem cell transplants nearly always cause infertility because of the high doses of chemotherapy involved.

Sometimes it is possible for men and teenage boys to store sperm before they start their chemotherapy. This is called sperm banking.

Treatment can cause an early menopause for women. You might have hormone replacement therapy (HRT) to help with the symptoms. Some women are able to store their eggs before starting cancer treatment, but this is not always possible. Research is going on all the time to try to help women have children after cancer treatment.

Graft versus host disease (GVHD)

If you have had a transplant from a relative or a matched unrelated donor, you are at risk of GVHD. 

This is because the donor bone marrow contains immune cells from the donor. These cells can sometimes attack some of your own body cells.

GVHD can cause:

  • diarrhoea
  • weight loss
  • yellowing of the eyes and skin (jaundice)
  • sore eyes or mouth
  • skin rashes
  • shortness of breath

GVHD can be severe and even life threatening for some people. But mild GVHD can also be helpful for some people. It is an immune system reaction and can help to kill off any leukaemia cells left after your treatment.

Let your treatment team know if you have any signs of GVHD. You can have treatments to help reduce the reaction. These are called immunosuppressives.

GVHD that affects your skin, gut or liver usually starts quite soon after your transplant. GVHD that affects the skin can cause long term problems such as rashes, and the skin can become tighter and less elastic. You should stay out of the sun because it can cause GVHD skin rashes to get worse.

Last reviewed: 
17 Mar 2015
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    D Engelhard and others
    Transplant Infectious Diseases, 2013. Volume 15, Issue 3

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    Bone Marrow Transplant, 2013. Volume 48, Issue 9

  • Infection-control interventions for cancer patients after chemotherapy: a systematic review and meta-analysis
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    The Lancet - Infectious Diseases, 2009. Volume 9, Issue 2

  • UK Stem Cell Strategic Forum Report
    NHS Blood and Transplant, 2010

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