Side effects of bone marrow and stem cell transplants
This page tells you about the side effects of bone marrow transplants and stem cell transplants. There is information about
Side effects of bone marrow and stem cell transplants
Bone marrow transplants and stem cell transplants are a way of giving high dose chemotherapy and sometimes whole body radiotherapy as a treatment for some types of leukaemia, lymphoma or myeloma. For a few weeks after the treatment
- You will be more at risk of getting an infection – you may have tablets to protect your digestive system and mouthwashes to prevent mouth infections. You will need to have a shower each day. You will have to avoid some foods such as unpeeled fruit, unwashed salads, lightly cooked or raw eggs, fresh cream and soft cheese. Visitors will need to wash their hands and may wear gloves and aprons. If you get an infection you will have antibiotics
- You may be anaemic and feel tired, lacking in energy and breathless when you move around. You may need to have a blood transfusion
- Your platelet levels will fall – platelets help the blood to clot so low levels mean you are at risk of bleeding. Tell your nurse or doctor straight away if you notice any bruising or bleeding. You may need to have a platelet transfusion
- You may have sickness and diarrhoea – you will have medicines to help control this
- You may have a sore mouth and mouth ulcers – you will have mouthwashes and lozenges to suck to try to prevent infection. You can have painkillers if your mouth is very sore
- You may have difficulty eating and drinking – it can help to try small meals, snacks and drinks often through the day. If you can't eat much, your dietitian will give you high calorie and protein drinks
You will lose immunity to diseases you were vaccinated against as a child, and so you will need the vaccinations again. You and your family members will need to have the flu vaccine and any children you contact should have had all their immunisations. Your doctor will advise you about this.
Longer term side effects
- Infertility – you will usually no longer be able to have children, but some people who have had a transplant do go on to have children. Sometimes it is possible for men and teenage boys to store sperm before they start their chemotherapy.
- For women, the treatment can cause an early menopause – doctors can give hormone replacement therapy (HRT) to help with symptoms. Women may be able to store their eggs before starting cancer treatment, but this isn't always possible
- Graft versus host disease (GVHD) – if you have had a transplant from a donor, there is a risk of the donated cells reacting against your own body tissues. Depending on which part of the body is affected, you may have diarrhoea, weight loss, jaundice, sore eyes or a sore mouth, shortness of breath or skin rashes. Your doctor can prescribe medicines to damp down this reaction.
The side effects of bone marrow transplants and stem cell transplants are caused by the high dose chemotherapy. You may 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 you will gradually begin to feel better.
In the longer term, these treatments often cause infertility, although some people who have had a transplant do go on to have children.
Another side effect called graft versus host disease (GVHD) can happen if you have bone marrow or stem cells from a donor.
You will have a low white blood cell count after your treatment. This means you are more at risk of getting an infection. You are likely to get an infection from the normally harmless bacteria we all have in our digestive systems and on our skin.
To try to stop this from happening your nurse may give you tablets called gut sterilisers (antibiotics) and mouthwashes. And they will encourage you to have a shower each day.
You are also at risk of infection from food. The nurses on the ward will tell you and your relatives about the food you can and can't eat. The rules vary from hospital to hospital but you may be told that
- Hot meals must be thoroughly cooked and eaten fresh
- Fruit must be washed and peeled
- Salads must be carefully washed (but they are often not allowed)
- You cannot have lightly cooked or raw eggs
- You cannot have fresh cream or soft cheese
Your room will be thoroughly cleaned every day. Your visitors will be asked to wash their hands before they come into your room. They may also have to wear disposable gloves and aprons. Visitors with coughs and colds are not allowed. Some hospitals don't allow you to have plants or flowers in your room because bacteria and fungi can grow in the soil or water, and may cause infection.
Even with all these precautions, most people do get an infection at some point and need to have antibiotics. You can help yourself by trying to do your mouth care properly and getting up to shower and have your bed changed even on the days you don't feel too good.
After a transplant you will have lost immunity to diseases you were vaccinated against as a child. The team caring for you will advise you about the immunisations you need and when. You should only have inactivated immunisations and not live ones. To lower the risk of you getting any of these infections it is important that all your family have the flu vaccine and any children have all their immunisations.
Your red blood cell count will also fall after your treatment. If it gets too low you will feel very tired and lacking in energy. You may also feel breathless when you move around. Your nurse will check your blood cell levels each day. If you are anaemic you will need a blood transfusion. This will help you to feel better straight away.
Sometimes people have a reaction to a blood transfusion, particularly if they have had a lot of transfusions of blood or platelets in the past. You may have a high temperature and feel shivery, or develop an itchy rash. The reaction feels uncomfortable at the time but soon passes. Tell your doctor or nurse if you feel hot, very cold or shivery when you are having a blood transfusion. They will give you some medicines to stop the reaction. They may also slow down the transfusion rate.
More rarely, there is a different type of reaction, causing chest or kidney pain (pain in your back or side), a flushed face and chills. You may also have a burning along the vein that your drip goes into. If you have any of these signs, tell your doctor or nurse straight away because they may need to stop the infusion.
Your platelet levels will also fall after your treatment. Platelets help the blood to clot. A low platelet level means you are at risk of bleeding. Tell your nurse or doctor straight away if you notice
- Blood in your urine
- Blood when you have your bowels open
- Bruises or tiny red spots on your skin
- Bleeding gums
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, which gives them a high temperature and makes them feel shivery. This is uncomfortable at the time but soon passes. Tell your doctor or nurse if you feel hot, very cold, or shivery when you are having platelets.
Your platelet count can take quite a while to get back to normal after a bone marrow or stem cell transplant. After an autologous transplant (when you have had your own bone marrow or stem cells) it may take many months to really recover.
A couple of weeks after your chemotherapy and radiotherapy, any sickness problems you have had should start to get better. But unfortunately other treatments you will be given can make you feel sick, such as antibiotics. You can have anti sickness medicines for as long as you need them.
Diarrhoea can develop as a reaction to the radiotherapy or chemotherapy. You may also have it due to an infection or it can be a feature of graft versus host disease. If the diarrhoea is severe, your nurse will give you tablets to control it. You will also need the underlying cause of the diarrhoea treated.
A sore mouth and mouth ulcers are very common after a transplant. They can develop as a reaction to chemotherapy or radiotherapy, or from a mouth infection. Your nurse will give you mouthwashes and lozenges to suck to try to prevent infection. Sucking on ice cubes can sometimes help to reduce the pain. You must be very careful not to damage the lining of the mouth, which can become very delicate just after a transplant. If your mouth is sore your nurse will give you painkillers.
If you are coping with sickness, diarrhoea and a sore mouth, you may not have much appetite just after your transplant. You will be encouraged to try small meals, snacks and drinks often through the day. If you are not able to eat much, your dietician will give you high calorie and protein drinks.
If you find it difficult to eat anything for a time, or if you have lost a lot of weight, your nurse may give you liquid nutrition through your central line. This will gradually stop as you get better and begin to eat more.
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 counts are at their lowest. When they start to pick up you will not get so many infections. And you won't need to have blood and platelet transfusions so often. Any side effects will wear off and your appetite will begin to come back.
Slowly you will feel you have more energy. But you will feel more tired than usual for quite a long time after your transplant. This may be for several months or even a couple of years. We have more information about tiredness (fatigue).
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. Ask your doctor if you think you would like to do this.
For women, treatment can cause an early menopause. Doctors can give hormone replacement therapy (HRT) to help with the symptoms. Women may be 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. Look in the section about fertility and chemotherapy for more information about this.
If you have had a transplant from a relative or matched unrelated donor, there is a risk of GVHD. This happens because the transplanted stem cells or bone marrow contain cells from the donor's immune system. These cells can sometimes recognise your own tissues as being foreign and attack them. This can be an advantage as they may also attack any cancer cells that are left after your treatment. Sometimes however, GVHD can affect other tissues such as the skin, liver, mouth, eyes, gut or lungs.
GVHD can cause
- Weight loss
- Sore eyes or mouth
- Shortness of breath
- Skin rashes
If you develop GVHD after your transplant, your doctor will prescribe drugs to damp down this immune reaction. These are called immunosuppressives.
If you are going to get GVHD affecting the skin, gut or liver this usually starts quite soon after your transplant. But GVHD affecting the skin can cause long term problems such as rashes, and the skin can become tighter and less elastic. Your doctor is likely to suggest that you stay out of the sun because GVHD skin rashes can often get worse in the sun.
We have a section with detailed information about graft versus host disease and how to manage it.
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