Side effects of bone marrow and stem cell transplants
This page tells you about the side effects of bone marrow and stem cell transplants. There is information about
The side effects for bone marrow and stem cell transplants are really the same as for chemotherapy. You are having the same drugs in higher doses. So the side effects can be more severe.
All these side effects are at their worst when you have just had your transplant and for a couple of weeks afterwards. When your blood counts start to rise you will start to feel better.
In the longer term, these treatments may 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 occur 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 most likely to get an infection from the normally harmless bacteria we all have in our digestive systems and on our skin.
To stop this from happening you may be given tablets called gut sterilisers (antibiotics) and mouthwashes. And you will be encouraged 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
- Hot meals must be thoroughly cooked and eaten fresh
- Fruit must be washed and peeled
- Salads must be carefully washed but are usually 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 be asked to wear disposable gloves and aprons. Visitors with coughs and colds are not allowed. Some centres don't allow you to have flowers in your room because infections can grow in the water.
Even with all these precautions, most people do get an infection at some point and have 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 not live ones. To lower the risk of you getting any of these infections it is important that all the family have the flu vaccine and any children have all their immunisations.
Your red blood cell count will 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 may 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. This is similar to a blood transfusion but only 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 can take many months to really recover.
Once you are over your chemotherapy and radiotherapy any sickness problems you have had should start to get better. But unfortunately other treatment you will be given can make you feel sick, such as antibiotics. You can have anti sickness drugs 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, you will be given 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. You will be given 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. You may feel very tired for several months or a couple of years.
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, chemotherapy can cause an early menopause. Doctors can treat this with hormone replacement therapy. 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 research. You can also find information about coping with infertility and early menopause in the section about sex and chemotherapy for women.
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.
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