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Side effects of bone marrow or stem cell transplants for non Hodgkin lymphoma

Men and women discussing non Hodgkin's lymphoma

This page tells you about the side effects of stem cell or bone marrow transplants for non Hodgkin lymphoma. You can find the following information

 

A quick guide to what's on this page

Side effects of bone marrow or stem cell transplants for non Hodgkin lymphoma

The side effects after transplants are much the same as when you have chemotherapy. But because you have higher doses, the side effects can be more severe. You may have additional side effects if you have radiotherapy as well. The main side effects of high dose chemotherapy are

  • Risk of infection
  • Drop in red blood cells (anaemia)
  • Risk of bleeding
  • Sickness and diarrhoea
  • Sore mouth
  • Difficulty eating and drinking
  • Feeling tired and run down

Side effects are at their worst just after your transplant, and for a couple of weeks afterwards. When your blood counts start to rise you will start to feel better. You can have medicines to control sickness and diarrhoea.

You will have to take special precautions against infection. Even with precautions, most people do get an infection at some point and have to have antibiotics.
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating NHL section.

 

 

About side effects

The side effects after transplants are much the same as when you have chemotherapy. You have the same drugs, just in higher doses. But because you have higher doses, the side effects can be more severe. And you may have additional side effects if you have radiotherapy as well.

 

Chemotherapy side effects

The main side effects of high dose chemotherapy are

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.

Risk of infection

You will have fewer white blood cells in your bloodstream 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 mouthwashes, and tablets known as gut sterilisers, which are antibiotics. 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. You may be given advice such as 

  • 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

You will be at risk of getting an infection called cytomegalovirus (CMV) which affects the lungs. Let your doctor or nurse know if you feel breathless.

Your room will be cleaned every day. Your visitors will have to wash their hands before they come into your room. And they may have to wear disposable gloves and aprons. Visitors with coughs and colds are not allowed. Some hospitals 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 mouthcare properly and getting up to shower and have your bed changed each day. It is important to try to do this even on the days when you really don't feel like it.

Anaemia

Your red blood cell count will fall after your treatment. If it falls too low, you will feel very tired and have little or no energy. You may also feel breathless when you move around. This is because red blood cells contain haemoglobin which carries oxygen around the body. Your doctor will check your blood counts each day. If you are anaemic, you can have a blood transfusion. This can help you to feel better very quickly. During the transfusion, tell your doctor or nurse if you feel hot or cold and shivery. Some people have a reaction to the blood and you may need medicines to reduce this.

Risk of bleeding

Your platelet levels in the blood will 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 have any of the following signs.

  • Blood in your urine
  • Blood when you have your bowels open
  • Bruises or tiny red spots on your skin
  • Nosebleeds
  • Bleeding gums

Your doctor or nurse will arrange for you to have a platelet transfusion. This is similar to a blood transfusion but only takes about an hour. You may react to the platelets. If you do, you will feel hot or very cold and shivery when you are having them. Tell your doctor or nurse if you have this. They will give you some injections into your drip to reduce the reaction.

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 a few months to really recover. 

Sickness and diarrhoea

Once you are over your chemotherapy and radiotherapy, any sickness problems you have had should start to get better. It is possible that some of the other treatments you will be given may make you feel sick, for example antibiotics. You can have anti sickness drugs.

Diarrhoea can develop as a reaction to the radiotherapy or to some chemotherapy drugs. You can have tablets to control diarrhoea if you need them.

Sore mouth

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 may have lozenges or pastilles to suck to try to prevent infection. You must be very careful not to damage the lining of the mouth which can be very delicate just after a transplant. If your mouth is very sore you will be given painkillers.

Difficulty eating and drinking

Not surprisingly, you may not have much appetite just after your transplant if you are coping with sickness, diarrhoea and a sore mouth. 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 high protein drinks.

If you find it difficult to eat anything for a time, or if you have lost a lot of weight, you may be given liquid nutrition through your central line. You may hear this called TPN (total parenteral nutrition). Your TPN will gradually stop as you get better and begin to eat more.

Feeling tired and run down

You can expect to feel very tired and run down after your transplant. The tiredness 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 start to feel better. You will also have less risk of getting infections. And you won't need 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 will feel more tired than usual for quite a long time after your transplant. You may tire more easily than usual for several months.

 

Radiotherapy side effects

Some treatment plans include radiotherapy to your whole body just before you have your bone marrow or stem cells back. You may hear this called TBI, which stands for total body irradiation. TBI can make you

  • Feel or be sick
  • Feel very tired
  • Have diarrhoea

You may sleep a lot for a few days after the treatment. Your nurses will make sure you have as much anti sickness medicine as you need. Do make sure you tell your nurses about sickness and diarrhoea so you can have something to help control it.

 

Effects on fertility

A longer term side effect of this type of treatment is infertility. Most people will no longer be able to have children. Bone marrow and stem cell transplants usually 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. It is sometimes possible for women having cancer treatment to have eggs or embryos frozen before they start treatment. Talk to your doctor early on if you want to find out more about this. It can take a few weeks and may delay your cancer treatment.

There is detailed information about coping with these effects in the sex and fertility and non Hodgkin lymphoma section.

 

Graft versus host disease (GVHD)

If you've 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 your donor's immune system. These cells can sometimes recognise your own tissues as being foreign and attack them. This can be an advantage as the immune cells may also attack any lymphoma cells left after your treatment.

Acute GVHD starts within 100 days of the transplant and can cause

  • Diarrhoea
  • Weight loss
  • Changes in the way your liver works
  • Skin rashes

If you develop GVHD after your transplant, your doctor will prescribe drugs to calm down this immune reaction. These are called immunosuppressants.

Chronic GVHD starts more than 100 days after the transplant and you may have skin rashes, diarrhoea, sore joints and dry eyes. Your doctor is likely to suggest that you stay out of the sun because GVHD skin rashes can often get worse in the sun.

There is detailed information about graft versus host disease in the section on coping physically with cancer.

 

Life after a transplant

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Updated: 29 October 2012