Side effects of a transplant

Read about the possible side effects of having a bone marrow or stem cell transplant for chronic myeloid leukaemia (CML).

The side effects of having a bone marrow or stem cell transplant are caused by high dose chemotherapy. You might have extra side effects if you also have total body radiotherapy as part of your 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 cell counts start to rise (engraftment) you will start to feel better.

Some side effects are serious and they can be life threatening. Let your team know if you have any side effects. They can do a lot to help you.

Other side effects might affect you in the longer term. 

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 you might have:

  • 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. 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.

Diet

You are also at risk of infection from some foods. The rules about what you can eat are different in different hospitals. While you are an inpatient and if you need it, you have meals that are less likely to cause an infection. Talk to your nurse and dietitian about getting a good balance between what you fancy eating and what might cause an infection. 

When first back at home you might need to take some precautions. For example:

  • 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

Ask your medical team if you need to follow a special diet at home and how long this should be for.

Even with these precautions you are very likely to get an infection at some point. You will need antibiotics to treat the infection.

Immunisations

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 know as soon as possible if you feel:

  • hot
  • shivery
  • itchy

Risk of bleeding

Your platelet level will fall after your treatment.

Bruising or bleeding easily

You might have:

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

You might find you are bruising more easily than normal.

You might have a platelet infusion to top up your platelets. It takes about half an hour and you have it through a drip into your central line.

Feeling or being sick

Feeling sick might be constant. It may be worse a few hours after chemotherapy treatment and you may be sick. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Tips 

•    Avoid eating or preparing food when you feel sick. 
•    Avoid hot fried foods, fatty foods or foods with a strong smell. 
•    Eat several small meals and snacks each day.
•    Relaxation techniques help control sickness for some people. 
•    Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale. 
•    Try fizzy drinks.
•    Sip high calorie drinks if you can’t eat.

Diarrhoea

Tell your doctor or nurse if you have diarrhoea. Drink at least 2.5 litres of fluid a day to help keep you hydrated. Let your doctor or nurse know straight away if the diarrhoea is severe or getting worse.

Ask your nurse about soothing creams to apply around your back passage (anus). The skin in that area can get very sore.

Sore mouth

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

  • chemotherapy
  • radiotherapy
  • a mouth infection

Doing your mouthwashes regularly will help. Sucking on ice-cubes can sometimes help.

Your treatment team will give you painkillers if you have a sore mouth. Let your nurse know if they aren't working. There are different medicines you can have or your nurse can increase your dose.

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 a tube into your tummy or 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 last for up to a couple of years.

Loss of fertility

Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men

You may be able to store sperm before starting treatment.

It can take a few months or sometimes years for fertility to return to normal. You can have sperm counts to check your fertility when your treatment is over. Ask your doctor about it.

Women

Chemotherapy can cause an early menopause. This stops you from being able to become pregnant in the future. Talk to your doctor about this before your treatment. It’s sometimes possible to store eggs or embryos before treatment.

Bone marrow and stem cell transplants nearly always cause infertility.

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 stem cells contain 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. It is an immune system reaction and can help to kill off any cancer cells left after your treatment.

Let your treatment team know if you have any signs of GvHD. You can have treatments with immunosuppressives to help reduce the reaction.

Last reviewed: 
23 May 2019
  • European guidelines for prevention and management of influenza in hematopoietic stem cell transplantation and leukemia patients: summary of ECIL-4 (2011), on behalf of ECIL, a joint venture of EBMT, EORTC, ICHS, and ELN
    D Engelhard and others
    Transplant Infectious Diseases, 2013. Volume 15, Issue 3

  • Guidelines for selection and HLA matching of related, adult unrelated donors and umbilical cord units for haematopoietic progenitor cell transplantation
    British Society of Blood and Marrow Transplantation, 2012

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

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