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Stem Cell or Bone Marrow Transplant Side Effects

Bone marrow and stem cell transplants can come with significant side effects. Some of these side effects happen shortly after transplant. Others may develop months or even years later.

Your transplant team can help you manage these problems.

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Problems soon after transplant

Problems that can happen soon after stem cell or bone marrow transplant include:

Many of these problems come from having your bone marrow wiped out by the conditioning treatment given just before the transplant (high doses of chemo or radiation to kill cancer and make room for new blood stem cells). You may also have side effects from the conditioning treatments themselves.

Your transplant team can help you cope with side effects. Some can be prevented, and most can be treated to help you feel better.

 

Always tell your transplant team about any problems you have or changes you notice.

  • This is not a complete list of possible side effects.
  • Some of these problems can be life-threatening, so it’s important to be able to reach your transplant team at night, on weekends, and during holidays.
  • Ask for their after-hours contact numbers to make sure you can reach them.

Mouth and throat pain

Mucositis (inflammation or sores in the mouth) is a short-term side effect that can happen with chemo and radiation. It usually gets better within a few weeks after treatment, but it can make eating and drinking very painful.

Your transplant team can help you make a plan to manage your symptoms.

Nausea and vomiting

Chemotherapy drugs can cause severe nausea and vomiting. To try to prevent it, doctors often give anti-nausea medications before each dose of chemo. As much as possible, the goal is to prevent nausea and vomiting because it’s easier to prevent it than to stop it once it starts.

Anti-nausea medications should continue for as long as the chemo is likely to cause vomiting. This can be up to 7 to 10 days after the last chemo dose.

No single drug can prevent or control chemo-related nausea and vomiting 100% of the time. In many cases, two or more medications are used. Tell your transplant team how well the medicines are controlling your nausea and vomiting. If they aren’t working, they will need to be changed.

Infection

Infections that cause only mild symptoms in people with normal immune systems can be quite dangerous for you. This is because your white blood cells are the primary way your body fights off infection. Right after transplant, you don't have many white blood cells that are working well.

You may be given antibiotics to try to prevent infections until your blood counts reach a certain level.

Your new stem cells start making white blood cells (engraftment) within the first 6 weeks after your transplant. The risk of infections is lower after engraftment, but it still can happen.

Signs of infection

Signs of infection include:

  • Fever
  • Cough
  • Shortness of breath
  • Diarrhea
  • Pain

 

A fever is one of the first signs of infection. Sometimes it’s the only sign.

It's very important to contact your transplant team if you have a fever or any other signs of infection.

You will need to take your temperature by mouth every day or twice a day for a while. Your transplant team will let you know when to call them with your temperature.

If you get a fever, tests will be done to look for possible causes of the infection (chest x-rays, urine tests, and blood cultures) and antibiotics will be started.

Common types of infection post-transplant

  • Bacterial infections are most common during this time.
  • Viral infections that were controlled by your immune system can become active again.
  • Fungal infections can also pop up.
  • You will take medicines to prevent or control these infections for about 6 months or longer after transplant.  

Pneumocystis pneumonia (PCP): This is also called Pneumocystis jirovecii pneumonia. It is a serious fungal infection that can cause fever, cough, and serious breathing problems. The germ doesn’t harm people with normal immune systems, but it can affect people whose immune systems aren’t working correctly yet after transplant.

Cytomegalovirus (CMV): This is a common viral infection that many adults have or had in the past. Adults with healthy immune systems may not have any symptoms, but CMV can cause serious pneumonia in people who’ve had transplants. Pneumonia from CMV mainly happens to people who were already infected with CMV or whose donor had the virus.

Your transplant team checks your blood tests for CMV before transplant and gives you a special medication to keep it under control. If neither you nor your donor had CMV, the transplant team might follow special precautions to prevent this infection while you are in the hospital.

Preventing infection

It can take 6 months to a year after transplant for your immune system to work as well as it should. It can take even longer if you have graft-versus-host disease (GVHD, see below).

You will be watched closely for signs of infection. Your transplant team will give you and your caregivers detailed information about the precautions you need to follow.

Avoid contact with:

  • Fresh flowers and plants. These can carry bacteria and fungi. Don’t bring them in your hospital room or living spaces at home.
  • Soil, disturbed soil, and mold. Don't touch or be near disturbed soil.
  • Feces (human, animal, and bird). Move cat litter boxes away from places you eat or spend time. Don’t clean pet cages or litter boxes. Give this task to a family member or friend.
  • Aquariums, reptiles, and exotic pets. Wash your hands after touching pets.

Take extra care with food and meal prep:

  • Avoid eating certain fresh fruits and vegetables that can carry bacteria and fungi.
  • You might also need to avoid certain other foods for a while.
  • All your food must be cooked well and handled very carefully.

 

Bleeding and transfusions

After transplant, you are at risk for bleeding because the conditioning treatment destroys your body’s ability to make platelets. Platelets are the blood cells that help your blood clot.

Your platelet counts will be low for several weeks after transplant. During this time, you might notice easy bruising and bleeding, such as nosebleeds and bleeding gums.  

While you wait for your transplanted stem cells to start working, your transplant team may have you follow special precautions to avoid injury and bleeding.

Platelet or red blood cell transfusions

  • If your platelet count drops below a certain level, you may need a platelet transfusion.
  • It also takes time for your bone marrow to start making red blood cells. You might need red blood cell transfusions from time to time as you recover.

For more information on the transfusion process, see Blood Transfusion and Donation.

 

Noninfectious lung problems

Pneumonitis is a type of inflammation (swelling) in lung tissue that’s most common in the first 100 days after transplant. But some lung problems can happen much later, even 2 or more years after transplant.

Unlike pneumonia, which is usually caused by germs, pneumonitis may be caused by radiation, graft-versus-host disease, or chemo. It can happen when the areas between the cells of your lungs (called interstitial spaces) get damaged.

If total body irradiation was given with chemo as part of the pre-transplant (conditioning) treatment, the risk of pneumonitis is higher and can be severe.

Watching for signs of lung problems

While you are in the hospital, you’ll get chest x-rays to watch for pneumonitis and pneumonia. Some doctors will do breathing tests every few months if you have graft-versus-host disease (see next section).

 

Report any shortness of breath or changes in your breathing to your transplant team right away.

There are many other types of lung and breathing problems that also need to be tested for and handled quickly.