Side Effects of a Bone Marrow Transplant (Stem Cell Transplant)

Approved by the Cancer.Net Editorial Board, 07/2020

A bone marrow transplant, also called a stem cell transplant, is a medical treatment that replaces bone marrow with healthy cells. Transplantation is used for certain types of cancer and other diseases of the bone marrow. Like any cancer treatment, it can cause side effects. These are different for everyone. They depend on the type of transplant, your general health, and other factors.

Many side effects go away with time, but some can be permanent. It is a good idea to talk with your health care team about all of the possible side effects before starting your transplant process.

Managing side effects is an important part of cancer care and treatment. This type of care is called palliative care or supportive care. Talk with your health care team about any symptoms you or the person you are caring for experience.

What are the side effects of an autologous transplant?

An autologous stem cell transplant is also called an AUTO transplant or stem cell rescue. An AUTO transplant uses your own stem cells as the replacement cells. A doctor gives them back to you after you have chemotherapy, with or without radiation therapy. Many side effects of an AUTO transplant are similar to side effects from chemotherapy and side effects of radiation therapy. The most serious side effect is a higher risk of infection from your body's low levels of white blood cells.

Infections

Chemotherapy and some other treatments weaken your body’s infection-fighting system, called the immune system. This is especially true of treatment given for a bone marrow/stem cell transplant, because the bone marrow is part of the immune system. When your immune system is weakened, your body cannot protect itself as well against germs. Most of these germs already live in your body. When your immune system is strong, these germs do not make you sick. But after a transplant, they can cause an infection.

Fortunately, most of these infections are fairly easy to treat with antibiotics. After about 2 weeks from your transplant day, the immune system cells called neutrophils will begin recovering. Neutrophils keep some common germs from making you sick.

You have the highest risk of infections in the first few weeks after transplant. However, your immune system may need a long time to recover after a transplant. You may need to take medications to fight infection for a year or more after your bone marrow/stem cell transplant. Your health care team will talk with you about ways to reduce your risk of infections by taking precautions during your recovery. Learn more about infections as a side effect of cancer treatment.

Other immediate side effects

The following side effects can develop right after the high doses of chemotherapy used for AUTO transplantation.

Long-term side effects

Some transplant side effects happen months or years later. These can include:

Infertility, meaning you cannot become pregnant or make a woman pregnant when you want to
Cataracts, an eye condition that causes cloudy vision
Sexual side effects and early menopause
Thyroid problems
Lung or bone damage
Another cancer

Side effects from an ALLO transplant

An allogenic transplant is also called an ALLO transplant. In an ALLO transplant, the replacement cells come from another person, called a donor. You have chemotherapy and sometimes radiation therapy to prepare your body to receive the donor's healthy cells. The side effects of an ALLO transplant are also similar to side effects from chemotherapy and side effects of radiation therapy. This includes a high risk for infections. And, you may have side effects from receiving another person’s stem cells, including a higher risk of infection and a risk of graft-versus-host disease (GVHD).

Many people have a “graft-versus-cancer cell effect” along with GVHD. This is because the new stem cells recognize and destroy cancer cells that are still in the body. This is the main way ALLO transplants work to cure cancers like leukemia.

Infection

When you have an ALLO transplant, your doctor will give you chemotherapy, with or without radiation therapy or other drugs to keep your body's immune system from destroying the new cells. These treatments affect your immune system and make infection risk higher. A weak immune system makes you more likely to get infections.

You will be at the highest risk of infection in the first few weeks after receiving the donor's cells. This risk will lessen over time, but infection risk reduction is an important part of a patient's long-term recovery.

Graft-versus-host disease

GVHD happens if the donor's stem cells attack your body causing inflammation. Even if your donor was a 100% match, you can still get GVHD. Your health care team can give you medication to prevent GVHD. If you still experience GVHD, your doctor will give you more medicines to manage the condition. GVHD can be life-threatening in some cases.

There are 2 types of GVHD: acute and chronic. Both can range from mild to severe.

Acute GVHD

This form of GVHD happens fairly quickly, in the first 3 months after an ALLO transplant. It often affects the skin, intestines, and liver. This can cause rashes, diarrhea, and jaundice. Jaundice is a liver problem that makes your skin and the whites of your eyes look yellow.

The treatment for GVHD is medication to block T cells. T cells are white blood cells that help the immune system fight infections. Blocking them keeps your transplanted immune system from attacking your body's own cells.

Chronic GVHD

Chronic GVHD usually develops more than 3 months after an ALLO transplant. It can last a few months or the rest of your life.

Chronic GVHD may or may not cause symptoms or need treatment. Or you might need treatment for specific problems. For example, you might have dry eyes and a dry mouth. Your liver might be slightly irritated. Or you might have other conditions, such as the skin losing some ability to stretch. This condition is called scleroderma. Other problems may include joint and muscle pain, weight loss, infections, and difficulty breathing.

Chronic GVHD may be treated with medications called corticosteroids. If this does not work well, you might take other medications to make your immune system less active.

Other immediate side effects

The following side effects can develop right after the high doses of chemotherapy used for ALLO transplantation.

Long-term side effects

Some transplant side effects happen months or years later. These can include:

Infertility, meaning you cannot become pregnant or make a woman pregnant when you want to
Cataracts, an eye condition that causes cloudy vision
Sexual side effects and early menopause
Thyroid problems
Lung or bone damage
Another cancer

You may have fewer long-term side effects if the chemotherapy before your transplant is less intense. People who have less powerful chemotherapy tend to have fewer long-term effects.

Talk with your health care team about possible side effects of a stem cell transplant. They can help answer your questions and make a plan to manage side effects.

Questions to ask the health care team

It is important to talk often with your health care team about side effects, before, during, and after your transplant. This helps you gather information and make decisions on treatment and care. Here are some possible questions to ask.

Will I have tests before the transplant process starts to check my general health? If so, which tests?
When could I start to experience side effects during this process?
What specific side effects are common with this type of transplant? How can they be managed or relieved?
Who should I call if I experience any side effects from my transplant?
What signs of an infection should I look out for?
What precautions to prevent infection should I follow? For how long?
What side effects should I tell my health care team right away?
If I will have an ALLO transplant, will I take any medications to prevent GVHD?
If I will have an ALLO transplant, what are the signs of GVHD that I should watch for?
What tests will I need later? How often?
What are the possible late effects of a transplant? How can they be managed or relieved?
How will having a transplant affect my daily life? Can I work? Can I exercise and do regular activities? Or, when can I restart these activities during my recovery?
Will having a transplant affect my sex life? If so, how and for how long?
Will having this transplant affect my ability to have a child in the future? If so, should I talk with a fertility specialist before treatment begins?