Overview of Stem Cell Transplant Side Effects

Stem cell transplants – whether autologous or allogeneic transplants – carry potential side effects and complications. Depending on the type of stem cell transplant performed, such as a bone marrow transplant or cord blood transplant, the risk of developing certain complications either increases or decreases. Furthermore, the type of high-dose chemotherapy treatment regimen used, as well as the type of treatable disease and the patient’s medical status, are all factors that may contribute to the risk of certain transplant side effects. The following are some potential side effects associated with stem cell transplants in general.

Stem Cell Transplant Side Effects

Eating and Appetite
Patients will be required to visit a dietician in order to ensure that an appropriate diet is maintained following a stem cell transplant. Eating problems due to a lack of appetite, nausea, or a sore mouth due to ulcers or a fungal infection may require that the patient consume nutritional beverages.

In addition, a patient may experience diarrhea or a sore bottom following a stem cell transplant. It is important for patients not to lose weight following a transplant, as a healthy weight maintains a proper number of blood cells produced in the body, which can in turn help to minimize side effects.

Infection
Following chemotherapy and a stem cell transplant, a patient’s immune system ability and the number of white blood cells in the body will be reduced, making her more susceptible to infection. An individual may develop an infection that is caused by bacteria normally present in the body. However, antibiotics and mouthwashes will typically be prescribed in order to avoid infection following a stem cell transplant.

Other precautions will also be recommended as required, as it is normal for a patient to experience a high fever at some point during recovery from stem cell transplants.

Anaemia
When anaemia occurs following a stem cell transplant, it is the result of a decreased amount of red blood cells in the blood and the subsequent decrease in haemoglobin levels that occurs. The main symptom associated with anaemia is fatigue. Blood transfusions may be required in order to restore haemoglobin until red blood cell production returns.

Thrombocytopenia/Bleeding
Thrombocytopenia refers to a decrease in platelet production in the blood. A platelet count will be checked daily through blood tests to reduce the risk of bleeding and bruising. A health care provider will also examine the skin for red spotting or rashes. If unusual bleeding occurs, it is important for the patient to seek medical attention as soon as possible. Abnormal bleeding can occur in the mouth or can be detected in the urine.

Veno-Occlusive Disease (VOD)
Veno-Occlusive Disease (VOD) affects the liver and in some cases can be fatal. VOD is a result of damage to the liver following high-dose chemotherapy and is more likely to occur in patients who have had previous chemotherapy or radiation treatment, or previous liver damage or hepatitis. Symptoms of VOD include abdominal swelling, liver tenderness, weight gain and jaundice. This typically occurs within the first two weeks following stem cell transplant.

Interstitial Pneumonia Syndrome (IPS)
Interstitial Pneumonia Syndrome (IPS) occurs when high-dose chemotherapy results in damage to the lungs and can occur at any time following a stem cell transplant. Symptoms of IPS can include a dry cough and shortness of breath and can be life-threatening. Patients should seek immediate medical attention if symptoms of IPS develop at any point following transplant.

Graft Failure
Graft failure occurs when the stem cell graft fails to grow following a stem cell transplant, resulting in bone marrow failure. Bone marrow failure subsequently causes an insufficient production of red blood cells, white blood cells and platelets in the blood, leading to infection, anaemia or bleeding. While total graft failure is rare, a second stem cell infusion is required in cases where it does occur. Graft failure is a serious complication that is life threatening.

Graft-Versus-Host Disease (GVHD)
Graft-Versus-Host Disease (GVHD) occurs when the body recognizes the transplanted stem cells as foreign substances and begins to attack and destroy these new stem cells. This occurs when the donor’s immune cells (T cells) are not recognized by HLA antigens. This makes finding a close stem cell donor match critical to the success of a stem cell transplant.

Stem Cell Transplant Long Term Side Effects

Long-term side effects following a stem cell transplant can include the following:

Cataracts
Cataracts in the eyes commonly occur in patients following a total body irradiation treatment. Cataracts are more likely to occur in patients receiving steroid doses and typically begin to develop between 18 and 24 months following a stem cell transplant. It is recommended that patients receive annual slit lamp eye evaluations.

Infertility
In some cases, infertility may occur in women following a stem cell transplant; however, total sterility is only likely to occur following total body irradiation. Younger women are more likely to recover ovulatory and menstrual cycles following a stem cell transplant, and hormone replacement therapy may be required.

In men, sterility is likely to occur following total body irradiation; however, following chemotherapy-only treatments, levels of sperm production are much more varied.

New Cancers
Chemotherapy and radiation treatments are known to increase the risk of developing new or "secondary" cancers. In general, the risk of developing secondary cancer in breast cancer patients following treatment is believed to be less than 2%. In lymphoma patients, there is an 8 to 10% chance of developing secondary cancers following high-dose chemotherapy and an autologous stem cell transplant. This risk is significantly decreased to 4 to 8% if conventional chemotherapy is the sole form of therapy used in treatment of lymphoma.

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