Side effects of a stem cell or bone marrow transplant | Cancer Research UK https://about-cancer.cancerresearchuk.org/about-cancer/cancer-in-general...

targeted drugs if you have them Your cancer type

Transplant main page

You might have extra side effects if you also have whole body
radiotherapy as part of the treatment. Whole body radiotherapy is also
called total body irradiation or TBI.

All the side effects are at their worst when you have just had your high dose
chemotherapy and for a few weeks afterwards. When your blood counts
start to rise (engraftment) you will start to feel better. Let your team know if
you have any side effects. They can do a lot to help you.

In the longer term, these treatments often cause infertility. Some people
who have had a transplant do go on to have children, but this is still quite
unusual.

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.

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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.

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.

Some pre school and primary school children have the flu vaccine as a
nasal spray. If your immune system is severely weakened, you should avoid
close contact with children who have had the nasal spray for 2 weeks
following their vaccination. Speak to your doctor if you are not sure whether
this applies to you.

Read more about the flu vaccine and cancer treatment

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 might need a blood transfusion to top up your red blood cells. This will
make you feel better almost straight away.

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Sometimes people have an allergic reaction to a blood transfusion. Let your

nurse or doctor know as soon as possible if you feel hot and shivery, or
itchy. You will have medicines to stop the reaction. Your nurse may also
slow down the transfusion rate.

More rarely, some people have:

chest or kidney pain (pain in your back or side)

a flushed face
chills
burning along the vein that your drip goes into

Tell your doctor or nurse straight away if you have any of the above. Your
nurse will need to treat your reaction and might stop the infusion.

Your platelet level will fall after your treatment. Platelets help the blood to
clot. A low platelet level means you are at risk of bleeding. You might find
you are bruising more easily than normal.

Tell your nurse or doctor straight away if you notice:

nosebleeds
bleeding gums when you clean your teeth
very heavy periods
blood in your urine or poo
bruises or small dark red spots on your skin

Your treatment team will arrange for you to have a platelet transfusion. You
have the platelets as a drip into your vein. It takes about half an hour.

Sometimes people have a reaction to platelets. This is uncomfortable at the

time but soon passes. Let your nurse or doctor know as soon as possible if
you feel:

hot
shivery
itchy

Your platelet count can take a while to get back to normal after a stem cell
or bone marrow transplant. It might take longer to recover if you have had
your own stem cells (rather than a donor's stem cells).

You might feel sick after your chemotherapy and radiotherapy. But
you should start to feel better after a couple weeks. Unfortunately other
treatments you have can make you feel sick, such as antibiotics. You can
have anti sickness medicines for as long as you need them.

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You might have diarrhoea as a reaction to the radiotherapy or

chemotherapy. You might also have it due to an infection or because you
have developed another side effects called graft versus host disease. Tell
your nurse or doctor if the diarrhoea is severe. They will give you medicine
that will help. You will also need treatment for the underlying cause of the
diarrhoea.

A sore mouth and mouth ulcers are very common after a transplant. They
can develop as a reaction to chemotherapy or radiotherapy or from a mouth
infection.

Your can have mouthwashes and lozenges to suck to try to prevent

infection. Ask for painkillers if you need them. Sucking on ice cubes can
sometimes help to reduce the pain.

Read about mouth care and treating mouth problems

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.

Read about drip or tube feeding

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.

Find out about coping with tiredness

A longer term side effect of a transplant is infertility. This means you will no
longer be able to become pregnant or father a child naturally. This
is caused by total body irradiation and the high doses of chemotherapy.

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Some people who have had a transplant do go on to have children

naturally, but this is unusual. Sometimes it is possible for men and teenage
boys to store sperm before they start their chemotherapy. This is
called sperm banking.

Treatment can cause an early menopause for women. You might have
hormone replacement therapy (HRT) to help with the symptoms. Some
women are able to store embryos or eggs before starting cancer treatment,
but this is not always possible. Research is going on all the time to try to
help women have children after cancer treatment.

Read about ways to try to preserve infertility and cope with

infertility

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.

Find out more about GvHD and how it is treated

Print page Last reviewed: 12 Sep 2018

The European Blood and Marrow Transplantation Textbook for

Nurses. Under the Auspices of EBMT
M Kenyon and A. Babic (Editors)
Springer Open, 2018

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Late effects of blood and marrow transplantation

Y Inamoto1 and SJ Lee
Haematologica, 2017. Volume 102, 4, pages 614–625

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

Diagnosis and management of chronic graft-versus-host disease

F Dignan and others
British Journal of Haematology, 2012. Volume 158, Pages 46-61

Diagnosis and management of acute graft-versus-host disease

FL Dignan and others
British Journal for Haematology, 2012. Volume 158, Pages 30-45

The information on this page is based on literature searches and

specialist checking. We used many references and there are too many
to list here. Please contact patientinformation@cancer.org.uk with
details of the particular issue you are interested in if you need
additional references for this information.

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