What Are Some Side Effects of Bone Marrow Transplants?

A bone marrow transplant also called stem cell transplant is a procedure in which healthy blood stem cells are infused into the body to replace the damaged or diseased bone marrow of the patient.

This is required when the bone marrow stops working and doesn’t produce enough healthy blood cells or in cases of blood cancers such as leukemia, multiple myeloma, or some types of lymphoma.

India is a popular destination for procedures like stem cell transplant. The world-class medical facilities at the internationally recognized hospitals along with the highly affordable bone marrow transplant cost in India are the prime reason for this surge in popularity.

Bone marrow transplants (BMTs) are of two types mainly:

• first is the one in which cells from the patient’s own body are used (autologous transplant)
• the second is when they are taken from a donor (allogeneic transplant).

Bone Marrow Procedure In Brief

In an autologous bone marrow transplant , the first step is to collect the patient’s stem cells from their blood and freeze them. Then high dose chemotherapy, with or without radiation therapy.

The frozen stem cells are thawed and reinfused back into the blood of the patient through an IV tube. Once the stem cells reach the bone marrow, they start to grow, multiply, and repopulate the marrow to make healthy blood cells again.

In an allogeneic bone marrow transplant , the process is different as the stem cells are collected from a matching donor. HLA (human leukocyte antigens) testing is done to determine the matching factor and usually, a sibling is the best match.

The patient is started on chemotherapy , with or without radiation therapy. Then the donor stem cells are given through an IV tube placed. The stem cells in an allogeneic transplant are not typically frozen as they can be collected as soon as possible after chemotherapy or radiation therapy.

BMT is an effective treatment for some types of cancer and disorders of blood and marrow. But the procedure can cause certain side effects. These side effects vary for different individuals, depending on the type of transplant, your general health, and other factors.

Some side effects might go away with time and some can be permanent. The short-term side effects may last for a few weeks or months while the long-term effects may last years or a lifetime. Before a transplant, the doctor and the medical team will discuss the possible side effects with the patient.

Side Effects from a Bone Marrow Transplant

Before a transplant, chemotherapy with or without radiation therapy is given to the patient to destroy the unhealthy bone marrow. This can have many side effects associated with chemotherapy and radiation therapy. The most serious of these is an increased risk of infections due to low levels of white blood cells.

Infections: Chemotherapy treatment can weaken the body’s immune system which fights off infection-causing agents. This leaves the body unprotected from normally diseases causing bacteria, viruses, and other germs. The risk of infection is the highest during the first few weeks after the transplant. But it takes time for the immune system to recover and it may never be completely the same after a transplant.

After about 2 weeks, a part of your immune system, known as neutrophils , will recover. Most infections are fairly easy to treat with antibiotics. People are also given some antiviral and antibacterial drugs to prevent infections for a year or more after transplant.

Other immediate side effects that may develop after high-dose chemotherapy are given below. These are the strongest for the following 1 to 2 weeks.

• Nausea and vomiting
• Fatigue
• Low levels of platelets – impact the clotting of blood
• Anemia due to low red blood cell levels
• Mouth Sores
• Diarrhea

Some of the long-term side effects of the treatment that develop months or years after transplant are:

• Infertility – inability to become pregnant, or make a woman pregnant
• Cataract – the lens of the eye gets cloudy and vision is not clear
• Thyroid problems
• Early menopause in women
• Damage to lungs or bones
• Risk of another cancer

These side effects are common to both autologous and allogeneic procedures.

Another important side-effect or complication that can occur in the case of allogeneic bone marrow transplants is graft-versus-host disease (GVHD).

The Two Types of Graft-vs-Host Diseases

Acute GVHD usually happens earlier, i.e during the first 3 months after the transplant. It usually affects the skin, digestive tract, and liver. The symptoms include rashes, diarrhea, and jaundice. The treatment for this involves medications to block the T cells, a kind of white blood cells that help the immune system fight infections. Blocking T cells will keep the immune system from attacking other cells of the body.

Chronic GVHD: typically develops later, more than 3 months after transplant and may last a few months or a lifetime. It can affect many organs. The treatment involves using medications called corticosteroids and when this standard treatment fails to work, many other immune-suppressing drugs may be used.

Signs and symptoms for this include:

• Pain in joint or muscles
• Shortness of breath
• Mouth sores
• A persistent cough
• Changes in vision, including dry eyes
• Skin changes, including scarring under the skin or skin stiffness – a condition called scleroderma
• Yellow tint to your skin or the whites of your eyes (jaundice)
• Dry mouth
• Rashes
• Abdominal pain
• Diarrhea, nausea, vomiting

Graft-versus-host disease: it is a potential risk when stem cells from a donor are given to the patient. This condition may occur when the donor stem cells that start the new immune system starts to attack the other cells in the body. This causes inflammation and other problems.

Most people who have an allogeneic transplant get GVHD and the risk is more if the stem cells used for the transplant are taken from an unrelated donor. But it can happen to anyone who receives stem cells from a donor. It may happen at any time after the transplant but is more common after the bone marrow has started to produce healthy cells.

Parting Words

We hope this brief overview of the side effects faced by people who are put in a position to have to undergo a bone marrow transplant helped answer some of the questions or concerns you may have had.