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The high doses of chemotherapy/radiation and long period of low blood counts can lead to serious
complications. These can occur at any time during and even after your transplantation. Many of these can
be treated with medications and careful monitoring. Some of them, however, can lead to life-threatening
situations. There may be a time when you will need to be monitored very closely in an intensive care setting.
If this occurs, the transplant team will continue to care for you with the intensive care staff.
Remember that all patients are unique and not every patient will develop these complications. We will watch
you closely for the following possible complications:
Infection
During and after your transplant you will be at risk for developing bacterial, fungal and viral infections.
Immediately after your transplant you are at risk for bacterial and fungal infections, as well as for reactivation
of certain viruses that reside in your body (for example, the chicken pox or herpes simplex virus). These can
be treated with antibiotics and other medications until your white blood cells begin to develop. Even the
slightest infection can become life-threatening. Infections can spread rapidly in your body; therefore,
you will remain on antibiotics until your white blood cell count is high enough to protect you.
During the first three months after your transplant you will continue to be susceptible to infections, especially
viral infections. Cytomegalovirus (CMV) causes severe infections of the gastrointestinal tract and liver, and can
also cause a fatal pneumonia. CMV is difficult to treat. Pregnant women should avoid contact with patients who have
a viral infection.
Your immune system may remain weakened for approximately one year following your
transplant. Although you can return to an active life, it is important for you to be slightly more cautious and
report any lingering illness to your transplant team. Generally, your referring physician will be able to treat
you without returning to the University, however there are some times when you should be evaluated by physicians
trained to take care of transplant patients. A common event for patients is to experience “shingles”
(herpes zoster), a reactivation of the chicken pox virus, in the year following transplant.
Veno-Occlusive Disease (VOD)
This is a complication involving mostly the liver and kidneys. It is caused by the high doses of chemotherapy used
during the transplant. When this occurs it becomes very difficult for the liver and kidneys to function normally.
Treatment includes medications, blood transfusions, careful monitoring of your liver and kidney function, blood tests
and/or dialysis. If veno-occlusive disease occurs, you may be transferred to an intensive-care unit for monitoring and
may require assistance with breathing by a machine called a ventilator.
Lung and Heart Complications
There is a possibility that the high doses of chemotherapy and fluids, as well as infections, can affect your
lungs and heart by decreasing their ability to function. For this reason, you will have tests done before,
during and after your transplant to monitor the condition of these organs.
Bleeding
Bleeding after transplant may occur since platelets are not being produced in sufficient numbers.
Platelet transfusions are given to try to prevent severe bleeding. Your family members may be asked to
donate platelets if you do not respond to donor platelets.
Graft Versus Host Disease: (GVHD)
This is a complication that occurs when the new stem cells (the graft) reject your body (the host). It can be
a very mild complication, or it may progress to a life-threatening one. It is common in allogeneic transplantation
and rarely occurs in autologous transplants.
The “acute” type of GVHD begins within the first
100 days after transplantation. It may be seen as a skin rash on all or part of your body. It also can involve the
intestinal tract (causing diarrhea) and the liver. “Chronic” GVHD can develop three to 12 months after
transplant. Sometimes it follows the acute type, but it can occur on its own. This type also affects the skin,
liver and intestinal tract, and can cause dryness of the eyes and mouth.
Many medications are given to you to prevent severe GVHD from occurring if you have an allogeneic transplant.
It is very important that you take all of these medications when they are scheduled. Prevention is the best way
to fight GVHD.
If GVHD is suspected, it is likely a procedure called a skin punch biopsy will be
performed. A small piece of skin will be sent to the laboratory to determine the presence of GVHD. This is
obtained by using a local anesthetic at a specific spot on the skin and “snipping” a small sample
of tissue; a stitch is generally required to promote healing. Except for the mild burning sensation to freeze
the skin, this is a painless procedure.
Lack of Engraftment
There is a possibility that the new stem cells will fail to develop or mature after the transplant.
There are various reasons for this, including development of some of the above complications. There are medications
that can be given to help stimulate these cells to grow. These are intravenous infusions given daily for several
days until your counts begin to recover. Your doctor, nurse or pharmacist will explain these in detail.
Relapse and Secondary Malignancies
Some patients will have their disease return even after transplant. In a small number of people, a
different malignancy can occur, caused from the chemotherapy and/or radiation used prior to transplant.
If this occurs, you and your physician will discuss available treatment options.
Infertility
It is important to speak to your physician about the possibility of infertility prior to your bone marrow
transplant since chemotherapy or radiation therapy you receive will likely lead to infertility or sterility.
Many women may require hormone replacement therapy after transplant. Sperm banking is a consideration for some
men, although previous treatment may have already caused sterility. Advanced medical technology has developed
additional methods of medically assisted reproduction techniques, such as freezing of embryos, invitro fertilization
and artificial insemination. Please discuss your options with your transplant doctor, nurse or social worker
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