Complications or Side effects of Bone Marrow Transplant

This article is medically reviewed by Dr. Amarnadh Polisetty, Consultant - Hematology and BMT Physician, HCG Cancer Centre, Vijayawada

Table of Contents

• What is Bone Marrow Transplant?
• Need for Bone Marrow Transplant
• Why Do Side Effects Occur After a Bone Marrow Transplant?
• Complications and Side Effects of Bone Marrow Transplantation
• How to Manage Side effects of Bone Marrow Transplantation
• Manage Bone Marrow Transplantation Side Effects with HCG
• Conclusion
• Frequently Asked Questions
• References
• Author Bio

What is Bone Marrow Transplant?

A bone marrow transplant is a procedure of replacing the unhealthy bone marrow with healthy stem cells. The stem cells in the bone marrow produce blood cells. The bone marrow transplant aims to manage various diseases, including blood disorders and cancers.

There are different types of bone marrow transplants, depending on the source of stem cells.

Autologous Bone Marrow Transplant

In this type of bone marrow transplantation, the patient's own stem cells are used for stem cell transplantation. The doctors collect the stem cells of the patients. The patients undergo high doses of chemotherapy that may or may not be combined with radiation therapy.

The stem cells collected before chemotherapy are then infused back into the patients. Autologous bone marrow transplantation is generally used to treat myeloma and lymphoma.

Allogeneic Bone Marrow Transplant

Allogeneic bone marrow transplant uses stem cells from another person who may be related to or unrelated to the patient. Before transplantation, the patients undergo chemotherapy, radiation therapy, or both (conditioning treatment).

Conditioning treatment removes the remaining cancer cells from the body. It also reduces the effect on the immune system and avoids the rejection of transplanted stem cells.

Once the stem cells are infused into the patient’s body, they travel to the patient's bone marrow, grow, and produce blood cells. The process of stem cells traveling to the bone marrow and producing blood cells is known as engraftment.

Need for Bone Marrow Transplant

A bone marrow transplant treats various conditions, including blood disorders and cancers. Some of the conditions that may require bone marrow transplant are acute or chronic leukemia, amyloidosis, aplastic anemia, germ cell tumors, Hodgkin’s or non-Hodgkin’s lymphoma, multiple myeloma, myelofibrosis, myeloproliferative disorders, and sarcoma.

Why Do Side Effects Occur After a Bone Marrow Transplant?

A bone marrow transplant is a complex procedure. Patients who undergo bone marrow transplants may experience various side effects and complications. There are several reasons for developing side effects of bone marrow transplants.

The stem cell transplant procedure involves intense conditioning. The administration of high-dose chemotherapy with or without radiation therapy during intense conditioning destroys the healthy cells. It causes several side effects, such as oral sores, nausea, vomiting, compromised immune systems, and skin reactions.

The side effects of bone marrow transplants may also occur due to a compromised immune system that increases the risk of infections. Further, patients undergoing allogeneic stem cell transplantation have a higher risk for graft-versus-host disease, in which the host's immune cells attack the new stem cells.

Complications and Side Effects of Bone Marrow Transplantation

The stem cell treatment side effects and complications include:

Complications after Allogeneic bone marrow transplant

Patients who undergo allogeneic bone marrow transplants can experience multiple complications. These may be short-term or long-term. Some of the complications include bleeding, infections, and anemia. Complications may also occur when the new stem cells produce new blood cells, and patients may experience organ dysfunction. Bone marrow transplant complications may occur due to intense chemotherapy, radiation therapy, or chemoradiation therapy. These include abdominal pain, diarrhea, oral pain, oral ulcers, and infections.

Complications after Autologous Bone Marrow Transplant

Patients undergoing autologous bone marrow transplants experience several complications. One of the complications of bone marrow transplant is bone marrow suppression during conditioning, which results in low levels of red blood cells, platelets, and white blood cells. This causes thrombocytopenia, anemia, and an increased risk of infection. Patients may sometimes require blood and platelet transfusions. Veno-occlusive disease of the liver is another complication of bone marrow transplant. This condition refers to the chemotherapy-induced liver damage. Patients with this disease experience liver tenderness, weight gain, fluid retention, and abdominal swelling and fullness. Patients may also develop interstitial pneumonia syndrome due to chemotherapy-induced lung cell damage as a complication of bone marrow transplant. It may be acute or chronic. Patients may experience shortness of breath and a nonproductive cough.

Long-Term Side Effects of Bone Marrow Transplantation

Patients with stem cell transplantation may experience long-term side effects. These side effects are usually presented after day 100 of the transplant procedure. Cellular immunity is fully restored during this phase of recovery, while humoral immunity takes a long time to be restored. The long-term side effects from bone marrow transplant include 'sicca' syndrome and cataracts. Cardiovascular side effects include cardiomyopathy, hypertension, and arrhythmia. Side effects related to the liver are liver cirrhosis, chronic hepatitis, and chronic graft-versus-host disease of the liver. The kidney-related side effect includes nephropathy, while the respiratory side effects are obstructive bronchiolitis and chronic obstructive pulmonary disease. Stem cell transplant also causes long-term effects on the endocrine system, and the patients may have infertility, diabetes, and hormonal imbalance. Long-term neurological side effects include peripheral neuropathy, while effects on the skeletal system are osteoporosis and avascular necrosis. Patients also have oral side effects, such as stomatitis and dental infections.

Short-Term Side Effects of Bone Marrow Transplantation

The early stem cell transplant side effects are increased risk of infections, including fungal, viral, and bacterial infections. 25% to 75% of the patients experience graft-vs.-host disease during the early period after transplantation. The condition affects the liver, skin, and gastrointestinal tract. The short-term BMT side effects are nausea and vomiting, hair loss, oral sores, bladder irritation, skin rash, fluid accumulation, low red blood cell count, and respiratory side effects such as cough, breathlessness, and wheezing.

How to Manage Side effects of Bone Marrow Transplantation

Some of the measures to manage the side effects of bone marrow transplantation are:

Medications

Several medicines are available to manage the side effects of bone marrow transplantation. The doctor prescribes immunosuppressive medications to prevent the immune system from attacking the transplanted stem cells. Nausea and vomiting are the common side effects post-transplant. Patients are prescribed anti-nausea medications to manage nausea and vomiting. Doctors may also prescribe pain medication to relieve pain due to oral ores, skin inflammation, or nerve damage. Prophylactic antibiotic treatment may also be administered to reduce the risk of infection.

Diet and Lifestyle Changes

Diet and lifestyle changes can help manage the side effects of bone marrow transplantation. Patients should eat a diet rich in vitamins, minerals, antioxidants, and proteins. They should also avoid alcohol and stay hydrated. Patients should consult their healthcare provider to plan a customized diet regimen. One must consume high-protein foods, adequate fruits and vegetables, and have appropriate hydration after their BMT procedure. During the early phase of recovery, patients should consume small, frequent meals and eat soft, easily digestible food. They should also avoid irritating foods like greasy, spicy, or sugary foods.

Cancer Prevention

Cancer relapse may occur in patients after stem cell transplantation. It is important to monitor health post-transplantation. Patients are advised not to skip their follow-up appointments. The follow-up schedule allows the doctor to monitor the side effects and complications of bone marrow transplantation and assists in detecting the cancer relapse at an early stage.

Physical Activity

Physical activities, such as aerobic exercises, balance exercises, and simple activities such as standing and sitting, help improve the side effects of bone marrow transplants. Patients should start physical activities slowly and then gradually progress under the doctor's supervision. Exercise helps lower the fatigue that patients experience after transplant. Exercise improves muscle strength, function, mood, and overall quality of life.

Manage Bone Marrow Transplantation Side Effects with HCG

As one of the leading hospitals for cancer treatment in India, HCG Cancer Centre offers comprehensive diagnostic and treatment facilities for different types of cancer.

With the dedicated department for BMT cases, the hospital is made capable of managing the side effects of post-transplantation. The expert team at the hospital regularly monitors the patients and diagnoses side effects and complications.

Treatment is provided according to the symptoms. The doctors at the center offer a customized plan to manage the side effects. The hospital also has nutritionists who can create an appropriate diet plan that aids in faster recovery.

Conclusion

A bone marrow transplant replaces damaged marrow with healthy stem cells, often used to treat blood disorders and cancers. There are two types: autologous, using the patient’s cells, and allogeneic, using donor cells.

While it offers curative potential, the procedure poses risks like infections, graft-versus-host disease, and long-term side effects. Ongoing medical care and lifestyle adjustments are crucial for recovery.

References

• Hematopoietic Stem Cell Transplantation - StatPearls - NCBI Bookshelf
• Allogeneic bone marrow transplantation in patients who relapse after autologous transplantation
• Bone marrow transplantation: a new strategy for intractable diseases
• Stem Cell or Bone Marrow Transplant Side Effects | American Cancer Society
• Side effects of a stem cell or bone marrow transplant | Cancer Research UK
• Stem Cell and Bone Marrow Transplants for Cancer - NCI
• Long-term physiological side effects after allogeneic bone marrow transplantation
• Long-Term Effects of Bone Marrow Transplantation
• Stem cell transplant - Risks - NHS
• Late effects of blood and marrow transplantation - PMC
• Autologous Transplant Guide: Treatment and Side Effects | UCSF Health
• Patient education: Hematopoietic cell transplantation (bone marrow transplantation)
• (Beyond the Basics) - UpToDate
• Post-Bone Marrow Transplant Patient Management

Author Bio

Dr. Amarnadh Polisetty
Consultant - Hematology and BMT Physician
MBBS, MD (General Medicine), DNB (Clinical Hematology)