Side Effects of Stem Cell/Bone Marrow Transplantation

Graft-Versus-Host Disease (GVHD)
Side Effect What You Can Do
 

Acute GVHD

  • Typically occurs within the first three months after an ALLO transplant and often affects the skin, intestines, and liver.
  • Patients develop rashes, diarrhoea, and jaundice (yellowing of the skin and the whites of the eyes) as each organ system is affected.
  • Treatment consists of medications that block T cells (a type of white blood cell that helps the body’s immune system fight infection).
Chronic GVHD
  • Typically occurs more than three months after an ALLO transplant, and it can last a few months or a lifetime.
  • It may not produce any symptoms or require treatment. However, it may become a source of health problems that need regular medical attention and treatment.
  • Symptoms may be mild (including dry eyes, dry mouth, and blood test abnormalities that indicate a slightly irritated liver) or more severe (including loss of skin elasticity, known as scleroderma; muscle and joint pains; weight loss; infection; and difficulty breathing). 
  • See treatments for individual side-effects further down

Digestive Tract Problems

Side Effect What You Can Do
Nausea and Vomiting
  • Speak to your child’s doctor regarding any medication that can be prescribed to help control the  nausea and vomiting and/or a sedative to help your child sleep through the nausea;
  • Ask your doctor if it is okay to give your child milk or antacids before taking oral anticancer drugs. Some oral anticancer drugs should not be taken with milk;
  • Feed your child something light about 3-4 hours before the treatment;
  • Encourage your child to rather eat small amounts of food often and slowly than try to eat a big meal;
  • Do not give your child  greasy, sweet, or spicy foods or foods that have strong smells;
  • Make your child cold meals like sandwiches instead of hot food;
  • Encourage your child to drink liquids first – then wait 30-60 minutes before eating solids. Most children can handle liquids better than solids;
  • See that your child rests after meals;
  • If your child is vomiting, do not give him or her anything to eat or drink until the vomiting is under control:
    • Once the vomiting is under control, give him or her small amounts of clear liquids such as water, a thin stock soup, milk-free ice lollies, and gelatine desserts
    • Start with 1 teaspoon every 10 minutes and gradually increase the amount to 1 tablespoon every 20 minutes. Work up to 2 tablespoonfuls every 30 minutes
    • When your child can keep down clear liquids, try denser liquids such as strained cereal, pudding, yoghurt, milkshakes, and cream soups
    • Give small amounts as often as your child can keep them down, and gradually work up to solid foods
Diarrhoea
  • Contact your doctor if your child’s diarrhoea is severe; this means if they have more than 3 loose stools per day;
  • Avoid giving your child fatty foods;
  • Serve foods that are high in protein and calories but low in fibre, such as plain or vanilla yoghurt, rice with stock, or noodles;
  • Give your child foods and liquids that are high in sodium and potassium:
    • Foods that are high in potassium and do not cause diarrhoea are boiled or mashed potatoes, and bananas, peaches and apricot juices

Mouth Problems

Side Effect What You Can Do
Sore Mouth or Throat/Mouth Sores
  • Consult your child’s doctor for medicine for your child’s mouth; this could include sprays, special mouthwashes, and medicated sweets;
  • Give your child a sponge toothbrush or a cotton cloth to clean his or her teeth;
  • Let your child rinse his or her mouth every 2-3 hours and after meals using plain water or a paste of baking soda and water;
  • Avoid giving your child very hot, cold, spicy, or acidic foods;
  • Serve soft foods.

Contact your child’s doctor if your child has mouth sores, painful areas, or patches of red or white in their mouth.

Difficulty Eating and Drinking
  • If you are coping with sickness, diarrhoea and a sore mouth, you may not have much appetite just after your transplant. 
  • You will be encouraged to try small meals, snacks and drinks often through the day. If you are not able to eat much, your dietician will give you high calorie and protein drinks.
  • If you find it difficult to eat anything for a time, or if you have lost a lot of weight, your nurse may give you liquid nutrition through your central line. This will gradually stop as you get better and begin to eat more.

Skin & Hair Problems

Side Effect What You Can Do
Hair Loss
  • Use a mild shampoo;
  • Cut your child’s hair short;
  • Avoid using hair dryers and electric curlers;
  • Use a wide-tooth comb;
  • If you are planning to have your child wear a wig, choose it before your child loses all their hair;
  • Protect your child’s scalp from sun and cold;
  • Try different hats, caps, beanies and scarves
Skin Redness
  • Consult your doctor if redness, pain, or swelling occurs
Dry, Itching Skin
  • Use mild soap and moisturisers. (Check with your child’s doctor before using moisturiser if he or she is undergoing radiation therapy.)
Moist Skin
  • Wash your child’s skin 2-3 times per day. Pat dry with a clean towel and powder lightly with corn-starch (Maizena).
Rashes
  • Call your child’s doctor; he or she may prescribe medication
Systemic Problems (Involving The Entire Body)
Side Effect What You Can Do
Infection
  • The chemotherapy and/or radiation therapy given before a stem cell transplant weakens a person’s immune system, lowering the body’s defences against bacteria, viruses, and fungi. That means stem cell recipients are especially vulnerable to infection during this early period of treatment.
  • Although most people think the greatest risk of infection is from visitors or food, most infections that occur during the first few weeks after a transplant are caused by organisms that are already in the patient’s lungs, sinuses, skin, and intestines. Fortunately, most of these infections are relatively easy to treat with antibiotics.
  • The reduced immunity of the early transplant period lasts about two weeks, after which the immune system is back to near full strength and can keep most common germs at bay without the help of medications. This is true for both autologous (AUTO) transplant recipients (who receive their own stem cells) and allogeneic (ALLO) transplant recipients (who receive stem cells from another person).
  • However, a risk of serious infection remains for ALLO transplant recipients because they are given anti-rejection drugs. These drugs suppress the immune system to prevent the body from rejecting the donor’s stem cells. However, this low immunity also leaves the body more at risk for infection. This risk increases when more anti-rejection drugs are needed. Your treatment team will work with you to prevent and manage infections.    
  • You will have a low white blood cell count after your treatment. This means you are more at risk of getting an infection. You are likely to get an infection from the normally harmless bacteria we all have in our digestive systems and on our skin.
  • To try to stop this from happening your nurse may give you tablets called gut sterilisers (antibiotics) and mouthwashes. And they will encourage you to have a shower each day.
  • You are also at risk of infection from food. The nurses on the ward will tell you and your relatives about the food you can and can’t eat.
    • The rules vary from hospital to hospital but you may be told that
    • Hot meals must be thoroughly cooked and eaten fresh
    • Fruit must be washed and peeled
    • Salads must be carefully washed (but they are often not allowed)
    • You cannot have lightly cooked or raw eggs
    • You cannot have fresh cream or soft cheese
  • Your room will be thoroughly cleaned every day. Your visitors will be asked to wash their hands before they come into your room. They may also have to wear disposable gloves and aprons. Visitors with coughs and colds are not allowed. Some hospitals don’t allow you to have plants or flowers in your room because bacteria and fungi can grow in the soil or water, and may cause infection.
  • Even with all these precautions, most people do get an infection at some point and need to have antibiotics. You can help yourself by trying to do your mouth care properly and getting up to shower and have your bed changed even on the days you don’t feel too good.
  • After a transplant you will have lost immunity to diseases you were vaccinated against as a child. The team caring for you will advise you about the immunisations you need and when. You should only have inactivated immunisations and not live ones. To lower the risk of you getting any of these infections it is important that all your family have the flu vaccine and any children have all their immunisations.
Anaemia/Fatigue  

  • Your red blood cell count will also fall after your treatment. If it gets too low you will feel very tired and lacking in energy. You may also feel breathless when you move around. Your nurse will check your blood cell levels each day.
  • If you are anaemic you will need a blood transfusion. This will help you to feel better straight away.
  • Sometimes people have a reaction to a blood transfusion, particularly if they have had a lot of transfusions of blood or platelets in the past.
  • You may have a high temperature and feel shivery, or develop an itchy rash. The reaction feels uncomfortable at the time but soon passes.
  • Tell your doctor or nurse if you feel hot, very cold or shivery when you are having a blood transfusion. They will give you some medicines to stop the reaction. They may also slow down the transfusion rate.
  • More rarely, there is a different type of reaction, causing chest or kidney pain (pain in your back or side), a flushed face and chills.
  • You may also have a burning along the vein that your drip goes into. If you have any of these signs, tell your doctor or nurse straight away because they may need to stop the infusion..
  • Here is what you can do:
    • Look for signs of weakness, tiredness, dizziness, chills, or shortness of breath in your child;
    • Call the doctor if your child develops any of these symptoms.
Blood Clotting Problems (Bleeding)
  • Your platelet levels will fall after your treatment. Platelets help the blood to clot. A low platelet level means you are at risk of bleeding. 
  • Tell your nurse or doctor straight away if you notice:
    • Blood in your urine
    • Blood when you have your bowels open
    •  Bruises or tiny red spots on your skin
    • Nosebleeds
    • Bleeding gums
  • 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, which gives them a high temperature and makes them feel shivery. This is uncomfortable at the time but soon passes. Tell your doctor or nurse if you feel hot, very cold, or shivery when you are having platelets.
  • Your platelet count can take quite a while to get back to normal after a bone marrow or stem cell transplant. After an autologous transplant (when you have had your own bone marrow or stem cells) it may take many months to really recover.
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