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Complications of Stem Cell Transplants

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By Judith Sachs
WebMD Feature
Reviewed by Arnold Wax, MD

Having a stem-cell transplant is a major challenge for your body. As you recover in the first weeks and months, you are likely to feel fatigued and weak. Certain side effects, like flu-like symptoms, nausea, and a changed sense of taste, are common. Try to be patient: You're building a brand-new immune system, and this takes time. Your doctors will monitor you closely and give you medications to prevent problems.

Along with these typical side effects, you may experience complications. Some come from the high-dose chemotherapy and radiation that may be part of the transplant process. (These may be less likely if you have had a "mini-transplant" with low-dose chemotherapy and radiation.) Other complications are caused by your body's attempts to reject donor stem cells.

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Complications From Transplants Using Your Own Stem Cells

The most common complications are:

  • bleeding and anemia
  • infections
  • interstitial pneumonia (inflammation of the tissue that supports the lungs)
  • liver damage and disease
  • dry and damaged mouth, esophagus, lungs, and other organs

Less often, some patients experience cataracts, infertility (if total-body radiation is given), and new, secondary cancers, sometimes as long as a decade after the original cancer.

There are many ways your doctor can help you with these complications. Antibiotics, antifungal medications, and antiviral medications can help prevent and treat bacterial, fungal, and viral infections. Growth factor drugs will speed the development of your new immune system, and transfusions may prevent or treat bleeding and anemia.

Complications From Transplants Using Donor Stem Cells

The most frequent complication is called graft-versus-host disease (GvHD). It develops when blood cells formed from the donor's stem cells think your cells are foreign and attack them. Between 30% and 70% of patients with a donor stem cell transplant get some form of GvHD. It may be mild, serious, or even life threatening.

The symptoms of GvHD include:

  • rash, itching and scaly skin
  • hair loss
  • gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal cramps)
  • liver damage (a yellow complexion or jaundice)
  • dry and damaged mouth, esophagus, lungs, and other organs

The chances of graft-versus-host disease increase when you and the donor are not closely matched. Having extensive chemotherapy and/or radiation before the transplant also raises risk. To prevent and treat GvHD, you may need a combination of antibacterial, antifungal, and antiviral drugs, as well as steroids and other therapies to lessen the immune response. Drugs used to prevent and treat graft-versus-host syndrome include anti-thymocyte globulin, cyclosporine, methotrexate, sirolimus, tacrolimus, and in some cases, even rituximab.

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