Complications of Stem Cell Transplants

From the WebMD Archives

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.

Complications From Transplants Using Your Own Stem Cells

The most common complications are:

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:

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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Graft failure, a rare complication, happens when your immune system rejects the donor's stem cells. If more donor stem cells are available, it can be treated with a second transplant, or with an infusion of residual lymphocytes -- a type of white blood cell -- from the donor.

A relapse of cancer is possible even years after your transplant. Most often, relapses happen because chemotherapy and radiation failed to kill all the cancer cells. Relapses can also occur if there were still cancer cells left in the blood collected before you had chemotherapy. With some aggressive cancers, the relapse rate after a transplant with your own cells may be as high as 50%.

Fortunately, "graft vs. tumor" effect may help prevent relapse. This good benefit occurs when the donor's mature immune cells recognize and attack any cancer cells found in your body after the transplant. To boost this effect, your doctor may want to give you an infusion of donor immune cells along with the donor stem cells. If a relapse does occur, it can be treated with a different chemotherapy regimen, a second transplant (if your own stem cells were used the first time, you may use a donor's cells), or both.

WebMD Feature Reviewed by Arnold Wax, MD on May 29, 2012

Sources

SOURCES:

National Cancer Institute: "Understanding Cancer Series/Stem Cells."

Leukemia & Lymphoma Society: "Blood and Marrow Stem Cell Transplantation."

Memorial Sloan Kettering: "About Stem Cell Transplantation."

Lee, S.J. Blood, 2005.

National Marrow Donor Program: "Post Transplant Care."

Sanz, J. Bone Marrow Transplantation, 2007.

Kim, Y.M. J Clin Invest. 2003.

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