Most of the complications of bone marrow transplantation, which occur at a short distance compared to bone marrow transplantation, are related to chemotherapy and other treatments carried out before transplant to destroy the patient’s cells. Other transplant complications may be related to the transplant itself or the drugs that prepare the body for the transplant.
Some complications related to bone marrow transplants can be prevented, and many can be controlled. The mentioned cases do not include all the complications, and you must report any suspicious symptoms or changes in your condition to your doctor as soon as possible. Some of these complications and symptoms may put your life at risk. Therefore, it is necessary to have a way to communicate with your medical staff at any time. Tell your doctor about any significant changes as soon as possible.
Complications of bone marrow transplantation are divided into two categories in terms of incidence after bone marrow transplantation:
Aphthous and inflammation in the mouth and throat are side effects of bone marrow transplant, chemotherapy, and radiation therapy in the short term. This complication usually disappears within a few weeks after the completion of chemotherapy and radiation therapy. However, it can make eating and drinking very difficult.
Since eating and drinking are essential during illness, it is necessary to treat mouth ulcers with the help of the medical staff.
Chemotherapy before a bone marrow transplant causes nausea and vomiting in many patients.
You may quickly get any infection by doing chemotherapy or radiation therapy for at least six weeks after a bone marrow transplant. Your new bone marrow is not fully established, and new white blood cells are not produced. Any infection at this time can put you at risk because your body’s defense system is not yet activated. Even infections that may be asymptomatic or have minimal complications under normal conditions may be severe and dangerous for some people.
Most of these infections are caused by bacteria. However, the viral infections already in your body and controlled by your immune system may also be activated during this time. In addition, fungal infections can also threaten the patient’s health.
Pneumocystis pneumonia infection is one of the most common types of fungal infections that can affect the lungs.
You will be given antibiotics to prevent infections until your white blood cell count is healthy. Before chemotherapy and the transplant, the doctor on the transplant team will check you for certain infections and give you medicine to control them if you have them. For example, the CMV virus, which exists in many healthy people and does not cause any disorder in their body, can cause a severe lung infection in people whose immune system is weakened.
Although after the activation of the new bone marrow, the possibility of getting infections decreases, it takes six months and one year (or even more) for the immune system to fight infections and health-threatening factors like those in the natural state.
Since your body is prone to infection, avoiding contact with anything that can transmit contamination or germs to you is necessary. For this purpose, you may be quarantined for a while and even in an isolation room to minimize your contact with the outside environment. If someone comes to visit you, they must disinfect their hands before entering the room, wear a mask, and wear a gown or gown. It is also necessary to use room slippers or shoe covers and gloves.
Your doctor will examine you for various signs of infection, such as fever, chills, sweating, cough, shortness of breath, and diarrhea. It is necessary that you, during hospitalization and after discharge; if such symptoms occur, you should inform your doctor quickly.
Because plants and flowers have fungal and bacterial contamination, you should avoid bringing them into your room.
Avoiding eating raw vegetables, fruits, and other foods is necessary for some time. Your food must be well cooked and handled with care so that it is not contaminated.
After a bone marrow transplant, you should avoid dealing with all kinds of domestic and domestic animals and not be exposed to their secretions, excrement, hair, and fluff. Contact with aquariums or fish can also be dangerous for your health. In case of animal contact, wash your hands with soap and water. Avoid contact with your own or other people’s feces.
Usually, despite following all these tips, patients get a fever. Since fever is the first and sometimes the only sign of infection in the body, it is necessary to inform your doctor about the onset of fever or any other sign of infection. Measure your body temperature with a thermometer 1-2 times a day. If you have a fever, tests will be done to determine the cause and possible type of infection. Tests such as chest x-ray, urine test, and blood test; And after that, antibiotic treatment will start for you.
Because your immune system is destroyed during chemotherapy and replaced by a bone marrow transplant, you may need to re-vaccinate your previous vaccines. Talk to your transplant team about the need for vaccination and how to get it.
After a bone marrow transplant, the risk of bleeding increases. Because the bone marrow loses the ability to produce platelets, platelets are cells responsible for stopping and clotting blood during bleeding. Therefore, until the transplanted bone marrow has not produced enough platelets, it is necessary to take the care the bone marrow transplant team teaches you.
Your platelets will be low for at least a few weeks. Therefore, during this period, you may quickly experience bleeding, such as bleeding gums or nose. If your platelet count falls below a certain level, you may need to receive a platelet transfusion.
Since it takes some time for your bone marrow to produce enough red blood cells, injecting red blood cells into your body after a bone marrow transplant may be necessary.
Bone marrow transplants may cause various pulmonary complications. The most acute side effects of bone marrow transplants are lung inflammation and pneumonia.
Pneumonia is a problem that occurs mainly during the first hundred days after transplantation. However, some lung problems may appear much later than two years after transplantation. Pneumonia is mainly caused by chemotherapy, radiation therapy, and graft-versus-host disease. Pneumonia is associated with fluid accumulation in the air sacs. If lung inflammation occurs due to damage to the space between lung cells, it is called interstitial lung disease.
Pneumonia can sometimes be severe, especially when chemotherapy and radiation therapy are done before a bone marrow transplant. Therefore, you must report any symptoms, such as shortness of breath or changes in breathing, to your doctor. Transplant-related lung problems usually require prompt treatment. The doctor may take a picture of your chest or perform breathing tests to check your condition.
Suppressing the activity of the immune system can cause the activity of opportunistic microbes in the lungs and cause pulmonary infection. A lung infection is called pneumonia. Pneumonia is also associated with lung inflammation.
When one person’s bone marrow is transplanted into another, the new bone marrow produces white blood cells, red blood cells, and platelets in the host’s body. White blood cells have the task of fighting anything that they recognize as foreign. Because the bone marrow belonged to someone else, the newly produced white blood cells may recognize the entire host’s body as non-self in some transplants. Graft-versus-host reaction, also known as GVHD, is the reaction of white blood cells from the transplanted bone marrow against the body cells of the transplant recipient.
New white blood cells usually attack specific skin, digestive tract, and liver tissues. This reaction may weaken or disable the target organ or increase the sensitivity of that organ to contamination and infection.
A graft-versus-host reaction is common and occurs in almost everyone who receives someone else’s bone marrow. Side effects of the host reaction may vary from very mild to very severe. Of course, this reaction is usually mild and only affects the skin.
To prevent this reaction, usually before a bone marrow transplant, steroid drugs are prescribed to the patient to prevent the reaction against the host by suppressing the immune system. If these drugs are ineffective in preventing GVHD, other drugs will be prescribed to suppress the immune system.
GVHD may be acute or chronic. The acute reaction occurs very soon after a bone marrow transplant and resolves after a short period. However, the chronic reaction may appear much later and last for a more extended period.
Acute graft-versus-host reaction occurs on average about 25 days after transplantation. However, this period may vary between 10 and 90 days. About one-third to one-half of those who receive a bone marrow transplant from another person experience acute GVHD. Acute GVHD occurs less frequently in younger people and those with HLA more similar to the bone marrow donor.
Early symptoms of acute GVHD are skin rash, burning, and reddening of the skin on the palms and soles (and other body parts). Other symptoms that may occur due to acute GVHD include nausea and vomiting, abdominal cramps, diarrhea (watery and sometimes bloody), loss of appetite, weight loss, jaundice (yellowing of the eyes and skin), and abdominal pain.
The chronic reaction may occur between 90 and 600 days (3 months to 2 years) after a bone marrow transplant. Usually, the first sign is a rash (redness) on the palms of the hands or feet. These red spots are usually dry and itchy and may slowly spread throughout the body. In severe cases, the skin may blister or peel and look sunburned. A person may also have a fever.
In addition to these symptoms, many other symptoms, such as digestive, respiratory, pain, and sensitivity to infection, may also occur in bone marrow transplant patients.
Treatment for chronic graft-versus-host disease is essentially the same as for acute graft-versus-host disease and is usually given until symptoms improve or even lifelong. Using these drugs increases the possibility of getting an infection to some extent.
Hepatic venous occlusive disease (VOD) is a dangerous condition in which the veins (veins) in the liver become blocked. This is rare and may occur in people who have received bone marrow from another person and have received melphalan or busulfan for chemotherapy before the transplant.
Because before the bone marrow transplant, the patient goes through a course of chemotherapy or radiation therapy, other cells in the patient’s body may become cancerous due to the mutagenic effects of these treatments. In addition, the absence of white blood cells before the transplant and the use of drugs that weaken the immune system can allow cancer cells to grow and divide.
One of the complications of bone marrow transplantation and other transplants is post-transplant lymphocytic hyperplasia disease or PTLD. The uncontrolled proliferation of lymphocyte cells that may occur after transplantation is called post-transplant lymphocytic hyperplasia disease or PTLD. This disease is a type of cancer. The cause of this disease is an infection of a group of T lymphocytes with an Epstein-Barr (EBV) type virus.
Almost all humans are infected with EBV. However, its immune system prevents it from activating and causing disease. Weakening the immune system during transplantation can activate the virus and infect cancerous T-lymphocytes.
PTLD is rare and occurs between 1 and 6 months after bone marrow transplantation.
PTLD can be life-threatening. Its common symptoms include enlarged lymph nodes, fever, and chills. Various methods are used to treat PTLD. One of these ways is to change the immunosuppressive drugs so that the white blood cells can control the activity of the virus again. More white blood cells may also be injected to help the patient’s immune system. In addition, other drugs may be prescribed for the patient.
Most of those who are treated with hematopoietic stem cells lose their fertility. Fertility loss is unrelated to the transplanted cells and occurs due to chemotherapy and radiation therapy before a bone marrow transplant.
Stem cell transplantation or bone marrow transplantation are complex treatments that carry a significant risk of serious complications. Before starting bone marrow transplant treatment, knowing the possible risks and benefits is essential. In general, younger people with no other severe medical conditions or who receive a bone marrow transplant from a close sibling are less likely to experience serious problems.
Dr. Majid Zohrabi started treating his patients in Dubai in 2022 and continues his activities in private medical centers in the UAE.