As a late effect, people who have undergone a stem cell transplant are at greater risk of developing skin cancer later in life. You will need to protect yourself against UV rays by using a sunscreen with a high sun protection factor and a hat when exposed to the sun. If you notice any changes in your skin, especially a mole, you should consult your doctor. For more information, help and advice on how to detect early signs of skin cancer, visit the NHS website.
Cataracts are cloudy spots that form on the lens of the eye. You may have blurry or hazy vision, making it more difficult for you to perform everyday tasks, such as driving. Cataracts may take a few years to appear after a transplant, so it's a good idea to have regular eye tests. If you underwent total body irradiation (TBI) as part of conditioning therapy, you're generally at greater risk of cataracts than if you they would have undergone chemotherapy alone.
If cataracts start to affect your daily life, you can undergo a simple surgical procedure to remove them. For more information, visit the Royal National Institute for the Blind website. Some people have lung problems as a late effect after a transplant. This can happen if you have chronic GvHD disease or if you have had a lot of infections during or after the treatment.
Lung problems may also be related to the conditioning therapy you received. Doctors will evaluate your lung function at follow-up visits, but you may also need an X-ray or other scan. If GvHD has caused these lung problems, doctors can refer you to a specialist. Heart problems can affect anyone, but there's a slightly higher risk of developing a heart condition if you had a stem cell transplant.
Research indicates that between 5 and 10% of people have heart problems in the decade after transplant. Infection is one of the most common early side effects of a stem cell transplant. It happens because the white blood cell count is very low and the immune system is weak. Viral or fungal infections can also occur.
The risk of infection in all types of transplants is high until the bone marrow starts producing white blood cells. The risk is higher after an allogeneic transplant because you may be taking medications to suppress your immune system and prevent graft-versus-host disease (GVHD). Graft-versus-host disease (GVHD) can occur after an allogeneic stem cell transplant. Healthy stem cells from the donor (the person who donates the stem cells) attack the cells of the recipient (the person who receives the stem cells). The donor cells see the recipient's cells as if they were foreign and begin to destroy them. GVHD can permanently damage an organ.
Venoocclusive disease (VOD) occurs when the small blood vessels that go to the liver become blocked. VOD is more common after an allogeneic transplant. It can occur in the first few weeks after a stem cell transplant and can cause liver damage. Liver problems that may occur include venoocclusive disease (VOD), graft-versus-host disease, infection, or damage due to medications given before the transplant.
Treatment is supportive and includes medications for VOD, infections, and pain. If kidney function is also affected, treatment includes limiting the amount of fluids you drink and changing some medications. Because chemotherapy drugs can cause severe nausea and vomiting, doctors often give anti-nausea medications at the same time as chemotherapy to try to prevent it. To the extent possible, the goal is to prevent nausea and vomiting, because it's easier to prevent them than to stop them once they start. Preventive treatment should begin before chemotherapy is given and should continue as long as chemotherapy is likely to cause vomiting, which may be 7 to 10 days after the last dose.
No medication can prevent or control chemotherapy-related nausea and vomiting 100% of the time. In many cases, two or more medications are used. You'll need to tell the transplant team how well medications control nausea and vomiting. If they don't work, they will need to be changed.
For at least the first 6 weeks after the transplant, until the new stem cells start producing white blood cells (graft), you can easily get serious infections. Bacterial infections are more common during this period, but viral infections that were controlled by the immune system can become active again. Yeast infections can also be a problem. Even infections that cause only mild symptoms in people with a normal immune system can be very dangerous for you.
This is because, immediately after the transplant, you don't have many white blood cells that work well and are the main immune cells that fight infections. You may be given antibiotics to try to prevent infections until your blood counts reach a certain level. For example, pneumocystis pneumonia (often called PCP) is a common infection that's easy to get. While the germ doesn't harm people with normal immune systems, in others it can cause fever, cough, and serious breathing problems. Antibiotics are often used to prevent transplant patients from contracting it.
Your doctor can test you before the transplant for signs of certain infections that may be active after the transplant and give you special medications to keep those germs under control. For example, the virus called CMV (cytomegalovirus) is a common infection that many adults have or have had in the past. Adults with a healthy immune system may not have any symptoms because their immune system can keep the virus under control. However, cytomegalovirus can be a cause of serious pneumonia in people who have undergone transplants, since the transplant reduces the number of white blood cells they have. CMV pneumonia primarily affects people who were already infected with CMV or whose donor I had the virus.
If neither you nor your donor had cytomegalovirus, the transplant team may take special precautions to prevent this infection while you're in the hospital. After grafting, the risk of infection is lower, but it can still occur. It can take 6 months to a year after the transplant for the immune system to work as well as it should. Patients with graft-versus-host disease (GVHD, see below) may take even longer.
It's important to talk to your cancer care team about your risk of infection during this time. Because of the increased risk, you will be closely monitored for signs of infection, such as fever, cough, shortness of breath, or diarrhea. Your doctor may check your blood often and will need to take extra precautions to avoid exposing yourself to germs. While you are in the hospital, everyone who enters your room should wash their hands thoroughly. They can also wear gowns, shoe covers, gloves and masks.
The transplant team will inform you and your family in detail about the precautions you should follow. There are many viruses, bacteria, and fungi that can cause infection after a transplant. You may be more at risk of contracting some than others. Despite all these precautions, patients often develop a fever, one of the first signs of infection. In fact, sometimes a fever is the only sign of infection, so it's very important to contact your cancer care team if you have a fever or if you have any other signs of infection.
You'll probably be asked to take your temperature orally every day or twice a day for a while. In addition, your cancer care team will tell you when to tell them about your temperature. If you have a fever, tests will be done to look for possible causes of the infection (chest x-rays, urine tests, and blood cultures) and you will be given antibiotics. Pneumonia caused by infection occurs more often, but pneumonitis can be caused by radiation, graft-versus-host disease, or chemotherapy, rather than by germs. The cause is damage to areas between cells in the lungs (called interstitial spaces).
The risk of acute GVHD can also be reduced by removing immune cells called T cells from donor stem cells before transplantation. However, this can also increase the risk of viral infection, leukemia relapse, and graft failure (which will be discussed later). Researchers are looking for new ways to extract only certain cells, called alloactivated T cells, from donor grafts. This would reduce the severity of GVHD and still allow the donor's T cells to kill any remaining cancer cells.
Chronic GVHD is treated with medications that suppress the immune system, much like those used for GVHD acute. These medications can increase the risk of infection while you are being treated for GVHD. Most patients with chronic GVHD can stop taking immunosuppressive medications once their symptoms improve. Posttransplant lymphoproliferative disorder (PTLD) is an uncontrolled growth of lymphatic cells, actually a type of lymphoma, that can occur after an allogeneic stem cell transplant.
It is related to T cells (a type of white blood cell that forms part of the immune system) and to the presence of Epstein-Barr virus (EBV). T cells normally help the body eliminate cells that contain viruses. When T cells don't work well, EBV-infected B cells (a type of white blood cell) can grow and multiply. Most people become infected with EBV at some point in their lives, but the infection is controlled by a healthy immune system.
Treatment given before the transplant weakens the immune system, allowing EBV infection to go out of control, which can cause a PTLD. Late cardiac effects are a potential major complication of HCT, which can significantly affect survivors' long-term health and quality of life. These may include cerebrovascular disease, coronary artery disease (CAD), and peripheral artery disease. Previously, it was reported that the standardized mortality rate (SMR) of HCT survivors with cardiovascular diseases was 2.3 times that of the control group (whereas a more recent study indicated that it was multiplied by 4.1).
Doctors prescribe antibiotics to prevent infections, and patients are likely to need transfusions of platelets and red blood cells. During this time, they will continue to experience the side effects of the chemotherapy they received during conditioning. Side effects may include nausea, diarrhea, hair loss, mouth sores, and fatigue. During and after a stem cell transplant, patients don't have an immune system to help them fight infections.
Therefore, even a cold can be dangerous. To kill cancer cells and help make room for new stem cells, patients receive chemotherapy before the transplant. As transplant methods have improved, more people are living longer and doctors are learning more about the long-term outcomes of stem cell transplantation. People who receive their own stem cell transplants (autologous transplants) are also less likely to have serious side effects. Bleeding can occur after a stem cell transplant because the platelet count is very low and reduces the ability of the blood to clot.
Studies have shown that people who have undergone allogeneic transplants have a higher risk of having a second cancer than people who received a different type of stem cell transplant. MD Anderson has developed the first guidelines for managing these side effects in children to help more patients receive CAR-T cell therapy more safely. Radiation treatments given before a stem cell transplant, chronic GVHD, infection, or the recurrence of cancer can damage brain tissue. Between 20 and 70% of patients who receive an allogeneic stem cell transplant as part of their cancer treatment will have at least one mild case of a condition called graft vs.
stem cell transplants can be used to treat cancers that affect the blood and lymphatic systems, inherited blood disorders, and autoimmune diseases. Autologous stem cell transplants are an option for patients whose cancer is in remission or has stabilized. You may need platelet transfusions until the transplanted stem cells start working, especially during the first month after the transplant. Fifty years of hematopoietic cell transplantation (HCT) have ushered in an exciting era of cell therapy and have made it possible to achieve enormous advances in improving patient outcomes with both malignant and non-malignant hematological diseases.
