After a Stem Cell Transplant: Recovery and Side Effects

For both types of transplant you'll usually receive high doses of chemotherapy (for an allogenic transplant you may also receive radiation), to destroy as many cancer cells as possible. Unfortunately, healthy bone marrow cells are also killed in this process.

Goals of a Stem Cell Transplant

The goal of both autologous and allogenic stem cell transplants is the same: To repopulate the destroyed and cancerous bone marrow with new stem cells that can produce healthy blood cells. The difference is that an allogenic stem cell transplant, unlike an autologous transplant, not only gives you high-dose chemotherapy but also allows your donor stem cells to launch an immune-mediated attack on your cancer cells.

Both types of stem cell transplants require long recovery times and carry the risk of side effects, though the risks of an allogenic stem cell transplant are higher than an autologous one, because you are receiving someone else's stem cells and immune cells. Those cells can attack your own body and lead to "graft-versus-host-disease."  That's why candidates for this procedure need to be chosen carefully.

"First and foremost," says Dr. Caitlin Costello, hematologist/medical oncologist at the University of California San Diego, Moores Cancer Center, "is that we have to prove that any patient who's going to undergo a transplant is fit and otherwise healthy." Dr. Costello explains that it's important to assess the strength of a patient's heart, lungs, liver, and kidneys before the transplant because the transplant does have risks and side effects that can be severe.

Risks and Recovery

The stem cells themselves are delivered intravenously, like a blood transfusion. "It's right after the transplant, when patients don’t have an immune system, which is the riskiest time of the entire transplant process," says Dr. Costello.

Patients often run a fever, but the danger is when the fever represents a true infection. "That's why we keep you in the hospital," says Dr. Costello. "We keep you in the hospital so we have our nursing staff and our doctors caring for you on a literal minute-by-minute basis, so that as soon as you have a fever I can immediately give you stronger antibiotics and I can immediately try and find the source of your fever."

In those first few weeks after the transplant, when the patient's own bone marrow has died off but the new bone marrow hasn't yet grown, doctors are concentrating on keeping the person protected.  In addition to fever and infection, common side effects of a stem cell transplant include:

• Fatigue
• Upset stomach
• Nausea
• Mouth sores
• Sore throat
• Loss of appetite

"These side effects can range from a nuisance to sometimes painful," says Dr. Costello. "I think it's important to know what you're getting yourself into, so you know what to expect."

The side effects vary widely from patient to patient, she explains. "Some patients are able to eat fine, have no problem during their transplant. Others sometimes need nutrition given intravenously to support them until the new immune system comes in and heals the wounds that chemotherapy and/or radiation caused."

The light at the end of the tunnel, says Dr. Costello, is usually after about two weeks when doctors see evidence of the new immune system starting to grow. "So every day we check your blood levels to see your white cell count increasing. As that happens, patients feel better. The mouth sores, nausea, upset stomach, diarrhea — whatever side effects are being experienced — start to get better." That's the point when patients can leave the hospital to finish their recovery at home. Their new immune system will be fully functional after about three or four months.

 

Reviewed by Dr. Adrienne Phillips, hematologist/oncologist, Weill Cornell Medicine

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