Side effects of an autologous stem cell transplant
Find out about side effects that might happen in the first few weeks after a transplant of your own cells.
An autologous stem cell transplant is an intensive treatment. The side effects will depend on the type of high-dose treatment you have. Your hospital team will give you more information about what to expect.
Most side effects are caused by having low numbers of blood cells. When your blood count goes up, the side effects will start to improve.
You will have medicines to prevent or reduce side effects. Always tell your doctor or nurse about any side effects you have. They may be able to change the medicines you are taking to ones that will work better for you.
The number of white blood cells (your neutrophils) will be very low for some time. This is called being neutropenic. Neutrophils are very important in fighting infection.
During this time, you are at risk of infection, even from the normal bacteria that live on your skin and in your digestive system. These bacteria are usually useful to our bodies. But they can cause infections when your immune system is not working well.
You will be given drugs to prevent and treat infections. Your nurses and doctors will take your temperature regularly and check for signs of infection. They will also ask you to tell them if you have symptoms that could be a sign of infection. These include:
- feeling cold and shivery
- having a sore throat
- having a cough or runny nose
- pain when passing urine (peeing)
- having diarrhoea.
The hospital staff will try to protect you from possible infections. But most people need antibiotics at some point while their immune system is recovering.
We have more information about avoiding infection.
Hospitals may have different rules about visitors. You may be restricted to only a few visitors each day. The ward nurses will tell your visitors how to help protect you from infections. People who feel unwell or have an infection should not visit you.
The number of red blood cells in your blood will be low at times. This is called anaemia. It can make you feel tired and short of breath. You may need blood transfusions until your body starts to make enough red blood cells again.
The treatment also reduces the number of platelets in your blood. You are likely to need transfusions of platelets to reduce the risk of bleeding or bruising.
Your doctors and nurses will examine you regularly for bruises or little red spots on the skin.
Tell a doctor or nurse straight away if you have:
- any bruising you cannot explain
- a nosebleed
- bleeding gums
- blood in your stools (poo) or urine (pee).
For a few months after your transplant, any blood or platelet transfusions you are given are first treated with radiation (irradiated). This is to prevent problems caused by white blood cells called lymphocytes, in the donated blood. Irradiated blood is not radioactive and will not harm you or anyone you come into contact with.
Some people may need all blood or platelet transfusions to be irradiated for the rest of their lives. Your doctor will talk to you about this. You will be given a medical alert card to carry in case you need blood in an emergency or at another hospital.
The chemotherapy drugs used in this treatment can cause a sore mouth and throat. You may also get painful mouth ulcers. The nurses will show you how to look after your mouth and teeth to reduce the risk of side effects. They will check your mouth regularly. If your mouth is sore, your doctor will prescribe painkillers. They may give you gels that can help.
Keeping your mouth clean is very important to prevent infections. Gently clean your teeth or dentures in the morning, at night and after meals. Use a soft toothbrush. The nurses may give you mouthwashes to use, or ask you to rinse your mouth regularly. Follow any advice you are given and drink plenty of fluids.
The treatment causes different side effects that can make eating difficult. These may include a sore mouth, feeling sick, loss of appetite or taste changes.
The nurses will give you advice, and you may also talk to a dietitian. It is important you do not lose too much weight. They will encourage you to try to eat small meals and snacks. You may need nutritional drinks until you can eat properly again.
You may need extra support to get the nutrition you need. Sometimes people need to have liquid food through a thin, soft tube that goes down the nose into the stomach. This tube is called a feeding tube. Some people may be given specially prepared nutrition into a vein through their central line or PICC line. As you start to eat again, the amount of liquid food you have is gradually reduced.
If you have diarrhoea caused by chemotherapy, your doctor can prescribe drugs to control it. Let them know if it is severe or if it does not get better. Make sure you drink at least 2 litres (3½ pints) of fluids every day if you have diarrhoea. If you are not able to drink very much because of a sore mouth, you may have fluids through a drip (infusion).
This is a common side effect of chemotherapy. You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss. After treatment, it is important to cover your head to protect your scalp when you are out in the sun until your hair has grown back.
We have more information about hair loss.
You will probably feel extremely tired and spend a lot of time sleeping. Sometimes you may feel too tired to concentrate on reading or even watching television.
At times, you may not feel able to have visitors, or see them for too long. Let them know how you are feeling so they do not disturb you if you want to rest.
Even though you are tired, it is a good idea to try to do some gentle exercise, such as stretching. A physiotherapist will show you how. This helps reduce the chances of getting a blood clot, and it keeps your muscles working and toned.
Some transplant units may have an exercise bike that you can use when you are feeling better and your blood counts have improved.
Some people may have late effects from chemotherapy. These are side effects you still have 6 months after chemotherapy, or side effects that begin years later. Late effects are not common, and any risk is outweighed by the benefits of chemotherapy.
Your cancer doctor or specialist nurse can explain any possible late effects of your chemotherapy treatment. Different drugs cause different late effects. Some drugs may cause:
And some chemotherapy drugs can increase the risk of:
What you can do
- not smoking
- eating healthily and keeping within recommended alcohol guidelines
- doing regular exercise
- protecting yourself from the sun
- taking part in national screening programmes to diagnose early cancers
- seeing your dentist regularly
- going to your GP straight away if you have possible cancer symptoms such as a lump or any unusual bleeding.
Support from Macmillan
Macmillan is here to support you. If you would like to talk, you can:
Below is a sample of the sources used in our stem cell and bone marrow transplants information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Carreras, Dunfour, Mohty and Kröger. The European Society for Blood and Bone Marrow Transplantation: Hematopoietic stem cell transplantation and cellular therapies. Springer, Switzerland. 2019.
FACT-JACIE International Standards for Hematopoietic Cellular Therapy – product collection, processing and administration. 7th edition. 2018.
Anthony Nolan. Operations and patient services user guide. Available from www.anthonynolan.org. Accessed January 2019.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.
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