Risks

A bone marrow transplant poses many risks of complications, some potentially fatal.

The risk can depend on many factors, including the type of disease or condition, the type of transplant, and the age and health of the person receiving the transplant.

Although some people experience minimal problems with a bone marrow transplant, others may develop complications that may require treatment or hospitalization. Some complications could even be life-threatening.

Complications that can arise with a bone marrow transplant include:

• Graft-versus-host disease (allogeneic transplant only)
• Stem cell (graft) failure
• Organ damage
• Infections
• Cataracts
• Infertility
• New cancers
• Death

Your doctor can explain your risk of complications from a bone marrow transplant. Together you can weigh the risks and benefits to decide whether a bone marrow transplant is right for you.

Graft-versus-host disease: A potential risk when stem cells come from donors

If you receive a transplant that uses stem cells from a donor (allogeneic transplant), you may be at risk of developing graft-versus-host disease (GVHD). This condition occurs when the donor stem cells that make up your new immune system see your body's tissues and organs as something foreign and attack them.

Many people who have an allogeneic transplant get GVHD at some point. The risk of GVHD is a bit greater if the stem cells come from an unrelated donor, but it can happen to anyone who gets a bone marrow transplant from a donor.

GVHD may happen at any time after your transplant. However, it's more common after your bone marrow has started to make healthy cells.

There are two kinds of GVHD: acute and chronic. Acute GVHD usually happens earlier, during the first months after your transplant. It typically affects your skin, digestive tract or liver. Chronic GVHD typically develops later and can affect many organs.

Chronic GVHD signs and symptoms include:

• Joint or muscle pain
• Shortness of breath
• Persistent cough
• Vision changes, such as dry eyes
• Skin changes, including scarring under the skin or skin stiffness
• Rash
• Yellow tint to your skin or the whites of your eyes (jaundice)
• Dry mouth
• Mouth sores
• Abdominal pain
• Diarrhea
• Nausea
• Vomiting

How you prepare

You'll undergo a series of tests and procedures to assess your general health and the status of your condition, and to ensure that you're physically prepared for the transplant. The evaluation may take several days or more.

In addition, a surgeon or radiologist will implant a long thin tube (intravenous catheter) into a large vein in your chest or neck. The catheter, often called a central line, usually remains in place for the duration of your treatment. Your transplant team will use the central line to infuse the transplanted stem cells and other medications and blood products into your body.

Collecting stem cells for transplant

If a transplant using your own stem cells (autologous transplant) is planned, you'll undergo a procedure called apheresis (af-uh-REE-sis) to collect blood stem cells.

Before apheresis, you'll receive daily injections of growth factor to increase stem cell production and move stem cells into your circulating blood so that they can be collected.

During apheresis, blood is drawn from a vein and circulated through a machine. The machine separates your blood into different parts, including stem cells. These stem cells are collected and frozen for future use in the transplant. The remaining blood is returned to your body.

If a transplant using stem cells from a donor (allogeneic transplant) is planned, you will need a donor. When you have a donor, stem cells are gathered from that person for the transplant. This process is often called a stem cell harvest or bone marrow harvest. Stem cells can come from your donor's blood or bone marrow. Your transplant team decides which is better for you based on your situation.

Another type of allogeneic transplant uses stem cells from the blood of umbilical cords (cord blood transplant). Mothers can choose to donate umbilical cords after their babies' births. The blood from these cords is frozen and stored in a cord blood bank until needed for a bone marrow transplant.

The conditioning process

After you complete your pretransplant tests and procedures, you begin a process known as conditioning. During conditioning, you'll undergo chemotherapy and possibly radiation to:

• Destroy cancer cells if you are being treated for a malignancy
• Suppress your immune system
• Prepare your bone marrow for the new stem cells

The type of conditioning process you receive depends on a number of factors, including your disease, overall health and the type of transplant planned. You may have both chemotherapy and radiation or just one of these treatments as part of your conditioning treatment.

Side effects of the conditioning process can include:

• Nausea and vomiting
• Diarrhea
• Hair loss
• Mouth sores or ulcers
• Infection
• Bleeding
• Infertility or sterility
• Anemia
• Fatigue
• Cataracts
• Organ complications, such as heart, liver or lung failure

You may be able to take medications or other measures to reduce such side effects.

Reduced-intensity conditioning

Based on your age and health history, your doctor may recommend lower doses or different types of chemotherapy or radiation for your conditioning treatment. This is called reduced-intensity conditioning.

Reduced-intensity conditioning kills some cancer cells and somewhat suppresses your immune system. Then, the donor's cells are infused into your body. Donor cells replace cells in your bone marrow over time. Immune factors in the donor cells may then fight your cancer cells.

Results

A bone marrow transplant can cure some diseases and put others into remission. Goals of a bone marrow transplant depend on your individual situation, but usually include controlling or curing your disease, extending your life, and improving your quality of life.

Some people complete bone marrow transplantation with few side effects and complications. Others experience numerous challenging problems, both short and long term. The severity of side effects and the success of the transplant vary from person to person and sometimes can be difficult to predict before the transplant.

It can be discouraging if significant challenges arise during the transplant process. However, it is sometimes helpful to remember that there are many survivors who also experienced some very difficult days during the transplant process but ultimately had successful transplants and have returned to normal activities with a good quality of life.

Living with a bone marrow transplant or waiting for a bone marrow transplant can be difficult, and it's normal to have fears and concerns.

Having support from your friends and family can be helpful. Also, you and your family may benefit from joining a support group of people who understand what you're going through and who can provide support. Support groups offer a place for you and your family to share fears, concerns, difficulties and successes with people who have had similar experiences. You may meet people who have already had a transplant or who are waiting for a transplant.

To learn about transplant support groups in your community, ask your transplant team or social worker for information. Also, several support groups are offered at Mayo Clinic in Arizona, Florida and Minnesota.

Overview

An allogeneic stem cell transplant uses healthy blood stem cells from a donor to replace your diseased or damaged bone marrow. An allogeneic stem cell transplant is also called an allogeneic bone marrow transplant.

A donor may be a family member, an acquaintance or someone you don't know. The blood stem cells used in an allogeneic stem cell transplant can be:

• Collected from the donor's blood
• Collected from the bone marrow within a donor's hipbone
• Collected from the blood of a donated umbilical cord

Before undergoing an allogeneic stem cell transplant, you'll receive high doses of chemotherapy or radiation to destroy your diseased cells and prepare your body for the donor cells.

Why it's done

An allogeneic stem cell transplant may be an option for people with a variety of cancerous and noncancerous diseases, including:

• Acute leukemia
• Adrenoleukodystrophy
• Aplastic anemia
• Bone marrow failure syndromes
• Chronic leukemia
• Hemoglobinopathies
• Hodgkin's lymphoma
• Immune deficiencies
• Inborn errors of metabolism
• Multiple myeloma
• Myelodysplastic syndromes
• Neuroblastoma
• Non-Hodgkin's lymphoma
• Plasma cell disorders
• POEMS syndrome
• Primary amyloidosis

What you can expect

Undergoing an allogeneic stem cell transplant involves:

• Undergoing high doses of cancer treatment (conditioning). During the conditioning process, you'll receive high doses of chemotherapy or radiation therapy to kill your cancer cells. What treatment you undergo depends on your disease and your particular situation.

  The cancer treatments used during the conditioning process carry a risk of side effects. Talk with your doctor about what you can expect from your treatment.

• Receiving an infusion of stem cells. Stem cells from a donor will be infused into your bloodstream, where they will travel to your bone marrow and begin creating new blood cells.
• Remaining under close medical care. After your transplant your care team will want to monitor you carefully for signs of complications. You may spend a few weeks in the hospital or nearby. Expect to undergo frequent blood tests and appointments to monitor your body's response to the transplant.

It takes a few weeks for the donor cells to settle in your bone marrow and begin making new cells. You may receive blood transfusions until your bone marrow recovers.