Side Effects of a Stem Cell Transplant (Bone Marrow Transplant)

Approved by the Cancer.Net Editorial Board, 02/2017

A bone marrow transplant is also called stem cell transplant. It is an effective treatment for some types of cancer. But it can cause side effects. Side effects are different for everyone. They depend on the type of transplant, your general health, and other factors.

Your side effects might go away with time, but some can be permanent. So before a transplant, talk to your health care team about possible side effects. This includes short-term effects that last a few weeks or months. You should also discuss potential long-term effects that can last years or a lifetime.

Your health care team will work with you to prevent side effects. They will also help you cope with them. This is called palliative care. It is an important part of your treatment plan. So tell your health care team about any side effects you experience.

Side effects from an AUTO transplant

Before a transplant, you will receive high-dose chemotherapy, sometimes in combination with radiation therapy. Many side effects of an AUTO stem cell transplant are similar to those of chemotherapy. One common side effect that can be serious is the risk of infection from low levels of white blood cells.

  • Infection. Treatments such as chemotherapy weaken your body’s infection-fighting system, called the immune system. This means that the body cannot protect itself normally against bacteria, viruses, and fungi. The highest risk of infection is during the first few weeks after transplant. However, your immune system is never completely the same after transplant. Most patients will receive antiviral and antibacterial drugs for up to a year or more after transplant. You will also receive repeat vaccinations against common infections.

    Most infections that develop right after a transplant come from the germs that normally live in your body. When your immune system is strong, they do not make you sick. But they can when your immune system is weak. Fortunately, most of these infections are easy to treat with antibiotics.

    About 2 weeks after you receive your stem cells, neutrophils, which are white blood cells that fight infection, will recover. These cells can keep some common germs from making you sick.

  • Other immediate side effects. The following side effects develop right after high-dose chemotherapy. They are strongest for the next 1 to 2 weeks.

    • Nausea and vomiting

    • Mouth Sores

    • Fatigue

    • Low levels of platelets, which can decrease how well blood can clot

    • Low levels of red blood cells, which can cause anemia

    • Diarrhea

  • Long-term side effects. There can also be side effects from transplants that develop months or years after treatment.

    • Infertility, which means you cannot become pregnant, or make a woman pregnant

    • Early menopause for women

    • Thyroid problems

    • Cataracts, a condition in which the lens of the eye gets cloudy and vision is more difficult, can occur in patients who had radiation therapy

    • Lung or bone damage

    • Risk of developing another cancer

Side effects from an ALLO transplant

The side effects of an ALLO transplant include side effects from chemotherapy (with or without radiation therapy) and from receiving another person’s stem cells. The most serious of these side effects includes a higher risk of infections and a risk of graft-versus-host disease (GVHD). 

  • Infection. The risk of infection from an ALLO transplant is similar to an AUTO transplant (see above). However, after an ALLO transplant you have a serious risk of infections throughout your life. When you have an ALLO transplant, doctors give you anti-rejection drugs. These drugs weaken your immune system to keep it from destroying the new cells. But a weak immune system makes you more likely to get infections. The more anti-rejection drugs you need, the higher your risk.

  • Graft-versus-host disease. The goal of an ALLO transplant is to replace your stem cells with cells from a donor. The cells will develop into a new immune system that will recognize and destroy cancer. This new immune system can also attack your body and cause inflammation, known as GVHD. GVHD may develop even if your donor was a 100% match. If you get GVHD, your physician will give you medications to suppress the immune system. Rarely, GVHD can be life threatening. There are 2 types of GVHD. Both can be mild to severe.

    • Acute GVHD. Acute GVHD usually happens in the first 3 months after an ALLO transplant. It often affects the skin, intestines, and liver. This can cause rashes, diarrhea, and jaundice. Jaundice is a yellow color in the skin and whites of the eyes. Acute GVHD is treated with medications to block T cells that are attacking the body. T cells are white blood cells that normally fight certain types of infections.

    • Chronic GVHD. Chronic GVHD usually happens more than 3 months after an ALLO transplant. It can last a few months or be long lasting. You might have mild symptoms and may not need treatment. But some patients may need treatment for problems such as dry eyes, dry mouth, skin tightening, or problems with the liver. Other possible complications of transplant include joint and muscle pain, weight loss, infections, and difficulty breathing.

  • Other immediate side effects. Some of the side effects of an ALLO transplant are similar to those seen with chemotherapy. A reduced intensity transplant uses milder doses of chemotherapy. People who are able to have a reduced-intensity transplant may avoid some of these side effects or experience less severe side effects.

    • Nausea and vomiting

    • Mouth Sores

    • Fatigue

    • Low levels of platelets, which can decrease how well blood can clot

    • Low levels of red blood cells, which can cause anemia

    • Diarrhea

    • Rare problems with organs, including the liver

  • Long-term side effects. There can also be side effects from transplants that develop months or years after treatment.

    • Infertility, which means you cannot become pregnant, or make a woman pregnant

    • Cataracts, a condition in which the lens of the eye gets cloudy and vision is more difficult, can occur in patients who had radiation therapy

    • Early menopause for women

    • Thyroid problems

    • Lung or bone damage

    • Risk of developing another cancer

More Information

Side Effects

Coping With the Fear of Treatment-Related Side Effects

Donating Bone Marrow Is Easy and Important: Here’s Why

Additional Resource

Be the Match: Guidelines for Long-Term Follow Up