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

Aprobado por la Junta Editorial de Cancer.Net, 08/2022

A bone marrow transplant is a medical treatment that replaces your bone marrow with healthy bone marrow stem cells. It is also called a stem cell transplant or, more specifically, a hematopoietic stem cell transplant. This type of transplantation can treat certain types of cancer and other diseases that affect the bone marrow. Like any cancer treatment, it can cause side effects. These side effects can be different for everyone and depend on the type of transplant you receive, your general health, and other factors.

It is a good idea to talk with your health care team about the possible side effects before starting your transplant process. This includes short-term side effects that are expected to go away over time, as well as side effects that may occur later, last longer, or be permanent. This will help you feel more prepared and supported if a side effect does occur.

And, talk with your health care team regularly about any symptoms or side effects you experience throughout your transplantation process and recovery. This includes when a side effect worsens or a new problem appears. Managing side effects is an important part of cancer care and treatment and it is especially important during transplantation. This type of care is called palliative or supportive care. It can help people with any stage of cancer feel better.

There are different kinds of bone marrow transplants and the side effects can be different. The side effects for an autologous transplant and an allogenic transplant are detailed below.

What are the side effects of an autologous bone marrow transplant?

An autologous bone marrow transplant is also called an AUTO transplant or stem cell rescue. During an AUTO transplant, your own stem cells are removed from your body before an intensive chemotherapy treatment. This intensive treatment, which can also include radiation therapy, damages your stem cells. The healthy stem cells are then put back in your body to "replace" the ones damaged by the treatment.

Many side effects of an AUTO transplant are similar to common side effects of chemotherapy and radiation therapy. The most serious side effect is a higher risk of infection from your body's low levels of white blood cells.

Infection. Chemotherapy and some other treatments weaken your body's infection-fighting system, called the immune system. This is especially true of treatment given for a bone marrow/stem cell transplant, because the bone marrow is part of the immune system. When your immune system is weakened, your body cannot protect itself as well against germs. Most of these germs already live in your body. When your immune system is strong, these germs do not make you sick. But after a transplant, they can cause an infection. Fortunately, most of these infections can be easily treated with antibiotics.

About 2 weeks after your transplant day, your immune system will begin to recover. You have the highest risk of infections in the first few weeks after transplant, but you will still be at a higher risk of infections for a year or more after. Your health care team will talk to you about ways to reduce your risk of infections during your recovery. Learn more about infections as a side effect of cancer treatment.

Other immediate side effects of AUTO transplants. The following side effects can develop right after the high doses of chemotherapy used for AUTO transplants:

Long-term side effects of AUTO transplants. Some transplant side effects happen months or years later. These can include:

What are the side effects of an allogenic transplant?

An allogenic transplant is also called an ALLO transplant. In an ALLO transplant, the replacement cells come from another person, called a donor. After a round of chemotherapy and sometimes radiation therapy, you will receive the donor's healthy cells.

The side effects of an ALLO transplant are similar to common side effects of chemotherapy and radiation therapy. This includes a high risk for infections. You are also at risk of side effects caused by having another person's stem cells, including a risk of graft-versus-host disease (GVHD; see below). Many people also have a "graft-versus-cancer-cell effect" along with GVHD. This is because the new stem cells recognize and destroy cancer cells that are still in the body. It is the main way ALLO transplants work to cure cancers like leukemia.

Infection. After an ALLO transplant, your doctor will give you chemotherapy, with or without radiation therapy or other drugs, to keep your body's immune system from destroying the new donated cells. These treatments affect your immune system and make infection risk higher. A weak immune system makes you more likely to get infections.

You are at the highest risk of infection in the first few weeks after receiving the donor's cells. The risks lessen over time, but infection risk reduction is an important part of your long-term recovery.

Graft-versus-host disease (GVHD). Sometimes donor cells can attack your body, causing inflammation. This is a specific side effect of ALLO transplantation called GVHD. Even if your donor was a 100% match, you can still get GVHD. Your health care team can give you medication to prevent GVHD. If you still experience GVHD, your doctor will give you more medications to manage the condition. GVHD can be life-threatening in some cases.

There are 2 types of GVHD: acute and chronic. Both can range from mild to severe.

What is acute GVHD?

This form of GVHD happens in the first 3 months after an ALLO transplant. It often affects the skin, intestines, and liver. It can cause rashes, diarrhea, and jaundice. Jaundice is a liver problem that makes skin and the whites of the eyes look yellow.

The treatment for acute GVHD is to block T cells. T cells are white blood cells that help the immune system fight infections. Blocking them keeps your transplanted immune system from attacking your body's own cells.

What is chronic GVHD?

Chronic GVHD usually develops more than 3 months after an ALLO transplant. It can last a few months or the rest of your life.

Chronic GVHD may or may not cause symptoms or need treatment. You may need treatment for specific problems. Some common problems of chronic GVHD include:

There are 2 medications approved by the U.S. Food and Drug Administration (FDA) to treat chronic graft-versus-host disease.

  • Ruxolitinib (Jakafi) in adults and children 12 years and older after 1 or more treatments with systemic therapy

  • Ibrutinib (Imbruvica) in children 1 year and older after 1 or more treatments with systemic therapy

Chronic GVHD can be treated with medications called corticosteroids. If this does not work well, you might take other medications to make your immune system less active.

Other immediate side effects. Side effects that can develop right after the high doses of chemotherapy used for ALLO transplantation include the following.

Late or long-term side effects. Some transplantation side effects can happen months or years later. These can include:

People who have less powerful chemotherapy treatments before their transplant tend to have fewer long-term physical effects.

Talk with your health care team about possible physical side effects of your bone marrow transplant, as well as what signs to watch for. They can help answer your questions and make a plan to manage short-term and long-term side effects.

Coping with emotional effects of bone marrow/stem cell transplantation

Bone marrow transplantation is an extended medical process, and many people experience a variety of emotional and social challenges during this treatment and recovery. This can include anxiety and depression. It can also include the uncertainty and stress that cancer brings, self-image changes, changes in relationships with loved ones, feelings of isolation, and grieving losses from cancer and its treatment.

Be sure to share your feelings, including with your health care team. They want to know how you are feeling during and after transplantation. There are many ways to help support your mental health during this stressful time, including counseling, joining a support group, journaling, art therapy, mindfulness, and meditation.

Questions to ask the health care team

It is important to talk often with your health care team about different types of side effects, before, during, and after your transplant. This helps you gather information and make decisions on treatment and care. Here are some possible questions to ask.

  • What tests will be done before the transplant process starts to check my general health?

  • When could I start to experience side effects during this process?

  • What specific side effects are common with this type of transplant? How can each one be managed or relieved?

  • Who should I call if I experience any side effects from my transplant?

  • What signs of an infection should I look out for?

  • What precautions to prevent infection should I follow? For how long?

  • What side effects should I tell my health care team right away?

  • If I will have an ALLO transplant, will I take any medications to prevent GVHD?

  • If I will have an ALLO transplant, what are the signs of GVHD that I should watch for?

  • What tests will I need later? How often?

  • What are the possible late effects of a transplant? How can they be managed or relieved?

  • How will having a transplant affect my daily life? Can I work? Can I exercise and do regular activities? Or, when can I restart these activities during my recovery?

  • Will having a transplant affect my sex life? If so, how and for how long?

  • Will having this transplant affect my ability to have a child in the future? If so, can you refer me to a fertility specialist before treatment begins?

  • Why is good nutrition important during and after a transplant? Should I meet with an oncology registered dietitian?

  • Who can I talk with about the emotional effects of cancer and this treatment?

  • What can I do at home to keep myself as healthy as possible?

Related Resources

What is a Bone Marrow Transplant (Stem Cell Transplant)?

What to Expect During Recovery From a Bone Marrow Transplant: An Expert Q&A

Resources on Bone Marrow/Stem Cell Transplant

Coping With the Fear of Treatment-Related Side Effects


Bone Marrow Transplant and Older Adults

More Information

Be the Match: Life After Transplant

Be the Match: GVHD Signs and Symptoms

BMT InfoNet: Transplant Basics

National Bone Marrow Transplant Link: Publications on Side Effects and Survivorship