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

Approved by the Cancer.Net Editorial Board, 07/2018

A bone marrow transplant, also called a stem cell transplant, 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 side effects 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. It also includes long-term effects that last years or a lifetime.

Managing symptoms, which can include anemia, is an important part of cancer care and treatment. This is called palliative care or supportive care. Talk with your health care team about any symptoms you or the person you are caring for experience.

Side effects from an AUTO transplant

Before a transplant, you will receive chemotherapy with or without radiation therapy. So, many side effects of an AUTO stem cell transplant are similar to the side effects of these treatments. The most serious of these side effects is a higher risk of infections from low levels of white blood cells. 

Infections. 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 other germs. The highest risk of infection is during the first few weeks after transplant. But your immune system is never completely the same after a transplant. Most people will receive antiviral and antibacterial drugs for up to a year or more after transplant.

Most infections right after a transplant come from the bacteria, viruses, and other 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 fairly easy to treat with antibiotics.

After about 2 weeks, a part of your immune system, known as neutrophils, 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 and 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 transplant that develop months or years after treatment.

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

  • Cataracts, a condition in which the lens of the eye gets cloudy and vision is more difficult

  • Early menopause for women

  • Thyroid problems

  • 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 and radiation therapy, if used. It also includes side effects 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 early after the transplant is similar to an AUTO transplant (see above). But after an ALLO transplant you have a serious risk of infections throughout your life. When you have an ALLO transplant, your doctor will give you chemotherapy, radiation therapy, or other drugs to keep your immune system from destroying the new cells. These treatments may affect your immune system and make infection risk higher. A weak immune system makes you more likely to get infections.

Graft-versus-host disease. GVHD happens when the new stem cells attack your body. This causes inflammation. Doctors have medications for GVHD. You get them even if your donor was a 100% match. If you still get GVHD, your doctor will give you more medicines to manage the condition. 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. The treatment is medication to block T cells. T cells are white blood cells that help the immune system fight infections. Blocking them keeps your immune system from attacking your body’s own cells.

  • Chronic GVHD. Chronic GVHD usually happens more than 3 months after an ALLO transplant. It can last a few months or a lifetime. You might not have symptoms or need treatment. Or you might need treatment for certain problems. For example, you might have dry eyes, dry mouth, and a slightly irritated liver, which is based on blood test results. Or you might have other conditions, such as the skin losing some ability to stretch. This condition is called scleroderma. Other problems may include pain in joints and muscles, weight loss, infections, and difficulty breathing.

    Chronic GVHD may be treated with medications called corticosteroids. When this standard treatment does not work, a number of other immune suppressing drugs may be prescribed. This can include ibrutinib (Imbruvica).

Many people 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. This is the main way ALLO transplants cure cancers like leukemia.

Other immediate side effects. Similar to an AUTO transplant, the following side effects may develop immediately after 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 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

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

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

  • Cataracts, a condition in which the lens of the eye gets cloudy and vision is more difficult

  • Early menopause for women

  • Thyroid problems

  • Lung or bone damage

  • Risk of developing another cancer

    Related Resources

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

    Donating Bone Marrow is Easy and Important: Here's Why

    Coping With the Fear of Treatment-Related Side Effects

    More Information

    Be the Match: About Transplant

    Be the Match: Life After Transplant