Late Complications Following a Bone Marrow, Stem Cell or Cord Blood Transplant
Some of the drugs used in the preparative regimen, as well as total body irradiation and chronic graft-versus-host disease, may affect your organs. In most cases, the organ damage is temporary and reversible.
The list of possible organ problems may seem overwhelming, but keep in mind that no one experiences all of them, and some people experience none at all.
The survivorship care plan your transplant center gives you will list ongoing tests you should have to ensure that your organs remain healthy after transplant.
Below are some, but not all, of the organs that may be affected.
Vision Problems after Transplant
Cataracts are a common side effect of transplant. If you develop a cataract, it can be surgically removed in an outpatient setting.
If you had total body irradiation (TBI) or chronic GVHD, you may experience dry eyes after transplant. Dry eyes can be managed with:
- artificial tears
- ointments
- tear duct plugs that help retain moisture in your eyes
- oral medications like Salagen® and Evoxac® can stimulate tears that moisturize the eyes
- special goggles called chamber glasses can also help keep your eyes moist
If the problem is more severe, eye drops made from your blood serum may help.
A special type of contact lens called PROSE, offered by BostonSight®, has improved vision for many patients with severely dry eyes that interfere with sight.
Some patients develop glaucoma after transplant. The risk is greatest among patients who received steroids to treat graft-versus-host disease. It is usually treated with special eye drops that lower the pressure in the eye.
Dental Problems after Transplant
Total body irradiation (TBI) and chronic GVHD can cause dental problems such as loose teeth, tooth loss and dry mouth.
You can reduce the risk of developing dental problems by:
- avoiding sugary foods, especially soft drinks that contain sugar
- brushing twice daily, after meals if possible
- flossing daily
- seeing a dentist at least once a year
Problems with Bones after Transplant
Loss of bone density (osteoporosis) sometimes occurs after transplant. It is most common in people who are:
- female
- older
- menopausal
- inactive
- have a small frame
- treated with steroids
If your bone density is low, your doctor may recommend::
- exercise
- calcium
- vitamin D
- estrogen replacement therapy
- bisphosphonate
Avascular necrosis (loss of blood flow to the bone) occurs in 5-20 percent of patients who had a transplant with donor cells. The risk is greatest among those who:
- are older
- had aplastic anemia or leukemia
- received total body irradiation
- had GVHD that was treated with steroids
Avascular necrosis usually affects the hips or knees. In mild case, exercise may help. More severe cases require surgery to replace the joint.
Heart Problems after Transplant
The risk of heart disease is up to three time higher than the general population for survivors of an allogeneic (donor) transplant. You can reduce your risk of heart disease through:
- exercise
- a healthy diet
- watching your cholesterol and blood pressure
- monitoring your blood glucose level.
Thyroid Problems after Transplant
Patients often develop an under active thyroid after transplant. Symptoms include:
- weight gain
- dry hair or skin
- hair loss
- sensitivity to cold
- constipation
In children it can affect growth as well.
The condition can be treated with oral thyroid hormones.
Lung Problems after Transplant
Ten to 20 percent of patients who were transplanted with cells from a donor develop a condition called bronchiolitis obliterans (BOS) during the first two years after transplant.
BOS is almost never seen in patients who had a transplant using their own marrow or stem cells.
Risk factors for BOS include:
- a history of GVHD
- a history of respiratory viral infections after transplant
- breathing problems prior to transplant
- older age
BOS reduces airflow through the lungs. Symptoms include:
- a dry cough
- shortness of breath
- wheezing
although approximately 20 percent of patients with BOS have no symptoms at all during the early stages of the disease.
BOS is very difficult to treat. Treatment usually consists of steroids, cyclosporine and tacrolimus, asthma medications and/or azithromycin. Best results are seen in patients who begin treatment early in the course of their disease.
Watch a video about lung and breathing problems after transplant.
Kidney disease can occur following transplant. The risk of kidney disease is greatest among patients who:
- have multiple myeloma
- were treated with total body irradiation (TBI)
- have chronic GVHD
Treatment for kidney disease varies depending on the particular type of kidney problem you have. Blood and urine tests can help detect kidney problems. If you have kidney problems, be sure to talk with your doctor about all medications you take, including herbal supplements, as some can make the problem worse.
Liver Problems after Transplant
Some patients who received many blood transfusions before or during transplant can develop iron overload - too much iron in your blood. Iron overload can:
- increase your risk of infection
- affect the health of your liver and heart
Iron overload is most common in people who have had multiple red blood cell transfusions before and after transplant such as patients with myelodysplastic syndrome (MDS), severe aplastic anemia, thalassemia and sickle cell disease.
Iron overload is typically treated by removing some of your blood through a process called phlebotomy. The procedure is similar to that used when you donate blood.
