The risks of transplant include:
Complications to Vital Organs
It is possible that treatment with a transplant can cause damage to multiple organs of the body. The most commonly affected organs are the heart, liver, lungs and kidneys. These organs will be monitored closely throughout transplant, and consulting doctors will assist the BMT team in the management of your care.
You are at a high risk for infections (bacterial, viral and fungal) related to your weakened immune system. These infections can come from out in the community or from within your own body. You will be on medications to prevent infections. You will require close monitoring and a quick response to infectious symptoms such as fever.
Our BMT team is working hard to introduce new therapies and medicines that can prevent and treat infection. Our center also has open clinical trials exploring the expansion and delivery of special immune cells called cytotoxic T lymphocytes (CTLs) taken from your donor that have been trained to prevent and treat certain viral infections. These CTLs can be administered in the weeks after you have received your donor’s stem cells. Your bone marrow transplant attending doctor may determine if you are eligible for these trials and therapies.
Mucositis is a potential side effect of the preparative regimen (chemotherapy) where your mucous membranes have died off, causing inflammation, pain and sometimes bleeding. This can occur in the mouth, throat and gastrointestinal (GI) tract. This side effect typically resolves when your white blood cell count increases.
Our BMT team has been working hard to develop new approaches to transplant that minimize this problem. We work with specialized doctors who are part of the Pain and Palliative Service. They will help minimize your discomfort from this expected side effect of transplant.
Graft-Versus-Host Disease (GVHD)
GVHD is a risk with allogeneic (donor) HSCT. GVHD is caused when the immune cells (specific kind of white blood cells called T cells) from the donor (graft) recognize your body (host) as foreign and cause a reaction. GVHD causes damage to tissues or organs in your body and affects their ability to function normally. The effects to these organs can be anywhere from mild to life-threatening and may be fatal. GVHD can occur early or late in the transplant process. Medications are started during the preparative regimen (chemotherapy) to prevent this complication and continue post-transplant. These medications suppress your immune system and cause you to be at increased risk for infections.
GVHD symptoms can include skin rash or peeling, yellowing of the skin, poor liver function, poor appetite, nausea, vomiting, stomach / abdominal pain, diarrhea or blood in the stool. Your attending doctor will evaluate your symptoms and start testing or treatment, if needed.
Our BMT team is working hard to introduce new strategies, therapies and medicines that can prevent and treat GVHD. Some of these approaches are being actively investigated at our center. Your bone marrow transplant attending doctor may determine if you are eligible for these trials.
Thrombotic Microangiopathy (TMA)
A complication involving the vascular system as a result of chemotherapy, infection or GVHD. The blood vessels become inflamed and small blood clots can form. This causes kidney injury, protein leaking in urine and high blood pressure. The lungs, heart and gut may also be affected.
New approaches now exist to identify and treat TMA early before it worsens. Some approaches are being actively investigated at our center. Your bone marrow transplant attending doctor may determine if you are eligible for trials that explore how best to diagnose and treat TMA.
Veno-Occlusive Disease (VOD)
Veno-occlusive disease is a complication involving the liver as a result of high doses of chemotherapy or radiation as part of the preparative regimen (chemotherapy). The blood vessels in the liver become blocked and the liver can no longer process medications and waste products in the blood. This causes swelling and may lead to other organ failure.
Our center has become an active location for new and developing treatments for VOD. Your bone marrow transplant attending doctor will determine the best prevention and treatment strategies for VOD.