Side effects

Transplant from a donor (allogeneic)

A transplant from a donor (allogeneic) is a more intensive procedure than high-dose treatment with stem cell support. The bone marrow takes longer to recover and the period during which you are at risk of infection is longer. Other possible complications, such as GVHD, may also prolong your stay in hospital.

High dose treatment and stem cell support

Recovery from high-dose treatment with stem cell support is quicker than it is from a transplant. You are at risk of infection for a shorter period and there are fewer complications. As a result, your stay in hospital is usually shorter. In many hospitals you will not be restricted to being in a room of your own. Once your blood counts begin to rise the medical and nursing staff will start to plan your discharge home.

The following side effects are common to both treatments.

Infection

The number of white blood cells in your body will fall after your treatment. As a result you will be very susceptible to infection caused by the bacteria which normally live in your body. These bacteria are present on your skin and in your stomach and intestine. In healthy people they are useful. When the immune system is temporarily impaired after high-dose treatment and a transplant, these bacteria may become harmful and cause infections. To try to avoid this, you will be given regular antibiotics and mouthwashes.

Most hospitals have their own policy on the preparation of food and what you can eat. This can vary from being extremely cautious to being very flexible. You can discuss this with the doctors and nurses looking after you. Care needs to be taken that your food does not contain bacteria which could harm you. Some general precautions are:

• Food brought in for you by friends or relatives should be very carefully prepared.
• Fruit and salads (if allowed) should be washed carefully.
• Avoid cream and sugary cakes.
• Avoid soft cheeses and dishes made with lightly cooked or uncooked eggs.
• Hot meals should be freshly prepared and thoroughly cooked (not reheated).

CancerBACUP’s information about avoiding infections when your immunity is low includes some tips on diet at this time.

The hospital staff will take care to make sure that infections are not brought into your room. The room and its contents will be thoroughly cleaned daily. Different hospitals have different policies about visitors, but you may be restricted to only a few visitors each day, and they will be told not to come if they are unwell. They may have to wash their hands and wear protective clothing so that they do not transfer any infection to you.

If you have had high-dose treatment with stem cell support you may not need to be in a room of your own and visiting may not be so restricted.

Even with these precautions, almost everyone will get a high temperature and need antibiotics.

Anaemia

The number of red cells in your blood (your haemoglobin level) may fall, which is known as anaemia and will make you feel very tired. You may need regular blood transfusions to counteract this until your body starts to make enough red blood cells again.

Bleeding

You are likely to need transfusions of platelets to make sure you have enough in your blood and to reduce the risk of bleeding or bruising. Your platelet count will be checked by daily blood tests and your doctor will examine you regularly for bruises or little red spots on the skin. It is sensible to use a very soft toothbrush when you clean your teeth, to avoid damaging your gums. If you develop any bleeding (e.g. in the mouth or when you pass urine), tell a doctor or nurse immediately.

Eating problems

You will probably see a dietitian regularly during your transplant, who will make sure that you are eating as well as possible.

It is very important that you do not lose too much weight, and the nurses looking after you will encourage you to try to eat small meals and snacks. If you are having eating problems, because of lack of appetite, nausea or a sore mouth, you may need to have nutritional drinks. If even these are difficult, you may need to be given a special fluid through your central line which will give you all the necessary nutrients. As you start to be able to eat again, the amount of fluid you are given through the line will be tailed off.

The section on diet and the cancer patient has some useful tips on coping with eating problems. Your mouth may become very sore while your white blood cell count is low, either from ulcers caused by radiotherapy, or from thrush – a fungal infection. You will be given mouthwashes, and lozenges to suck regularly to try to prevent this, and painkillers too, if needed. Mouth care is essential, both for your comfort and to prevent infections developing in your mouth and spreading to other parts of your body.

CancerBACUP has information about mouth care during chemotherapy.

You may also develop diarrhoea and a sore bottom. This normally settles within a few days. If it is severe, it can be controlled with medicine.

Most of these symptoms are worst when your blood count is at its lowest, in the second and third week after the high-dose treatment. You will feel unwell during this time. You may also have a poor appetite and may lose weight. When your blood count starts to recover, the symptoms will start to improve, your appetite will return, you will be less prone to infection and will not need so many blood and platelet transfusions. You will start to feel better again, although you can still expect to tire easily and feel fairly weak for several months more.

For more information, see coping with tiredness (fatigue).

When the healthy cells in your blood have reached a safe level (although not yet normal) you will be allowed to go home, as long as a friend or relative stays with you. You will be given a 24-hour telephone contact number in case you have any worries, and you will need to go back frequently to the hospital as an outpatient for check-ups.