Life after a Bone Marrow Transplant
Patients usually recover quickly from transplants that involve implanting their own cells (autologous transplants). Following discharge from hospital, patients attend 3–4 check-ups during the first 2 months and disease process monitoring is then overseen by the haematologist.
Recommendations concerning diet and overall care should be followed for the first 2 months.
This type of transplant can weaken the immune system and therefore vaccinations received up to that date may no longer be effective. In this respect, a blood analysis is performed 6 months after the transplant to determine whether or not the patient needs to be re-vaccinated.
These vary from centre to centre. Nevertheless, it is important to understand that the body is more susceptible to infectious complications during BMT treatments because the immune system is weakened for the first 6–12 months. The risk of infection increases in function of the type of transplant and treatment received; having said that, it is always a very relevant complication whatever the case may be. That is why it is essential to follow the hygiene and diet recommendations indicated by the transplant team from the start of the procedure and for as long as considered necessary to avoid developing an infection.
Post-transplant monitoring is different in treatments that use stem cells from a healthy, compatible donor. After being discharged from hospital, patients attend weekly appointments featuring blood tests and some complementary tests.
Complications associated with allogeneic transplants
Graft-versus-host disease (GVHD). Patients who receive an allogeneic transplant must take immunosuppressive therapy to prevent or control the appearance of a common complication called “graft-versus-host disease” (GVHD).
GVHD occurs when the donor’s stem cells identify the host’s body as being foreign and therefore attack its tissues. The likelihood of suffering GVHD increases in function of the number of incompatibilities between the recipient and donor. There are two types of GVHD: acute, in which symptoms occur in the first 2–3 months post-transplant; and chronic, where symptoms generally develop after 3 months.
The duration of this complication may vary (from 3–6 months up to 1–2 years) and it depends on a lot of factors, e.g., type of transplant, type of donor and the source of the stem cells.
Most common symptoms of GVHD
- Various kinds of skin lesion including skin sclerosis (fibrosis), the appearance of dark stains or the loss of natural skin pigment.
- Dry syndrome. Consists of a dry mouth and dry eyes (gritty feeling).
- Lung problems (cryptogenic organising pneumonia). This courses with a cough, fatigue and extreme tiredness.
These symptoms are generally uncomfortable and require management and attention from an interdisciplinary group which not only includes the transplant specialist but also comprises specialists from dermatology, ophthalmology, pulmonology and others in function of the tissue or organ damaged.
Cataracts. This is a relatively frequent complication at 3–6 years post-transplant in patients who receive radiotherapy in the conditioning regime and corticosteroids at some time during treatment. Cataracts are easily resolved through eye surgery.
Hormonal disorders. Given the high incidence of potential hormonal disorders, BMT patients are monitored by endocrinology, gynaecology and urology services based on any symptoms they present.
Secondary neoplasms. This is the appearance of any type of cancer cells after the transplant. It is a rare side effect that may occur at least 10 years after receiving the transplant.
Nausea and vomiting. These may appear during or after treatment and so patients are advised to eat lighter meals and more often throughout the day. We recommend eating room temperature or cold foods as they are better tolerated. It is also a good idea to take food supplements with meals in an attempt to increase your energy intake. Patients are given antiemetics during the conditioning regime to prevent the appearance of nausea and vomiting.
Diarrhoea. Avoid foods that contain lactose or caffeine, carbonated beverages, fatty foods or high fibre foods and it is important to drink plenty of fluids.
Mucositis. Mucositis is inflammation of the digestive tract’s mucous membrane and typically involves the appearance of ulcers and/or redness; it can affect any part of the tract, from the oral to the anal mucosae. Patients should follow appropriate oral hygiene steps to prevent the onset of mucositis, e.g., the use of a soft-bristled brush and a saline and sodium bicarbonate mouthwash. Use lip balms to keep lips well hydrated. Avoid acidic, fried, bitter, spicy, very salty or highly seasoned foods. Nor are raw vegetables, unripe fruits or carbonated beverages recommended. It is better to eat room temperature or cold foods. The best tolerated textures are soft or ground foods. The need to administer analgesics or some other specific treatment will be evaluated in cases of intense pain when swallowing and/or the appearance of ulcers.
Asthenia. A feeling of persistent physical, emotional and mental exhaustion that does not improve upon resting.
Alopecia (hair loss). This is a temporary effect and hair will grow back after finishing the treatment. However, it often grows back with different characteristics, e.g., more or less curly than before, etc.