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Survivorship Guide for Bone Marrow/Stem Cell Transplant
Coping with Late Effects

Chemotherapy and Radiation – Late Effects

The high-dose chemotherapy and/or radiation that you may receive prior to, during, or after your transplant can cause long-term damage to healthy cells and organs, and in turn this can affect your future health and well-being. The extent of the damage depends on many factors, including the type and extent of chemotherapy, the amount of radiation, and the ability of your damaged organs to heal themselves.

Aftereffects of Chemotherapy

  • Fatigue
  • Early or premature menopause
  • Infertility
  • Changes to the heart
  • Reduced lung capacity (difficulty breathing)
  • Kidney and urinary problems
  • Neuropathy (numbness, tingling, and other sensations in areas of the body, especially hands and feet)
  • Muscle weakness
  • Cognitive problems such as memory loss or inability to focus
  • Osteoporosis
  • Changes in texture and appearance of hair and nails
  • Secondary cancers

Aftereffects of
Radiation

  • Cataracts (if radiated near eyes)
  • Permanent hair loss (if scalp is radiated over certain dose levels)
  • Dental decay, tooth loss, receding gums (if radiated near mouth)
  • Loss of tears and ability to produce saliva (if head/face radiated)
  • Problems with thyroid or adrenal glands (if neck or kidney area radiated)
  • Slowed or halted bone growth in children (if bone radiated)
  • Decreased range of motion in the treated area
  • Skin sensitivity to sun exposure (in the area of skin that was radiated)
  • Problems with the digestive system (if abdomen was radiated)
  • Secondary cancers (in area radiated)
  • Infertility (if ovaries or testes were directly radiated)

This chart was adapted from a number of sources that can be found in the reference section.

Graft Versus Host Disease

Another common and serious long-term BMT side effect is Graft Versus Host Disease. GVHD is a condition in which the donor’s immune system (the graft) attacks the transplant recipient (the host). Immune systems are designed to distinguish between self and other and to attack foreign invaders such as viruses and bacteria. GVHD is caused by the genetic differences between the donor’s immune system and that of the recipient. Because of these differences, the new immune system (the graft) does not recognize the transplant recipient (the host) as self, and therefore launches an attack. Additional information on GVHD can be found on the National Bone Marrow Transplant Link’s website at: www.nbmtlink.org/webcasts.

In the case of autologous transplants or a transplant from an identical twin, the donor and recipient are genetically identical, and there is generally no GVHD. In allogeneic transplants where the donor is related, approximately 30-40% of individuals experience GVHD. In transplants from an unrelated donor, where the donor and recipient are genetically more different, approximately 60-80% of transplant recipients experience GVHD.[28]

In the case of transplants from unrelated donors, GVHD tends to be more severe than with related transplants because of the genetic differences between the donor and the recipient. Depending on the characteristics of the population being studied, about one-third to one-half of the people receiving a transplant from an unrelated or sibling donor have some active GVHD two years post transplant.[29] Treatment for chronic GVHD takes two to three years on average, and in most cases, resolves within five years. Generally, individuals with active GVHD report more problems with physical and mental health. However, once GVHD resolves, there is no reported difference between those who had chronic GVHD and those who never had GVHD.[29]

Although severe GVHD is very debilitating, mild GVHD can be considered beneficial. When the new immune system attacks the host cells, it also targets any remaining cancer cells, thus reducing the risk of recurrence. This is known as the “Graft Versus Leukemia Effect” or “Graft Versus Tumor Effect.” Because of this, doctors must often tread a fine line, trying to reduce severe GVHD while maintaining the benefits of the anti-cancer effect of mild GVHD.

GVHD can occur any time after transplant. GVHD that occurs in the first 100 days post transplant usually causes a red and raised skin rash, diarrhea, or liver inflammation and is called “acute GVHD.” GVHD that occurs more than 100 days post transplant can be either a form of late acute GVHD or may be chronic GVHD. Acute and chronic GVHD are different in the symptoms they cause and in how they respond to treatment.

Symptoms of Chronic GVHD

GVHD can affect any part of the body. Areas that are commonly affected include the skin, eyes, mouth, digestive tract, joints, lungs, and liver. In addition to damaging organs and various body parts, GVHD may also cause immunosuppression and fatigue. Because of its attack on your immune system, GVHD can make you more vulnerable to a wide variety of infections and diseases.

Chronic GVHD Symptoms [28] [30]

Organ Symptoms may include:
Skin Itchy, raised rash, dark spots, tautness of skin, skin scarring and thickening (sclerosis), impaired joint mobility, and limited or no sweating (leading to heat intolerance)
Liver Abnormal liver function leading to jaundice (yellowing of skin and eyes), severe liver disease
Eyes Dry eyes leading to burning sensation, redness and general irritation, sensitivity to light, possible vision impairment
GI Tract Problems with digestion, diarrhea, heartburn, stomach pain, difficulty swallowing/eating, weight loss
Mouth Dry mouth, sensitivity to spicy or acidic foods, sores in mouth, dental cavities, weight loss, difficulty swallowing due to less saliva
Lungs Shortness of breath, hard to take deep breaths, difficulty breathing, wheezing
Joints, tendons, and muscles Pain and tightening around the joints, muscle weakness, contractures of the tendons that make extending and contracting arms and legs difficult
Genitourinary Vaginal dryness, tightness, or stricture
Immune function Increased risk of infections – bronchitis, pneumonia, and other types of infections
Derma and appendages Hair loss, including scalp hair, eyelashes, eyebrows, premature graying, ridging of nails

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