Complications of Bone Marrow or Hematopoietic Stem Cell Transplantation

Complications of Bone Marrow Transplantation

Complications of Bone Marrow or Hematopoietic stem cell transplantation include graft-versus-host disease, graft failure, increased susceptibility to infections and complications due to the chemotherapy and /or radiation used prior to the procedure.

Complications of bone marrow transplantation/ hematopoietic stem cell transplantation include:

Complications due to chemotherapy and/or radiation used prior to transplantation

Chemotherapy including immunosuppressive drugs and /or radiation used prior to transplantation often cause adverse effects like nausea, vomiting and skin redness. Cyclophosphamide, an anticancer and immunosuppressant drug can cause oral mucositis i.e. inflammation of the mouth and hemorrhagic cystitis i.e. inflammation of the urinary bladder with bleeding. Loss of hair, reduced blood counts, liver damage and pneumonia are the other complications that could occur with treatment.

Some complications due to chemotherapy and/or radiation occur during later life. These include delayed growth and development of secondary sexual characteristics in children, low sperm counts in males, absence of ovulation in females, thyroid dysfunction, cataract and aseptic necrosis of the femoral head.

• Graft - Versus- Host Disease
  Graft-versus-host disease occurs due to a reaction between the white blood cells of the donor bone marrow and the recipient's cells. It is more commonly seen in case of unmatched or unrelated donors, older patients, or patients who are unable to receive full doses of immunosuppressive drugs. The disease could affect the skin, liver and digestive tract of the host and could also lead to death in severe cases.
• Graft failure
  When the graft fails to take up in the donor and produce new blood cells, it results in graft failure. Graft failure could occur due to a number of causes. These include:
• Rejection of the graft by the host
• Inadequate number of stem cells transplanted
• Damage to the cells during storage and pretreatment
• Use of drugs that have a damaging effect on the bone marrow post transplantation
• Infection with cytomegalovirus or herpes simplex type 6 virus
• Infections
  Due to decreased immunity, post-transplantation patients are particularly susceptible to infections. They have to be administered antibiotics and medications to prevent infection due to viruses, fungi and Pneumocystis carinii.

References:

1. Harrison�s Principles of Internal Medicine 17^th edition
   
2. Czechowicz A and Weissman I. Purified Hematopoietic Stem Cell Transplantation - The Next Generation of Blood and Immune Replacement. Immunol Allergy Clin North Am. 2010; 30(2): 159�171.