What complications can come from a blood and marrow transplant?

What is CMV?

What is shingles?

What is graft-versus-host disease (GVHD)?


What complications can come from a blood or marrow transplant?
Complications that follow a blood or marrow transplant may include:

• Toxicity of preparative regimen
  Chemotherapy, radiation therapy, antibiotics and immunosuppressive agents may cause complications in major organs, including the gastrointestinal tract, liver, kidneys, lungs and/or heart.
• Bleeding
  The platelets which help blood clot may be low. Major bleeding can be prevented with transfusions of platelets. However, some patients may not respond well to transfused platelets and may still be at risk for bleeding.
• Mouthsores
  Mouth sores (mucositis) may develop as a result of chemotherapy or radiation treatments. Mouth sores will heal after the new white blood cells begin to grow.
• Hair loss
  Hair loss usually occurs within a week after transplant. This is a temporary side-effect of the preparative chemotherapy regimen.
• Infection
  The chemotherapy and/or radiation given to a BMT patient suppresses the patient's immune system. Until the transplanted stem cells engraft and create new white blood cells, the patient is extremely susceptible to infections that may become life-threatening. Patients will receive medications to try to prevent infections. Once the stem cells engraft, the risk of infection declines, however the patient's new immune system may not be fully functioning for six months to a year post-transplant. Infections may be viral, bacterial or fungal.
• Graft failure
  When the bone marrow function does not return or is lost after a period of time it is called graft failure. The patient's body may reject the donated stem cells or the stem cells simply fail to grow and produce new blood cells. Graft failure may occur with any type of transplant, whereas rejection only occurs in an allogeneic donor transplant.
• Graft-versus-host disease (GVHD)
  Graft-versus-host disease (GVHD) occurs when cells from the donor identify the patient's body as foreign and attack it. If GVHD develops within 3 months of transplant it is called acute GVHD; when it develops later, it is called chronic GVHD. Common symptoms in acute GVHD may include skin rash, jaundice, liver disease, nausea and diarrhea. Chronic GVHD produces skin rash, thickening of patches of skin, liver and lung disease, nausea and weight loss. Dry eyes and dry mouth may also occur.
• Relapse
  Recurrence of the malignant disease following transplant.
• Veno-Occlusive Disease (VOD) of the liver 
  VOD can occur as a result of chemotherapy. It is an inflammatory clotting in the veins of the liver. Symptoms include jaundice, weight gain, and extra fluid in the abdominal cavity.

What is CMV?
Cytomegalovirus (CMV) is a type of virus which can cause infections in healthy individuals but can be dangerous to immune-suppressed patients. This virus may cause pneumonia, colitis or hepatitis. Half of the general population is infected by CMV during their lifetime. But they are unaware of having the disease. If the patient does not have any apparent experience wtih CMV, he or she is "CMV-negative." Care is then taken to prevent exposure to CMV. If the patient has been exposed in the past, then they are "CMV positive." This means CMV can recur. The symptoms of CMV can be mild or may become life-threatening if the virus invades the blood, lungs, liver or other organs. Anti-viral medications are available to help prevent and treat this virus.

What is shingles?
The same virus that causes chicken pox causes shingles. This virus is Varicella Zoster Virus or Herpes zoster. Some BMT patients develop shingles during the first year post-transplant. Shingles usually manifests itself as an itching, blistering skin rash that extends along one of the body's nerve branches. It can be painful and is quite contagious. Herpes zoster can be treated with antiviral antibiotics.

What is graft-versus-host disease(GVHD)?
GVHD is a frequent complication of allogeneic BMTs. It occurs when new stem cells (graft) recognizes the patient's body (host) as foreign and sends T-lymphocytes to attack. Symptoms may include skin rash, nausea, vomiting, diarrhea, liver disease and jaundice. GVHD may increase the risk of infection and may be chronic. Chronic GVHD may develop months after BMT. It may also affect the eyes, mouth, lungs and vagina as well as skin, liver and the gastrointestinal tract, as in eary (acute) GVHD.