It is extremely stressful to be diagnosed or having a family member or friend being diagnosed with a life-threatening illness. It is not just the diagnosis that compounds the stress; it is also the debilitating treatment that follows. Many types of blood cancers are treated by stem cell or bone marrow transplantation, but they come with a baggage of short term and long term side effects. Life post-transplant may require adjustment in many ways as it may have new challenges. Of all the available treatments for blood cancer, the most rigorous one is the allogeneic stem cell or bone marrow transplant (BMT).
Before this type of transplant, a particular regimen is given to patients, which involves heavy doses of chemotherapy, radiation, and antibody treatments, or in some cases a combination of the three. Some patients have been subjected to months or even years of chemotherapy eventually leading up to the transplant. This is known as ‘conditioning’ and may have many side effects both short and long term. The sole purpose of conditioning is to attack the tumour cells in the patient’s bone marrow and destroy the cancer. In this process it collaterally destroys immune cells, including T cells, which makes the patient’s body more tolerant of the donated stem cells and less likely to attack them.
Unfortunately, the regimen damages healthy tissues, including the kidneys, liver, lungs, and skin, and especially the gastrointestinal tract and the destruction of immune cells makes the patient extremely vulnerable to infections with bacteria, viruses, fungi, and parasites.
The transplant on the other hand could lead to graft-versus-host disease (GVHD). In this condition the immune cells from the donor may attack the patient’s healthy tissues. Following are some useful tips for coping up with life post bone marrow transplant.
Risk of Infection
You have a low white blood cell count after your intensive treatment, which may put you more at risk of getting an infection. This can be from normally harmless bacteria that harbours in your in our digestive system [called commensals] and on our skin.
To avoid this you might have to use:
- anti-fungal medicines
A shower everyday helps and changing bedsheets, cleaning room every day is a good habit to reduce chances of infections. Visitors having cold and cough should avoid visiting and every visitor must wash their hands before entering your room.
Small meals throughout the day and eating whenever you feel like it is imperative as you won’t have much appetite just after your transplant. Following precautions and practices may help in reducing the chances of infections.
- Heating all hot meals thoroughly and eating them fresh
- Washing and peeling all fruit
- Carefully and thoroughly washing all salad leaves
- avoid lightly cooked eggs
- avoid soft cheese
After a transplant you tend to lose immunity to diseases you were vaccinated against as a child. You need to have these vaccinations again after your treatment; your transplant team will let you know which vaccine shots you need.
Loss of fertility
A long-term side effect of this type of treatment is infertility. This means you will no longer be able to become pregnant or father a child naturally. The high doses of chemotherapy involved during Stem cell or bone marrow transplants nearly always cause infertility. There are some exceptions to this, few people who have had a transplant go on to have children, but these cases are quiet rare.
Sperm banking is another option that people opt for before they start their chemotherapy, wherein men and teenage boys store their sperm beforehand.
Treatment can cause an early menopause for women. You might have hormone replacement therapy (HRT) to help with the symptoms. Women can store embryos or eggs before starting cancer treatment, but this is not at all times possible. Scientists are working on devising a solution to this, to try and help women have children after cancer treatment.
Graft Versus Host Disease (GVHD)
The risk of GVHD arises if you have had a transplant from a matched unrelated donor or a relative. This is because the donor stem cells contain immune cells from the donor. Our own body cells are attacked by these cells.
GVHD can cause:
- Weight loss
- Yellowing of the eyes and skin (jaundice)
- Sore eyes or mouth
- Skin rashes
- Shortness of breath
For some people GVHD can be severe and even life threatening. But trivial GVHD can also prove to be helpful for some. Since it is an immune system reaction, it can help to kill off any cancer cells left post your treatment.
Depression or Anxiety
It is not uncommon to face anxiety or depression post bone marrow transplant. Some of the symptoms of anxiety include, fear, feeling worried, or dreaded. Some of the symptoms of depression also include:
- Feeling irritable, sad, or an ‘empty’ mood that won’t go away
- Sleeping more or less than usual or not being able to sleep
- Not being involved or finding pleasure in activities you used to enjoy, including sex
- Having trouble remembering, concentrating, or making decisions
- Feeling guilty, hopeless, helpless or worthless
- Thoughts of hurting or killing yourself
Having these symptoms for 2 weeks or longer, is a sign that you need to ask for help. Your doctor might recommend a prescription medicine, talking to a therapist or both. One of the good ways to overcome anxiety or depression is talking with other people who already have undergone successful transplant.
Though bone marrow transplant is only lifesaving treatment in some cancers, it may some adverse effects on your well-being. It is most important to believe in yourself and you will come out with flying colours.
Dr. Shrinath Kshirsagar is Hematologist/Hemato-Oncologist and Stem Cell Transplant Physician with over 5 years of experience. He was trained under one of the stalwart in the field of Hematology and transplant in India. He has over 5 years of professional experience with several National and International Publications to his name. He was a part of the team which did more than 200 Transplant over 2 years at the same center. His special interest is autologous and allogenic stem cell transplantation for benign as well as malignant blood disorders and immunotherapy. He is the member of the Indian Medical Association, American Society for Blood and Bone Marrow Transplantation, Society of Hematologic Oncology, USA; and the fellow in the Clinical Hematology and Stem Cell Transplantation-Tata Medical Center.