A bone marrow transplant is a potentially dangerous procedure that is not to be undertaken lightly. Bone marrow transplants are most effective when they occur early in the course of a patient’s disease.  At this point, the patient has less cancer and the disease has not had a chance to become resistant to therapy. However, the significant risks that come with bone marrow transplants make physicians less comfortable about mandating this treatment so early in the disease when other, less invasive treatments might be equally effective.

For this reason, many physicians will first try the less potentially harmful treatments and closely monitor them for progress. If the treatment appears to be largely ineffective, bone marrow transplant may become a viable alternative. 

Patients who undergo bone marrow transplants should be aware that there is always a significant chance that the body will reject the transplanted bone marrow, with potentially life-threatening consequences. Infections and graft-versus-host disease can be fatal for patients who have recently undergone a bone marrow transplant. The risks associated with bone marrow transplants must be weighed against the potential life-saving benefits of the procedures. Risks for donors are minimal, while patients who receive the transplantation face a greater number of potential complications.

Transplant patients

Patients who undergo a bone marrow transplant may experience an increased susceptibility to bleeding and infection, especially in the first month after the procedure. As a result, a physician may prescribe antibiotics to prevent infection and order transfusions of platelets to prevent bleeding and red blood cells to treat anemia.

Other short-term side effects of bone marrow transplants include:

• Nausea and vomiting
• Fatigue
• Loss of appetite
• Mouth sores
• Hair loss
• Skin reactions

Long-term risks associated with transplants are largely a result of chemotherapy or radiation therapy administered prior to the transplant. These include:

• Infertility
• Cataracts (clouding of the eye lens)
• Secondary cancers
• Liver, kidney, lung or heart damage

In some cases, the body will reject the new marrow. This complication is more likely in patients receiving an allogeneic transplant for aplastic anemia. In some cases, a second transplant may be necessary.

Patients who receive allogeneic transplants may experience a complication known as graft-versus-host disease (GVHD). This occurs when a donor’s white blood cells identify normal cells in the patient’s body as foreign and attack them.  Damage to the skin, liver, intestines and other organs may result. GVHD can take two forms:

• Acute GVHD. Occurs within a few weeks of the transplant. It usually doesn’t last long but in severe cases, it can be fatal.
  
  
  
• Chronic GVHD. Develops much later than the acute form of the disease and is often difficult to treat. However, patients who experience this disorder after an allogeneic transplant for leukemia are less likely to have recurrent leukemia.

To prevent GVHD, patients may receive medications that suppress the immune system known as immunosuppressants. Donated stem cells can also be treated with a process called T-cell depletion that removes the white blood cells that cause GVHD. If GVHD has already developed, it can be treated with steroid medications or immunosuppressive agents.

Bone marrow donors

Bone marrow donors usually do not experience any significant problems after the procedure. Only a small amount of marrow is actually removed, and the most common side effect is some stiffness and soreness at the donation site for a few days following the procedure. Some people also may feel tired for a short time after donating. The only significant risks are those associated with any surgical procedure, such as a reaction to anesthesia or medical complications.

The donor’s body replaces the lost bone marrow within a few weeks of donation. Total recovery time varies from a few days to a several weeks.