Acute Lymphocytic Leukemia - Treatment After Relapse

Side Effects and Complications

Common side effects include nausea, vomiting, fatigue, mouth sores, and loss of appetite.

The procedures themselves are fairly dangerous and carry a small risk for death. When it was first used, transplantation procedures had 10 - 25% morality rates. Now mortality rates are below 5 percent. Potentially serious complications include:

Infection resulting from a weakened immune system. This is the most common side effect and can persist for several months after the transplant. Because the stem cell procedure is done more swiftly, the risk period is shorter than with bone marrow transplantation. Many patients develop severe herpes zoster virus infections (shingles) or have a recurrence of herpes simplex virus infections (cold sores and genital herpes). Pneumonia, cytomegalovirus, and fungal infections are among the most important life-threatening infections. Fungal infections are of particular concern because they are both very serious and their incidence is increasing with advances in conditioning treatments, immunosuppression and use of potent antibiotics. The patient may require very strong antibiotics and antifungal medications as well as granulocyte colony-stimulating factors or G-CSF (e.g. lenograstim, filgrastim) to stimulate the growth of infection-fighting white blood cells.
Graft-versus-host-disease (GVHD) is a serious attack by the patient's immune system triggered by the donated new marrow. It occurs in over half of allogeneic transplants. GVHD can results in weight loss, bacterial infections, and skin and organ problems that may persist for up to three years after the procedure. In some cases it is fatal. Careful matching of the donor and preventive immunosuppressive drugs, such as corticosteroids, methotrexate, and cyclosporine, may reduce the risk for this potentially life-threatening side effect.
Secondary cancers. There is a small long-term risk for leukemia after transplantation in young people. Use of newer chemotherapeutic drugs, however, may not pose as high a danger.
Bleeding because of reduced platelets. This risk is highest within the first 4 weeks after bone marrow transplantation.
Other side effects include heart, lung, and liver complications, infertility, transplant failure, muscle problems (stiffness, cramps, joint pain), frequent urination, and bladder control problems.
Older patients should be screened for osteoporosis and hypothyroidism (underactive thyroid).