Late Effects of Bone Marrow and Stem Cell Transplant on Organs and Tissues

Bone marrow and stem cell transplantation can cause difficulties with heart, lungs and other organs years later. Knowing your risk and monitoring for late effects is vital.

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Some of the drugs used in the preparative regimen, as well as total body irradiation and chronic graft-versus-host disease, may affect your organs. In most cases, the organ damage is temporary and reversible. 

The list of possible organ problems may seem overwhelming, but keep in mind that no one experiences all of them, and some people experience none at all.

Your transplant program should give you a list of ongoing tests you should have to ensure that your organs remain healthy after transplant.

Below are some, but not all, of the organs that may be affected.

Vision Problems after Transplant

Cataracts are a common side effect of transplant. If you develop a cataract, it can be surgically removed in an outpatient setting.

If you had chronic graft-versus-host disease (GVHD), you may experience dry eyes and other vision problems after transplant. Click here to learn more about eye problems caused by graft-versus-host disease after transplant.

Dental Problems after Transplant

Total body irradiation (TBI) and chronic GVHD can cause dental problems such as loose teeth, tooth loss and dry mouth.

You should undergo a dental exam annually to detect and treat these problems.

Additional oral problems can be caused by graft-versus-host disease.  Click here to learn more about dental and other oral problems caused by graft-verus-host disease.

Bone Health after Transplant

Loss of bone density (osteoporosis) sometimes occurs after transplant. It is most common in people who are:

  • female
  • older
  • menopausal
  • inactive
  • have a small frame
  • treated with steroids

If your bone density is low, your doctor may recommend::

  • exercise
  • calcium 
  • vitamin D
  • estrogen replacement therapy
  • bisphosphonate 

Avascular necrosis (loss of blood flow to the bone) occurs in 5-20 percent of patients who had a transplant with donor cells. The risk is greatest among those who:

  • are older
  • had aplastic anemia or leukemia
  • received total body irradiation
  • had GVHD that was treated with steroids

Avascular necrosis usually affects the hips or knees. In mild case, exercise may help. More severe cases require surgery to replace the joint.

Watch a video about bone health after transplant.

Heart Health after Transplant

The risk of heart disease is up to three time higher than the general population for survivors of an allogeneic (donor) transplant. You can reduce your risk of heart disease through:

  • exercise
  • a healthy diet
  • watching your cholesterol and blood pressure
  • monitoring your blood glucose level.

Watch a video about preventing and managing heart problems after transplant;

Thyroid Issues after Transplant

Patients may develop an underactive thyroid after transplant. Symptoms include:

  • weight gain
  • dry hair or skin
  • hair loss
  • sensitivity to cold
  • constipation
  • fatigue

In children it can affect growth as well.

This condition is typically treated with oral thyroid hormones.

Lung Problems after Transplant

Ten to 20 percent of patients who were transplanted with cells from a donor develop a condition called bronchiolitis obliterans (BOS) during the first two years after transplant.

BOS is almost never seen in patients who had an autologous stransplant (a transplant using their own marrow or stem cells).

Risk factors for BOS include:

  • a history of GVHD
  • a history of respiratory viral infections after transplant
  • breathing problems prior to transplant
  • older age

BOS reduces airflow through the lungs. Symptoms include:

  • a dry cough
  • shortness of breath
  • wheezing

Approximately 20 percent of patients with BOS have no symptoms at all during the early stages of the disease.  

BOS is very difficult to treat. Best results are seen in patients who begin treatment early in the course of their disease.

Watch a video about BOS and other breathing problems after transplant.

Kidney Problems after Transplant

Kidney disease can occur following transplant. The risk of kidney disease is greatest among patients who:

  • have multiple myeloma
  • were treated with total body irradiation (TBI)
  • have chronic GVHD

Treatment for kidney disease varies depending on the type of kidney problem you have. Blood and urine tests can help detect kidney problems. If you have kidney problems, be sure to talk with your doctor about all medications you take, including herbal supplements, as some can make the problem worse.

Liver Problems after Transplant

Some patients who received many blood transfusions before or during transplant can develop iron overload - too much iron in your blood. Iron overload can:

  • increase your risk of infection
  • affect the health of your liver and heart

Iron overload is most common in people who have had multiple red blood cell transfusions before and after transplant such as patients with myelodysplastic syndrome (MDS), severe aplastic anemia, thalassemia and sickle cell disease. 

Iron overload is typically treated by removing some of your blood through a process called phlebotomy. The procedure is similar to that used when you donate blood. 

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Updated August 2023