The complications that may arise from a bone marrow transplant are dependent on the type of transplant that is performed. Due to the complexity of the procedure, complications can occur regardless of the type of transplant. For instance, graft versus host disease is more likely to occur in allogeneic and half-matched transplants. Complications can either be acute or chronic.
Acute Complications: Acute complications occur within a short period after transplant. Such as follow,
Acute graft versus host disease( As a complication of bone marrow transplant)
This includes graft versus host disease (gut, liver, skin). .it may occur early at the time of engraftment or later within months to one year.
Cytokine Release Syndrome :(Complication of bone marrow transplant):
In bone marrow transplant, CRS occurs within 24 to 48 hours of infusion of stem cells, i.e., the donor’s bone marrow usually occurs in a haploid identical transplant. It may be severe and can cause the death of the patient. Signs and symptoms include a severe high-grade fever that sometimes cannot respond to antipyretic and steroid therapy.
What is the main cause of cytokine release syndrome?
The main cause of CRS is the activation of CAR-T cells against donor bone marrow or stem cells. Its management includes high doses of corticosteroid drug-specified cytokines such as rituximab and, tocilizumab, ab, etc. Corticosteroids decrease inflammation, and drugs specified to cytokine decrease or inhibit cytokine formation and release.
Graft Failure:
Graft failure can be either acute or chronic. Acute graft failure occurs within two to three weeks of the transplant. Typically, grafting begins after two weeks. In cases of graft failure, the number of cells does not increase and remains less than 100. Platelet and hemoglobin levels also remain on the lower side, requiring continuous transfusion of platelets and packs of red blood cells.
Infection during Transplant:
Infection is also a major risk during transplant; some patients get bacterial, viral, or fungal infections.
Bacterial Infections:
Bacterial infections can manifest as pneumonitis and bloodstream infections. BSIs usually involve opportunistic bacteria or normal flora in the human body. However, when a patient becomes neutropenic, these organisms can invade the host in the form of bloodstream infections or urinary tract infections.
Viral Infections:
Cytomegalovirus (CMV) is a common viral infection that occurs during a bone marrow transplant. It can remain inactive in the patient’s body and become active when the patient’s immune system is weakened due to neutropenia. This is known as recurring or congenital CMV. Sometimes, the virus can also spread to the patient from a donor’s T-cells, which is called acquired CMV infection. This type of infection is usually observed in allogeneic bone marrow transplants. The treatment of CMV can be very expensive and may also suppress the patient’s bone marrow, which can delay the patient’s engraftment during bone marrow transplant.
Fungal infections during BMT.
Fungal infections during transplant are also very severe infections during the transplant or neutropenia phase. However, these infections may be in the bloodstream, in the urinary tract, in the nasal sinuses in the respiratory tract known as mucormycosis or zygomycete, or in the skin.
Internal bleeding:
Patients with low platelets may bleed internally. Bleeding might be intracranial, from the urinary tract, or from the gastrointestinal tract. Sometimes, bleeding becomes very massive and can lead to the death of the patient.
Infertility:
Due to the result of high-dose chemotherapy and radiation therapy, patients may not be able to produce offspring because high-dose radiation and chemotherapy drugs damage male /female gonads or offspring-producing cells
Organ failure:
Organ failure may be due to drugs used during transplant treatment. Medications such as immunosuppressive drugs or other medications used to treat infections such as fungal, bacterial, or viral infections may have adverse effects on the kidneys or liver. Drug-induced organ toxicity can be reversed by stopping the drug. To avoid this, the healthcare provider must keep an eye on drug doses and their adjustment to patient symptoms and daily monitoring of organ function tests such as renal function tests and live function tests.
Due to the result of high-dose chemotherapy and radiation therapy, patients may not be able to produce offspring because high-dose radiation and chemotherapy drugs damage male /female gonads and offspring-producing cells.
Vino-occlusive disease (VOD): VOD is a major complication of bone marrow transplant. Moreover, in Vod, vessels of the liver become blocked. This may be due to drugs used in transplants, such as high-dose chemotherapy or radiation therapy.
What are the symptoms of veno-occlusive disease?
Weight gain
Deranged liver function test
Ascites (distended abdomen due to filled fluid in the abdominal cavity)
Jaundice due to obstructed veins
Enlarged liver (hepatomegaly)
Veno-occlusive disease requires prompt and expensive treatment. If left untreated or treatment is not available, it can be fatal for patients.
A bone marrow transplant is a complex procedure that involves administering high doses of chemotherapy and radiation therapy to the patient. These treatments affect the patient’s entire body and all body systems, resulting in the experience of various symptoms such as nausea, vomiting, diarrhea, weight loss, infertility, and others. Due to this, patients undergoing a transplant require special care in a specific setup.
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