Complications

•What complications can come from a blood or marrow transplant?

•What is CMV?

•What are shingles?

•What is graft-versus-host disease?

•What is veno-occlusive disease?

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What complications can come from a blood or marrow transplant?
Complications that can result from a bone marrow transplant include:

Toxicity of preparative regimen
Chemotherapy, radiation therapy, antibiotics and immunosuppressive agents may cause complications in major organs, including the gastrointestinal tract, liver, kidneys, lungs and/or heart.

Bleeding
The platelets which help blood clot may be low. Major bleeding can be prevented with transfusions of platelets. However, some patients may not respond well to transfused platelets and may be at serious risk for bleeding.

Mouthsores
Mouth sores (mucositis) may develop as a result of chemotherapy or radiation treatments. Mouth sores will heal after the new white blood cells begin to grow.

Hair loss
Hair loss usually occurs within a week after transplant. This is a temporary side-effect of the preparative regimen.

Infection
The chemotherapy and/or radiation given to a BMT patient suppresses the patient's immune system. Until the transplanted stem cells engraft and create new white blood cells, the patient is extremely susceptible to infections that may become life-threatening. Patients will receive medications to try to prevent infections. Once the stem cells engraft the risk of infection declines, however the patient's new immune system may not be fully functioning for six months to a year post-transplant. Infections may be viral, bacterial or fungal.

Graft failure
When the bone marrow function does not return or is lost after a period of time it is called graft failure. The patient's body may reject the donated stem cells or the stem cells simply fail to grow and produce new blood cells. Graft failure may occur with any type of transplant, whereas graft rejection only occurs in an allogeneic transplant.

Graft-versus-host disease
Graft-versus-host disease (GVHD) occurs when T-cells from the donor identify the patient's body as foreign and attack it. If GVHD develops within 3 months of transplant it is called acute GVHD; when it develops later, it is called chronic GVHD. Common symptoms in acute GVHD include skin rashes, jaundice, liver disease, and diarrhea. Chronic GVHD produces temporary darkening of the skin, hardening and thickening of patches of skin and the liver, and parts of the gastrointestinal tract may be affected.

Relapse
Recurrence of the malignant disease following transplant.

Veno-Occlusive Disease (VOD)
VOD can occur as a result of chemotherapy. It is an inflammatory clotting in the veins of the liver. Symptoms include jaundice, with liver dysfunction, weight gain, and extra fluid in the abdominal cavity. It may often be managed successfully, and completely resolve. However, complications can arise that can be fatal. 
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What is CMV?
Cytomegalovirus (CMV) is a type of virus which can cause inapparent infections in healthy individuals but can be dangerous to immune-suppressed patients. CMV is a member of the herpes family. This virus may manifest itself as pneumonia, colitis or hepatitis. Half of the general population is infected by CMV during their lifetime, but are unaware of having the disease. A simple test before BMT can determine whether CMV is present in the patient's body. If not, the patient is "CMV-negative" and care is taken to prevent exposure to CMV. If the patient has been exposed in the past then they are CMV positive and CMV can recur when you are immunosuppressed. The symptoms of CMV can be mild or may become life-threatening if the virus invades the blood, lungs, liver or other organs. Anti-viral medications such as immunoglobulins and antibiotics are available to help prevent and treat this virus.
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What are shingles?
The same virus that causes chicken pox causes shingles, also called varicella zoster virus or herpes zoster. Some BMT patients develop shingles during the first year post-transplant. Shingles usually manifests itself as an itching, blistering skin rash that extends along one of the body's nerve branches. It can be very painful and is quite contagious. Herpes zoster can be treated with acyclovir.
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What is graft-versus-host disease(GVHD)?
GVHD is a frequent complication of allogeneic BMTs. It occurs when new stem cells (graft) recognizes the patient's body (host) as foreign and sends T-lymphocytes to attack it. Symptoms may include skin rash, blisters, nausea, vomiting, diarrhea, and jaundice. GVHD may increase the risk of infection.
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What is veno-occlusive disease?
Veno-occlusive disease (VOD) is a liver problem caused by the high-dose chemotherapy and/or radiation given to patients during the conditioning phase of their BMT. In VOD, the blood vessels that carry blood through the liver become clogged and swollen. The liver's ability to remove toxins, drugs and other waste products from the bloodstream is impaired. The liver swells and the kidneys may retain excess water. The fluid build up may leak into the abdominal cavity or the lungs in severe cases of VOD. Liver damage from mild or moderate VOD is reversible. Severe VOD can be fatal.
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