Hematopoietic stem cell transplantation is the only cure for many malignant blood diseases including leukemia and lymphoma, and is equivalent to an extra-large surgical operation. The transplantation process inevitably causes some adverse effects on the patient’s body, mainly the following:
Major organ damage
Patients need to receive high-dose radiotherapy before transplantation, and radiation and chemotherapy drugs will inevitably cause damage to the gastrointestinal tract, liver, kidneys, heart and lungs. The most common are gastrointestinal reactions such as nausea and vomiting, and patients may have abnormal liver and kidney function and cardiac insufficiency.
Monitor the patient’s heart, lung, liver, and kidney functions, and give timely treatment such as liver and kidney protection; while radiotherapy, actively give symptomatic treatment such as antiemetic to minimize organ damage.
Infection, anemia, bleeding
Patients are prone to infection and fever when their peripheral blood leukocytes drop to their lowest value within two weeks after receiving overdose radiotherapy; they are prone to bleeding when their platelets are low; and low red blood cells lead to anemia symptoms such as dizziness and weakness.
After transplantation, when we reach the myelosuppression phase, hematopoietic growth factors, including granulocyte colony-stimulating factor, erythropoietin and thrombopoietin, are given in a timely manner to help patients restore hematopoiesis; platelet and suspended red blood cell transfusions are also actively requested to help survive the myelosuppression phase; if infection develops, broad-spectrum, highly effective anti-infective therapy is also given in a timely manner.
Once the patient’s bone marrow hematopoietic capacity is restored in about two weeks, the infection, anemia, and bleeding symptoms described above will be significantly improved.
Graft versus host disease (GVHD)
Graft versus host disease (GVHD) is classified as acute or chronic.
- Acute GVHD often occurs within 100 days of transplantation, and patients present with liver impairment such as rash, diarrhea, and jaundice.
- Chronic GVHD occurs 100 days after transplantation and is a systemic disease that resembles an autoimmune disease, often involving multiple organs.
Immunosuppressive therapy is given during transplant to prevent GVHD, and if a patient develops these symptoms after transplant, other immunosuppressive therapy such as hormones is given to try to control its extent and reduce organ damage.
Hemorrhagic cystitis
Hemorrhagic cystitis is one of the common complications of hematopoietic stem cell transplantation and is caused by damage to the bladder mucosa from the chemotherapeutic agents used for pretreatment, and is also closely associated in part with viral infection. The clinical manifestations are varying degrees of hematuria with symptoms of urinary frequency, urgency, and pain.
Most patients can be cured after heavy infusion, alkalinization of urine, and antiviral treatment.
Graft rejection
Refers to the failure of donor hematopoietic stem cells to implant in the patient, and once graft rejection occurs, the hematopoietic stem cells cannot be transplanted successfully.
The search for a suitable donor before transplantation, pretreatment, supportive treatment with blood products and antibiotics, hematopoietic growth factor application, and effective prevention of transplantation comorbidities can all lead to a lower risk of graft rejection and a higher success rate.