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Bone Marrow Transplant



Late Complications




Survivors of hematopoietic stem cell transplantation (HSCT) generally have multiple long term health problems related to:

  • Therapy:
    • Chemotherapy and/or radiation therapy
  • Chronic graft versus host disease (cGvHD)
  • Other factors may also play a role:
    • Previous malignancy
    • Complications during transplant (such as septicaemia and hypotension)
    • Supportive therapy (such as nephrotoxic antibiotics and antifungal therapy) 

Usually these side effects overlap and produce significant morbidity.

Armenian et al compared the risk of chronic health problems in cancer survivors treated only with conventional chemotherapy, those treated with HSCT and in the siblings of cancer survivors. Severe, chronic health conditions were far more common in survivors treated with HSCT. Undergoing HSCT from an unrelated donor or a conditioning regime that included TBI (whole body RT) was associated with an increased risk of severe  adverse health conditions. Survivors after HSCT were more likely to have endocrine problems (especially gonadal failure in women), neurosensory impairments, second malignant neoplasms (6.9%) and cardiovascular disease (4.8%).


Late Effects of therapy:

Radiation therapy (RT):

Whole body low dose RT (often called Total Body Irradiation or TBI) can affect many organs and lead to multiple late effects.  These side effects are exacerbated by the high dose chemotherapy also given as part of the conditioning regime.

Examples of long term health problems related to RT component of conditioning regime:

Region affected by TBI Long-term health Risk
    • Increased risk for the development of a second malignant neoplasm2, 3
    • Leukemia – usually AML
    • Solid tumor – often a sarcoma or brain tumor
  • Reduced growth of all the structures within the RT field
    • Significantly worse for young patients
    • Increased risk of osteoporosis (early onset)
    • Increased risk of avascular necrosis
    • Leukoencephalopathy
    • Long term neurocognitive problems
    • Increased long term risk of cerebrovascular event (stroke)
    • Cataracts



  • Metabolic syndrome
  • Growth hormone abnormalities
    • Reduced salivary output with xerostomia and increased risk of dental caries
    • In young children abnormal development of teeth
    • Hypothyroidism
    • Thyroid cancer
    • Interstitial disease and pulmonary fibrosis
  • Increased risk of coronary vascular disease
    • Renal damage and dysfunction
  • Hypertension
    • Delayed puberty
    • Infertility
    • Early onset of menopause in females
Immune system
    • Increased risk of infection



Examples of late health problems related to the chemotherapy component of conditioning regime:

  • Cyclophosphamide is directly responsible for:
    • Infertility
    • Increased risk of secondary leukemia
  • Bleomycin is directly responsible for:
    • Pulmonary damage


Chronic graft versus host disease (cGvHD):

cGvHD affects many organs, but the major targets are:


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