Complications of Transplant
Some children sail through transplant with no problems. Others experience one crisis after another.
Some children live well and never look back. Some die from transplant complications and some die from relapse of their cancer.
Children are unique individuals. Doctors cannot predict who will do well and who will have problems. Nor can they tell whether a simple complication will become a life-threatening situation.
Super high dose chemotherapy destroys the immune system while killing remaining cancer cells in the body. Transplanted stem cells or marrow engraft and “rescue” the child.
Until this happens, your child will be at very high risk of developing infections.
Most transplant related infections arise from bacteria inside the body. Frequent hand washing, controlled ventilation, and wearing gowns, gloves and particulate masks can minimize the risk of transmitting infections.
Antibiotics are prescribed for up to a year after transplant to protect against bacterial infections. High dose antibiotics will be given if your child’s oral temperature rises above 38°C (100.4°F) in the first month after transplant. However, caution is needed as antibiotics can cause fungal infection to thrive.
Viral infections become a risk about 3-4 weeks after transplant. They do not respond to antibiotics. Many transplant protocols include preventive acyclovir, granciclovir or immunoglobulin as viruses are extremely difficult to eradicate.
Cytomegalovirus (CMV) is uncommon if the child is CMV negative. The virus can also be prevented by transfusing CMV negative or filtered blood products.
Prevention is the best approach.
Veno-Occlusive Disease (VOD)
Rarely, super high-dose chemotherapy given before transplant can cause blood vessels in the liver to become swollen and blocked, restricting blood flow. This may develop slowly or have a very sudden onset. The risk of VOD is higher in children who have already had a transplant or who have serious liver problems.
Symptoms include swelling and tenderness in the upper right abdomen (where the liver is located), unexplained weight gain, jaundice (yellowing of the skin and eyes), and rarely, fluid in the abdomen, known as ascites.
The liver won’t work as well as usual. Treatment supports the liver until it has recovered naturally.
Treatment includes restricting fluid intake, diuretics (which increase urination to eliminate excess fluid from the body), anti-clotting medications to thin the blood, and removal of all but the most essential amino acids from IV nutrition (hyperalimentation).
Sometimes, the infused stem cells don’t work properly and the bone marrow fails to produce enough new blood cells. This is called graft failure and can lead to repeated infections, bruising, bleeding and anaemia.
Total graft failure is rare, but if it does happen, a second infusion of stem cells will be needed. This is why more stem cells or marrow are collected than are needed for one transplant. Without a second transplant, a child with total graft failure will live for only a short time.