From the Guidelines
Allogeneic bone marrow transplantation is associated with significant complications, including graft-versus-host disease (GVHD), infections, graft failure, organ toxicity, veno-occlusive disease, secondary malignancies, and infertility, which can be serious and potentially life-threatening. The main complications include:
- Graft-versus-host disease (GVHD): This occurs when donor immune cells attack the recipient's tissues, typically affecting the skin, liver, and gastrointestinal tract, as noted in a study published in 2000 1.
- Infections: Due to immunosuppression, patients are at high risk for bacterial, viral, and fungal infections, with common pathogens including cytomegalovirus, Aspergillus, and Pneumocystis jirovecii, as highlighted in a guideline published in 2020 1.
- Graft failure: The transplanted stem cells may fail to engraft or be rejected by the recipient's immune system.
- Organ toxicity: Chemotherapy and radiation used in conditioning regimens can damage various organs, including the liver, lungs, and heart.
- Veno-occlusive disease: This liver complication can lead to hepatic dysfunction and multi-organ failure.
- Secondary malignancies: There's an increased risk of developing new cancers, particularly lymphomas and skin cancers.
- Infertility: The high-dose chemotherapy and radiation can impair fertility in both men and women.
To manage these complications, patients require close monitoring, prophylactic medications, and prompt treatment of emerging issues, as recommended in a guideline published in 2020 1. Immunosuppressive drugs like cyclosporine or tacrolimus are used to prevent GVHD, while antimicrobial prophylaxis is essential to prevent infections, as noted in a study published in 2005 1. Long-term follow-up is crucial to detect and manage late complications, which can occur after the first 100 days post-transplantation, including infections, late radiation-related toxicities, and secondary malignancies, as highlighted in a study published in 2020 1.
From the FDA Drug Label
- 2 Graft versus Host Disease In clinical studies with RETHYMIC, GVHD occurred in 11 (10%) RETHYMIC-treated patients of whom 6 (55%) died. RETHYMIC may cause or exacerbate pre-existing GVHD. Seven patients (7%) experienced autologous GVHD, 3 patients (3%) experienced GVHD due to maternal cells and 1 patient (1%) experienced GVHD due to cells from a prior hematopoietic cell transplant (HCT)
The complications associated with allogenic bone marrow transplantation include Graft versus Host Disease (GVHD), which may manifest as fever, rash, lymphadenopathy, elevated bilirubin and liver enzymes, enteritis, and/or diarrhea 2.
- GVHD occurred in 10% of patients, with 55% of those cases being fatal
- Risk factors for GVHD include atypical complete DiGeorge anomaly phenotype, prior HCT, and maternal engraftment
- Autoimmune disorders may also occur, including thrombocytopenia, neutropenia, proteinuria, hemolytic anemia, alopecia, hypothyroidism, autoimmune hepatitis, and autoimmune arthritis
- Renal impairment and cytomegalovirus infection are also considered risk factors for complications
- Patients may be at risk of developing post-treatment lymphoproliferative disorder (blood cancer) due to underlying immune deficiency
- Transmission of serious infections and transmissible infectious diseases may occur due to the use of human tissue in the transplantation process 2.
From the Research
Complications of Allogenic Bone Marrow Transplantation
The complications associated with allogenic bone marrow transplantation can be severe and life-threatening. Some of the complications include:
- Nonmalignant organ or tissue dysfunction 3
- Changes in quality of life 3
- Infections related to delayed or abnormal immune reconstitution 3
- Secondary cancers 3
- Graft-versus-host disease (GVHD), which can be acute or chronic 4, 5, 6
Graft-Versus-Host Disease (GVHD)
GVHD is a major complication of allogenic bone marrow transplantation, resulting in considerable morbidity and mortality 4. It can be acute or chronic, with different clinical manifestations and pathobiological mechanisms. Acute GVHD usually occurs within 2 to 6 weeks after transplantation and affects the skin, liver, and gastrointestinal tract 4, 6. Chronic GVHD involves a wider range of organs and can cause scleroderma, liver failure, immune complex disease, glomerulonephritis, and autoantibody formation 4, 5.
Other Complications
Other complications of allogenic bone marrow transplantation include:
Management and Treatment
The management and treatment of these complications are crucial to improving patient outcomes. This includes preventive measures, such as prophylactic immunosuppressive drugs, and treatment of acute and chronic GVHD with steroids and other medications 5, 6.