Dealing with early side effects

Early side effects

Most of these early problems come from the chemotherapy and/or radiotherapy you had before your transplant but other concerns, such as Graft versus Host Disease (GvHD), could also develop.

Your medical team will be monitoring you every day and will treat any of the side effects you might have.

Some side effects may persist for longer or develop when you are further into your recovery.

Nausea and vomiting

It’s common to feel sick and be sick after your transplant because of your treatment, medication, a possible infection or GvHD. Nausea normally only lasts a week or two for most people. If you struggle with nausea for longer, talk to your transplant team because they might need to change your medication.

Possible treatments – Anti-emetic drugs stop you feeling nauseous. They may be given as tablets, through your central line or as a patch on your skin.

What might help – It’s important to replace lost fluids and stay hydrated. Isotonic drinks or sachets of oral rehydration salts replace lost salts and sugars (electrolytes) that your cells need to stay healthy.  

Diarrhoea

As with nausea, diarrhoea can have many different causes (including GvHD). If diarrhoea occurs for a long time, it can affect how you absorb vitamins and minerals from food, which can lead to weight loss. It’s important to tell your doctor or nurse if you are having diarrhoea.

Possible treatments – Anti-diarrhoeal medication can help but your medical team will be keen to identify the cause of the problem. They might suggest changes to your diet, eating habits or medications.

What might help – Eating plain foods that are easier to digest and keeping hydrated with plenty of fluids.

Sore mouth (mucositis)

Chemotherapy damages the cells in the mucosal lining of your mouth. The skin can break down, which can cause painful ulcers to form inside your mouth and throat.

Ulcers may also form further down your digestive tract, which can cause discomfort and make it difficult to eat certain foods. This normally occurs about a week after treatment and will clear up in a week or two.

Possible treatments – Painkillers and sprays or gels that keep your mouth moist. If you find regular painkillers are not working well enough, your doctor might recommend a continuous infusion of a strong painkiller, such as morphine, given through a small pump into the tissue just under the skin. You will also be encouraged to practise good oral hygiene and use mouthwash. A toothbrush with softer bristles could be more suitable if you have sore gums.

What might help – It will probably be easier to eat softer foods like mashed potato and soup. Ice lollies can help to numb any gum pain and are a good way of taking on extra fluid.

Weight loss and lack of appetite

Food can often taste different after chemotherapy and you might find that you don’t have the same appetite for food as you did before. If you also experience prolonged sickness and diarrhoea, it could stop you getting the nutrients and energy needed for your recovery.

Possible treatments – Your weight will be monitored by your medical team regularly. You may see a dietician who can advise on how to increase your nutritional intake and give you supplement drinks or soups.  However, if problems persist, you may need to be fed via a feeding tube. There are two possible types that provide nutrition in slightly different ways.

• Enteral nutrition – When nutrition is passed through a small tube directly into your stomach. This will most likely be a nasogastric tube, inserted through your nose and down your throat. It will probably stay in for a few weeks or until your condition improves. These tubes help patients who have sore mouths or find swallowing difficult.  

• Parenteral nutrition – When nutrition is delivered directly into your bloodstream through your central line. It will be administered by your nurse and then your line will be cleaned to reduce the risk of infection. This option is often used if you experience severe GvHD in your digestive tract or if it’s very difficult to keep any food or drink down. 

More information on feeding tubes is available from Cancer Research UK.

What might help –  Try changing your eating habits or the types of food you eat. Eating smaller amounts of plain foods more often and drinking flavoured water could be an easier option.

Our diet section has more information and advice on eating well after your transplant.

Fatigue

When we talk about fatigue, we don’t just mean feeling tired after hard work. Fatigue is when you find it difficult to concentrate and have no energy, even after lots of rest and a good night’s sleep.

Fatigue can be a short-term effect of your treatment that improves after a few months, but some patients experience it more than a year after their transplant. As surprising as it sounds, gentle exercise has been shown to help reduce treatment-related fatigue and improve your strength and energy levels. You will really feel the benefit of doing something, no matter how small.

Possible treatments – Your hospital’s physiotherapist can set up a programme of lite exercises and stretches for you to do daily.

What might help – Keep things in balance, as your energy levels are likely to go up and down. The secret is to not overdo it on a good day but, even more importantly, still try to do something on what might feel like a bad day.

You can find lots of advice in our Managing Fatigue section, including tips on balancing your energy levels and being active.

Some of our patients share their experience of their fatigue after a stem cell transplant in this video.

Risk of infections

In the few weeks after your transplant, your new immune system is still developing. This means that there is a greater risk of picking up an infection. Your medical team will look out for the early signs of an infection, such as a raised temperature, so that you are treated as soon as possible.  

Possible treatments –  You will be given a course of antibiotics, anti-fungal or anti-viral drugs depending on the cause of your infection.

What might help – The protective isolation ward you are staying in will have measures in place to reduce the risk of infection. This includes air filters, alcohol gel hand washes, daily bedding changes and regular cleaning. 

Other concerns

Some patients develop other complications such as liver and kidney problems. More information is available in our guide The Seven Steps: The Next Steps (PDF 480KB).