What Are The Long-Term Side Effects of Autologous Stem Cell Transplant?
by Dr. C.D. Buckner M.D. updated 8/2018
There are several long-term or late side effects that result from the chemotherapy and radiation therapy used in autologous stem cell transplant. The frequency and severity of these problems depends on the radiation or chemotherapy used to treat the patient. It is important to have the doctors providing your care explain the specific long-term side effects that can occur with the actual proposed treatment. Some examples of complications you should be aware of include the following:
Cataracts: Cataracts occur in the overwhelming majority of patients who receive total body irradiation in their treatment regimen. In patients who receive chemotherapy without total body irradiation, cataracts are much less frequent. The onset of cataracts begins at 18 to 24 months following treatment. Patients who have received large doses of steroids will have an increased frequency and earlier onset of cataracts. Patients are advised to have slit lamp eye evaluations annually with early correction with artificial lenses.
Infertility: The overwhelming majority of women who receive total body irradiation will be sterile. However, some prepubertal and adolescent females do recover ovulation and menstruation. In patients who receive chemotherapy-only preparative regimens, the incidence of sterility is more variable and more age related (i.e., the older the woman is at the time of treatment, the more likely chemotherapy will produce anovulation). These are important considerations because of the need for hormone replacement. All females should have frequent gynecologic follow-up examinations.
The overwhelming majority of men who receive total body irradiation will become sterile. Sterility is much more variable after chemotherapy-only regimens. Men should have sperm counts performed to determine whether or not sperm are present and should be examined over time, as recovery can occur.
New Cancers: Treatment with chemotherapy and radiation therapy is known to increase the risk of developing a new cancer. These are called “secondary cancers” and may occur as a late complication of high-dose chemotherapy. For patients with breast cancer treated with high-dose chemotherapy, the risk of developing a secondary cancer has been reported to be less than 2 percent. Patients with lymphoma treated with high-dose chemotherapy and autologous stem cell transplant appear to have about an 8 to 10 percent chance of developing a secondary cancer if treated with total body irradiation and 2 to 4 percent if treated with high-dose chemotherapy and no radiation. Patients with lymphoma treated with conventional chemotherapy have also been reported to have a 4 to 8 percent risk of developing a secondary cancer. How much additional risk occurs from high-dose chemotherapy is unclear; however, high-dose radiation clearly increases the risk of developing a secondary cancer.
High-dose chemotherapy and autologous stem cell transplant is increasingly used to treat certain cancers because it improves cure rates. Patients should be aware of the risk of secondary cancer following high-dose chemotherapy treatment and discuss the benefits and risks of high-dose chemotherapy with their primary cancer physician.