Debbie, Clinical Nurse Specialist, in hospital with a patient

Early side effects after transplant

During the first few weeks of your recovery, while still in hospital, you’re likely to experience some side effects from your treatment. On this page, we explain some of the side effects and their possible treatments.

What’s on this page?

Why are there early side effects?

Most early side effects come from the chemotherapy or radiotherapy you had in conditioning therapy before your stem cell transplant.

Some side effects may stay for longer or start developing when you‘re further into your recovery, including conditions like graft versus host disease (GvHD).

Your medical team will continue to monitor you every day and treat any side effects you’re experiencing.

Nausea and vomiting

After your transplant, it’s common to feel sick (nausea) and to be sick (vomiting). You might experience this because of:

  • your conditioning treatment
  • your medication
  • a possible infection
  • GvHD.

For most people, nausea normally only lasts a week or two. But if you struggle with nausea for longer, talk to your transplant team – they might need to change your medication.

Possible treatments

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A type of medication called ‘anti-emetic drugs’ can help stop nausea. You might take them as tablets, through your central line, or as a sticky plaster on your skin that contains the medication.

What might help

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It’s important to replace lost fluids and stay hydrated. You can drink isotonic drinks or use rehydration salt sachets to replace the lost salts and sugars your cells need to stay healthy. You might hear these sugars called ‘electrolytes’.

Mary with her family

The cells were starting to take, and everything was looking good, but I was being sick morning, noon and night. I couldn’t keep anything down and I became so weak I couldn’t even stand… They mixed two different drugs, and within two days I’d stopped being sick. I had to start eating again bit by bit

Mary, who had a stem cell transplant to treat acute lymphoblastic leukaemia (ALL)

Diarrhoea

You might have diarrhoea if you’re finding that:

  • you need to poo more often than usual
  • your poo is looser and more runny or watery than usual.

Like nausea, there are lots of different reasons why you might experience diarrhoea. If you have it for a long time, it can affect how well you absorb vitamins and minerals from food, which can lead to weight loss. It’s important to tell your doctor or nurse if you’re having diarrhoea.

Possible treatments

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You might take anti-diarrhoeal medication to help with the symptoms. But your medical team will also want to identify the reason why you’re having diarrhoea. They might take samples to test for infection, or might suggest changes to your diet, eating habits or medications.

You might get tablets to help treat and prevent further diarrhoea. If you’re still in hospital while experiencing diarrhoea, doctors might need to give you medicine through your central line to make sure your body absorbs it.

What might help

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It might help to eat plain foods that are easier to digest. You’ll also need to stay hydrated by drinking plenty of fluids.

For more information about treating diarrhoea, visit the Cancer Research UK website.

Sore mouth (mucositis)

Chemotherapy can damage the cells inside your mouth, which you might hear called the ‘mucosal lining’. When this skin breaks down, painful ulcers can form inside your mouth and throat, as well as a dry or sore mouth. You might hear this called ‘mucositis’.

Ulcers may also form further down your digestive tract, which means the organs where food and drink travel through your body. This can cause discomfort and make it difficult to eat certain foods.

You might experience this within the first couple of weeks of conditioning therapy starting, but it usually clears up in a week or two.

Possible treatments

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You can use sprays or gels that keep your mouth moist, as well as taking painkillers. If you find regular painkillers aren’t working well enough, your doctor might recommend a continuous infusion of a strong painkiller, like morphine.

Doctors will give you stronger painkillers through a small pump into the tissue just under the skin, which you might hear called a ‘subcutaneous’ pump. With a small needle, this is usually placed into the skin on your abdomen, back of your upper arm or upper leg.

It’s also important to practise good oral hygiene and use mouthwash. A toothbrush with softer bristles might feel better if you have sore gums.

What might help

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You’ll probably find it easier to eat softer foods like mashed potato and soups. Ice lollies can help to numb any gum pain, plus they’re a good way of getting extra fluid.

Weight loss and lack of appetite

After chemotherapy, you might find that:

  • foods taste different than before
  • you don’t have the same appetite for food as you did before.

If you also experience sickness and diarrhoea for a long time, it could stop you getting the nutrients and energy needed for recovery. For the same reasons, it could also lead to weight loss.

Possible treatments

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Your medical team will regularly monitor your weight. You may also see a dietician who can advise on how to increase your nutrients and might give you supplement drinks or soups.

However, if the problems don’t go away, doctors might need to make sure you get the right nutrients by using a feeding tube. There are two different types of feeding tube:

  1. Enteral nutrition - Nutrition comes through a small tube directly into your stomach. This is usually a ‘nasogastric’ tube, which means inserted through your nose and down your throat. You’ll probably have this for a few weeks or until your condition improves. These tubes also help if you have a sore mouth or find it difficult to swallow.  
  2. Parenteral nutrition – Nutrition is delivered directly into your bloodstream through your central line. Your nurse will do this procedure and then clean your line to reduce the risk of infection. People often get parenteral nutrition in cases of severe GvHD in the digestive tract, or if it’s very difficult to keep any food or drink down.

For more information on feeding tubes, visit the Cancer Research UK website.

What might help

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You might find it helps to:

  • change your eating habits
  • change the types of food you eat
  • eat smaller amounts of plain foods more often
  • drink flavoured water.

For more information and advice on eating well after your transplant, see our page about diet.

In the video below, people share their insights on managing diet after a stem cell transplant.

Fatigue

Fatigue is when you find it hard to concentrate and have no energy, even after lots of rest and a good night’s sleep.

For some people, fatigue can be a short-term side effect that improves after a few months. For other people, fatigue might last more than a year after their transplant.

It might sound surprising, but gentle exercise can help to:

  • reduce treatment-related fatigue
  • improve your strength and energy levels.

You might really feel the benefit of doing something, no matter how small.

Possible treatments

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While there are no specific medications to treat fatigue, there are some ways to manage it. For example, your physiotherapist in hospital might set up a programme of gentle exercises and stretches for you to do daily.

What might help

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As your energy levels are likely to go up and down:

  • On what feels like a good day, try not to overdo things by exercising too much.
  • On what feels like a bad day, it’s important to still try to do something small to get you moving.

For more information and advice, including tips on balancing your energy levels and being active, see our page on managing fatigue.

In the video below, people share their experiences of fatigue after a stem cell transplant.

Risk of infections

In the few weeks after your transplant, your new immune system is still developing. This means you’re at greater risk of picking up an infection, as well as some infections being harder to fight.

Your medical team will look out for the early signs of infection, like a high temperature, so they can treat you as soon as possible.

Possible treatments

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Depending on the type and cause of your infection, doctors might give you:

  • antibiotics
  • anti-fungal medications
  • anti-viral medications.

You might take medication in different ways depending on the type of infection. Doctors might give you medicine through your central line or as oral antibiotics, which are usually in tablet or capsule form.

What might help

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In your protective isolation ward, there should be measures in place to reduce the risk of infection. These might include:

  • air filters
  • alcohol gel hand washes
  • daily bedding changes
  • thorough and regular cleaning.

Some people develop further complications from infections, such as liver and kidney problems.

For information about long-term recovery, you can read or download our guide The Seven Steps: The Next Steps (PDF 480KB).

Your mental health

While it’s easy to focus on the physical effects of hospital treatment and recovery after a transplant, try not to ignore the effects on your mental wellbeing.

It’s easy to have negative thoughts about your situation and feel anxious about your future. Although these experiences are perfectly normal, they could turn into something more serious – especially if you can’t see close family and friends during your time in protective isolation.

You should talk to your medical team if you:

  • have been feeling very low for two weeks or more
  • can’t find the motivation to do anything, even important tasks
  • feel unable to control your thoughts
  • are feeling much more anxious than usual.

Possible treatments

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Depending on how you’re feeling, you might take medication to help with a developing mental health problem like depression or anxiety.

Another option is talking to a counsellor or doing another type of talking therapy. Your transplant team will be able to refer you if this is something you’d like to try.

What might help

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For tips and advice on looking after your mental health and wellbeing, visit our other pages on:

We have more suggestions for how to cope in our booklet Your Mental Health and Stem Cell Transplant.

If you want to speak to someone more directly, you can apply for the Telephone Emotional Support Service – a service for stem cell transplant patients and family members.

Last updated: 06/09/2024

Next review due: 06/09/2027