Possible Side Effects- Autologous Stem Cell Transplant

What are all of the possible side effects of an autologous stem cell transplant? I had an ASCT in December of 1995. Over the past 30-odd years, I’ve experienced many short-term, long-term, and late-stage side effects.

I research and blog about MM, so I thought I knew about all of the possible side effects of an ASCT. Turns out, based on the list below, that there are lots of side effects that can result from an ASCT that I didn’t know about. I have to say that ChatGPT is a remarkable research tool.

Here is a comprehensive list of possible side effects grouped by category:

🔥 Immediate and Short-Term Side Effects (First Few Weeks Post-Transplant)

1. Hematologic (Blood-related)

Severe neutropenia, anemia, thrombocytopenia (due to marrow ablation)
- Increases risk of:
  - Infections (bacterial, viral, fungal)
  - Fatigue
  - Bleeding or bruising

2. Gastrointestinal

Nausea and vomiting
Mouth sores (mucositis or stomatitis)
Diarrhea
Loss of appetite
Taste changes
Esophagitis
Weight loss and dehydration

3. Infectious

Febrile neutropenia
Reactivation of latent viruses (e.g., herpes simplex, cytomegalovirus)
Opportunistic infections (due to prolonged immune suppression)

4. Fatigue

Often profound and prolonged

5. Skin and Hair

Hair loss (alopecia) from chemotherapy
Rashes or dry skin

6. Organ Toxicities

Liver dysfunction (elevated LFTs, veno-occlusive disease – rare)
Kidney dysfunction
Heart complications (e.g., arrhythmias, heart failure – rare)
Lung toxicity (pneumonitis, especially if prior radiation or lung disease)

🧠 Neurologic and Psychological Effects

Chemo-brain (cognitive dysfunction, memory problems)
Mood disorders (depression, anxiety)
Delirium or confusion (especially during hospitalization)

📉 Intermediate to Long-Term Effects (Weeks to Months or Longer)

1. Delayed Hematologic Recovery

Continued low blood counts for weeks to months
Delayed immune reconstitution (increased risk of infection for ~6–12 months)

2. Secondary Cancers

Small risk of secondary malignancies, including:
- Myelodysplastic syndromes (MDS)
- Acute myeloid leukemia (AML)
- Solid tumors (rare)

3. Fertility Issues

Chemotherapy-induced infertility (often permanent)

4. Endocrine Disorders

Possible thyroid dysfunction
Rare: Adrenal insufficiency

5. Peripheral Neuropathy

More commonly caused by other MM drugs (e.g., bortezomib), but may be worsened

💉 Procedural and Logistical Side Effects

Central line complications (infection, clotting, discomfort)
Stem cell collection issues (low yields, need for multiple sessions)

Summary

Category	Key Side Effects
Hematologic	Low WBC, RBC, platelets; infection, bleeding
GI	Nausea, vomiting, diarrhea, mucositis
Infection	Febrile neutropenia, viral/fungal reactivation
Systemic	Fatigue, fever, organ toxicity
Neurologic	Chemo-brain, confusion, anxiety
Long-term	Secondary cancers, infertility, immune suppression

If the ASCT procedure was lifesaving or even if it gave MM patients a shot at a longer life, I would be the first person to encourage MM patients to risk the side effects discussed. But numerous studies over the years have demonstrated that ASCT does NOT give longer overall survival (OS) to MM patients.

If you would like to learn more about possible therapies to reduce your risk of side effects you can email me at David.PeopleBeatingCancer@gmail.com. Exercise, nutrition, supplementation, etc. have shown the ability to reduce the risk of side effects.

Hang in there,

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Long-term follow-up of BMT CTN 0702 (STaMINA) of postautologous hematopoietic cell transplantation (autoHCT) strategies in the upfront treatment of multiple myeloma (MM).

Background: STaMINA was a phase III trial comparing progression-free survival (PFS) among 758 pts randomized to: 1. second autoHCT then lenalidomide (Len) maintenance (Auto/Auto, n = 247); 2. consolidation with Len/bortezomib/ dexamethasone (RVD) followed by Len maintenance (Auto/RVD, 254); 3.

Len maintenance (Auto/Len, 257). All three arms were similar (Stadtmauer JCO 2018). Len maintenance was designed to continue for 3 years and amended to allow continuation until disease progression through a follow up protocol (07LT, NCT#02322320). We report 6 yr follow up for STaMINA and the results of Len discontinuation beyond 3 years…

Results: Using intent-to-treat (ITT), 6yr PFS and overall survival (OS) was the same among Auto/Auto (43.9%; 73.1%), Auto/RVD (39.7%, 74.9%) and Auto/Len (40.9%, 76.4%)(p = 0.6; p = 0.8). Protocol defined high risk disease, (HR = 1.53, p < 0.0001) and age (p = 0.03) were adverse risks for PFS. In as treated analysis, 6yr PFS were 49.4%, 39.7% and 38.6% for Auto/auto (170), Auto/RVD (222) and Auto/Len (361), respectively (p = 0.01). 6yr PFS in high risk pts as treated analysis were 43.6% and 26% for Auto/auto and Auto/Len, respectively (p = 0.03). Landmark analysis at 38 mo included 215 pts who continued Len maintenance (either on 07LT study or commercial Len) vs. 207 who stopped. Baseline demographics; study arm on 0702, induction pre-autoHCT were similar. Len discontinuation after 38 mo was associated with inferior PFS (79.5% vs. 61% at 5yr; HR = 1.91, p = 0.0004) but similar OS. Incidence of all second primary malignancies (SPM)(81 cases with 43 heme-malignancies) was associated with age.

Conclusions: Long term outcomes are similar using ITT, but as treated analysis suggested a PFS benefit for tandem autoHCT, driven mainly by pts with high risk MM. Len discontinuation even at 38 mo was associated with inferior PFS. Clinical trial information: NCT02322320.

possible side effects of an autologous stem cell transplant possible side effects of an autologous stem cell transplant?

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