Potential side effects

Any side effects you have will depend on the type of high-dose treatment you had. Your hospital team will tell you what to expect and what they can do to help.

Possible side effects include increased risk of infection, anaemia and bleeding due to low blood counts. You may also feel sick, have a reduced appetite and a sore mouth. A dietitian and your nurse will help you manage these. You may also lose your hair and feel very tired.

Less common problems include graft failure. This is when the infusion of stem cells does not work and the bone marrow does not produce enough new blood cells. Growth factors may be used to try to stimulate the bone marrow to recover.

You will have regular blood tests, as well as tests to check your general health. Most side effects are worst when your blood count is at its lowest. When your blood count goes up, the side effects will start to improve. When your blood count has reached a safe level, you will be able to go home.

The side effects of high-dose treatment

The side effects you have will depend on the type of high-dose treatment you had. Most side effects are worst when your blood count is at its lowest. This is usually at the end of the first week and throughout the second week after high-dose treatment. When your blood count goes up, the side effects will start to improve. You will be at less risk of infection, your appetite will improve and you will start to feel better.

You will have medicines to prevent or reduce side effects. Always tell your doctor or nurse about any side effects you have. They may be able to change the medicines you are taking to ones which will work better for you. Your hospital team will give you more information about what to expect.


Risk of infection

The number of white blood cells (your neutrophils) will be very low for some time. This is called being neutropenic. Neutrophils are very important in fighting infection.

During this time, you are at risk of infection, even from the normal bacteria that live on your skin and in your digestive system. These bacteria are usually useful to our bodies but can cause infections when your immune system is not working well.

You will be given medicines to prevent and treat infections. Your nurses and doctors will take your temperature regularly and check for signs of infection. They will also ask you to tell them if you have any symptoms that could be a sign of infection. These include:

  • feeling cold and shivery
  • having a sore throat
  • having a cough or runny nose
  • pain when passing urine
  • having diarrhoea.

The hospital staff try to protect you from possible infection. But most people will need antibiotics at some point while their immune system is revovering.

Keeping clean

Your room will be cleaned daily and your sheets changed. In most hospitals, you will have your own toilet and shower.

It is important to keep your skin clean. The nurses will give you advice about showering and washing your hands. They can help you with this if you are tired. They will also explain how to look after your mouth and keep it clean.

Being careful with food

During your time in hospital, there will be rules about what you can eat. This is to help you avoid food that may contain bacteria. Each hospital has its own guidelines. Your nurse or dietitian can explain them to you. The rules may include:

  • Avoid soft cheeses, pâté and unpasteurised foods.
  • Do not eat lightly cooked or uncooked eggs.
  • Wash and peel fruit and vegetables.
  • Hot meals should be freshly prepared and well cooked (not reheated).
  • Avoid probiotic or bio yogurts and drinks.
  • Avoid takeaway foods.

Visitors

Hospitals may have different rules about visitors. You may be restricted to only a few visitors each day. The ward nurses will tell your visitors how to protect you from infections. For example they must wash their hands before going into your room and may be asked to wear a plastic apron. People who feel unwell or have an infection should not visit you.


Anaemia

High-dose treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If there are low levels of red blood cells, you may be tired and breathless. Tell your doctor or nurse if you feel like this. You may need regular blood transfusions until your body starts to make enough red blood cells again.

Irradiated blood

For at least three months after your treatment has finished, you will have irradiated blood or platelets if you need a transfusion. Some people may need to have irradiated blood for the rest of their lives. Your doctor can talk to you about this. You will be given a medical alert card to carry in case you need blood in an emergency or at another hospital.


Bruising and bleeding

High-dose treatment reduces the number of platelets in your blood. You are likely to need transfusions of platelets to reduce the risk of bleeding or bruising. Any platelets you have will be treated with radiation.

Your doctors and nurses will examine you regularly for bruises or little red spots on the skin.

Tell a doctor or nurse straight away if you have:

  • any bruising you can’t explain
  • a nosebleed
  • bleeding gums
  • blood in your stools (bowel motions) or urine.


Feeling sick

High-dose treatment can make you feel sick or sometimes be sick. Your doctor will prescribe anti-sickness (anti-emetic) drugs to prevent or reduce this. Let your doctor or nurse know if your anti-sickness drugs are not helping as there are different types you can try. Anti-sickness medicines can be given as tablets, by injection into your line or port, or under the skin (subcutaneously).


Sore mouth

The treatment can cause a painful throat and mouth ulcers. While your white blood cell count is low, you are also at risk of mouth infections. Keeping your mouth clean is important to prevent infections that can spread to other parts of your body.

The nurses will advise you how to look after your mouth and teeth. Use a soft toothbrush when cleaning your teeth to protect your gums. You will have mouthwashes to use regularly to try to prevent infections. It is common for your mouth to become sore while your blood count is low. Talk to your doctor or nurse, as they can give you some painkillers. These may be given as liquids or as an injection if you are having difficulty swallowing because of pain.


Eating problems

During treatment, it is important you don’t lose too much weight. Try to eat small meals and snacks regularly, even if you don’t have much appetite or if food tastes different. The nurses and dietitian will give you advice.

If you have a sore mouth, eating may be difficult. You may need to have nutritional drinks until you can eat properly again. Sometimes people need to have liquid food through a thin, soft tube that goes down the nose into the stomach (a feeding tube).

Some people may have another type of liquid food that is given through their central line or PICC line. As you start to eat again, the amount of liquid food you are given is gradually reduced.


Diarrhoea

If you have diarrhoea caused by chemotherapy, your doctor can prescribe drugs to control it. Let them know if it is severe or if it does not get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea. If you are not able to drink very much because of a sore mouth, you may be given fluids through a drip (infusion).


Hair loss

This is a common side effect of chemotherapy. You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss. After treatment, it is important to cover your head to protect your scalp when you are out in the sun until your hair has grown back.

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.


Tiredness (fatigue)

You will probably feel extremely tired and spend a lot of time sleeping. Sometimes you may feel too tired to concentrate on reading or even watch television.

At times, you may not feel able to have visitors, or see them for too long. Let them know how you are feeling so they do not disturb you if you want to rest.

Exercise

Even though you are tired, it is a good idea to try to do some gentle exercise, such as stretching. A physiotherapist will show you how. This helps reduce the chances of getting a blood clot, and it keeps your muscles working and toned.

Some transplant units may have an exercise bike that you can use when you are feeling better and your blood counts have improved.

Coping with fatigue

Denton describes how he coped with fatigue (tiredness) during his treatment for prostate cancer.

About our cancer information videos

Coping with fatigue

Denton describes how he coped with fatigue (tiredness) during his treatment for prostate cancer.

About our cancer information videos


Starting to recover

When your blood count has reached a safe level and you are improving, you can go home. You will need some support at home from a relative, friend or partner. The hospital can also arrange some help for you. You will have a 24-hour telephone contact number in case you have any worries. You will need to go back to the hospital regularly as an outpatient for check-ups.

Back to Side effects of high-dose treatment with stem cell support

Less common problems

Graft failure and hepatitis are less common problems of high-dose treatment with stem cell support.