POSSIBLE SIDE EFFECTS
MARROW ALLOGRAFTS
WHAT ARE THE SIDE EFFECTS ?
Allograft complications are always possible, although the technique is well codified. In multiple myeloma, the "mini-graft" technique is often used, which reduces the risks. The main complications of this type of transplant are:
- Bacterial, fungal and viral infectious complications (cytomegalovirus, VZH, HHV6).
- Venous thrombosis, in particular of the vessels of the spleen and the liver, which can result in jaundice and effusions of liquids in the belly or ascites.
- A disease of the graft versus the recipient ( GVHD for G raft- V ersus - H ost - D isease ). It evolves in two phases. The acute phase results in skin lesions, liver damage and diarrhea. The chronic phase (6 months after the transplant) which results in a table of system disease.
CONSTRAINTS OF THE ALLOGraft
From the transplant to six months, it is better not to go far from the transplant center because of the risk of infection and possible flare-ups of acute GVHD.
From six months to a year, you must keep "a thread in the paw" with your transplant center. During this period you run the risk of:
- Contracting a common seasonal viral infection
- Declare a shingles
As a result, a number of situations must be avoided, at all costs, such as:
- Go in crowds and in polluted places
- Take public transport
- Swimming in the sea or in the pool
- Have unprotected sex
It should not be forgotten that exposure to the sun is prohibited for at least 2 years if you have had GVHD because exposure to the sun can trigger a new outbreak of the disease.
AUTOGRAFTS
The immediate complications are not serious (infections, mucositis and digestive disorders) and especially related to chemotherapy and are quickly resolved.
In the longer term, the risk of developing a myelodysplastic syndrome is not zero.
CHEMOTHERAPY AND CORTICOSTEROID THERAPY
FOR CONVENTIONAL CHEMOTHERAPY The main adverse effects Most often encountered are:
- Nausea, vomiting, diarrhea
- Fatigue or asthenia
- Hair loss (alopecia) or body hair
- Neurological disorders such as peripheral neuropathies and/or hearing disorders (tinnitus, hearing loss - hypoacusis)
- An increased risk of deep vein thrombosis (phlebitis)
FOR CORTICOTHERAPY
In the event of corticosteroid therapy, complications such as diabetes mellitus, sodium retention with weight gain, muscle loss (amyotrophy), psychic disorders (excitability or depression, etc.) may be observed especially in the elderly. Diabetic decompensation is possible and increased monitoring is required.
FOR THALIDOMIDE
The teratogenic risk
In the event of administration of thalidomide, precise monitoring is necessary because the risk of teratogenicity is increased, causing serious congenital anomalies, potentially lethal in the unborn child after exposure during pregnancy.
Therefore, thalidomide should never be used in pregnant women or women who may be pregnant, unless all the conditions of the pregnancy prevention program are met.
Pregnancy prevention program requirements must be met by all patients, and apply to both males and females .
Other possible side effects
The risk of deep vein thrombosis and pulmonary embolism is increased by thalidomide.
The risk of peripheral neuropathies is increased and the toxicity is cumulative.
One can also observe constipation and drowsiness and therefore, taking
medication is recommended in the evening.
Lenalidomide
This molecule being structurally close to thalidomide, a pregnancy prevention program is also necessary.
THE RISK OF INFECTIOUS
A risk of bacterial or viral infection exists because most treatments, chemotherapy, targeted therapies and corticosteroids, can lead to episodes of neutropenia (decrease in the number of white blood cells) or even febrile neutropenia
IN BRIEF, THE MAIN TOXICITIES OF TARGETED THERAPIES
| imids | Side effects |
|---|---|
| Thalidomide | neuropathies, drowsiness, constipation, venous thrombosis, hypotension |
| Lenalomide | less common neuropathies, thrombocytopenia, neutropenia, venous thrombosis |
| Bortezomid | fatigue, neutropenia (mechanisms different from lenalomid), digestive disorders, shingles |
THE IMPACT ON FERTILITY
Some chemotherapies used can decrease fertility. In any case, the doctor who prescribes the chemotherapy will inform you in detail about these issues.
It is always possible to collect sperm or eggs before starting treatment and store them frozen for use several years later. This is managed by the Centers for the Study and Conservation of Eggs and Human Sperm ( CECOS ).
Comments
Post a Comment