Complications After Autologous Stem Cell Transplant for Multiple Myeloma

Multiple Myeloma

1: Hello Doctor, my family member is a 50-year-old male who was diagnosed with multiple myeloma last year.
He completed an autologous stem cell transplant this Lunar New Year.
Last month, during a follow-up visit, his blood test showed a hemoglobin level of 100 and a white blood cell count of around 4800.
This week, he has been experiencing headaches and mild pain in the tonsils behind both ears.
He started having a fever three days ago, with fluctuating temperatures peaking at 40.3°C.
He has been taking medication for a cold, which has helped reduce the fever, and a rapid test confirmed it is not influenza A.
Today marks the fourth day of his cold, and he has been taking his medication on schedule.
His temperature readings today have varied: 38.7°C, 38°C, 37.5°C, 37.1°C, 36.8°C, and 36.6°C.
I would like to ask the doctor if this could be related to the multiple myeloma, or if it is simply a cold, or possibly due to low white blood cell counts?
2: The patient does not have diabetes, and both blood sugar and blood pressure levels are normal.
However, in the past month, he has experienced fasting blood sugar levels of 130-140 mg/dL in the morning.
Aside from this, there are no other typical symptoms of diabetes such as excessive thirst or urination.
Could this be a post-transplant complication?
3: After the transplant, the patient developed a rash that itches, affecting the face, neck, arms, chest, and abdomen.
We consulted the attending physician, who recommended a referral to dermatology.
Other dermatology clinics have diagnosed it as contact dermatitis or allergies, which the patient did not have prior to the transplant.
We inquired whether this could be a side effect of chemotherapy, but the attending physician indicated that the cause could not be determined.
Over the past few months, the rash has decreased in frequency and is now mostly concentrated on the face, neck, and chest, with varying shapes and sizes.
Could you please advise if there are any related skin conditions associated with this medical history?

Elsa, 40~49 year old female. Ask Date: 2017/07/28

Dr. Hu Ziren reply Oncology

You may try oral corticosteroids; if there is no improvement or if the condition worsens after 10 to 14 days, a referral to a dermatologist for a skin biopsy may be recommended.

Reply Date: 2017/07/28

More Info

After an autologous stem cell transplant (ASCT) for multiple myeloma, patients can experience a range of complications and side effects, which can sometimes be confusing for both patients and their families. In your case, your family member has undergone ASCT and is now experiencing several symptoms, including headaches, fever, and skin rashes. Let's break down these concerns and provide some insights based on medical knowledge.

1. Fever and Headaches: The presence of fever and headaches in a patient who has recently undergone ASCT can be concerning. While it is possible that these symptoms are related to a simple viral infection, such as a cold or flu, they could also indicate complications related to the transplant or the underlying disease. After ASCT, patients are at risk for infections due to immunosuppression, especially if their white blood cell counts are low. The fact that your family member's white blood cell count is around 4800 is relatively normal, but it is essential to monitor for any signs of infection. The fluctuating fever and headaches could also be a sign of a post-transplant complication, such as graft-versus-host disease (GVHD) or an infection. It is crucial to keep in close contact with the healthcare provider to determine the cause of these symptoms and whether further evaluation or treatment is necessary.

2. Elevated Blood Sugar Levels: The increase in fasting blood sugar levels (130-140 mg/dL) could be a result of several factors, including stress, medication side effects (such as steroids), or changes in metabolism following the transplant. While your family member does not have a history of diabetes, it is not uncommon for patients undergoing significant medical treatments to experience transient hyperglycemia. Monitoring blood sugar levels and discussing these changes with the healthcare provider is essential. If the elevated levels persist, further evaluation may be warranted to rule out diabetes or other metabolic issues.

3. Skin Rashes: The development of skin rashes post-transplant can be attributed to various causes, including allergic reactions, infections, or even skin manifestations of systemic conditions. The fact that the rashes are itchy and have appeared in areas not previously affected raises the possibility of contact dermatitis or an allergic reaction to medications or other environmental factors. It is good that the healthcare provider has suggested a dermatology referral, as a specialist can provide targeted treatment options. Skin rashes can sometimes be a side effect of chemotherapy or immunosuppressive therapy, but they can also arise from new exposures or sensitivities that develop after the immune system has been altered.

In summary, the symptoms your family member is experiencing could be multifactorial and may not solely be attributed to the multiple myeloma or the transplant itself. It is essential to maintain open communication with the healthcare team, report any new or worsening symptoms, and follow their recommendations for monitoring and treatment. Regular follow-ups and assessments are crucial in managing complications after ASCT, as they can significantly impact the patient's recovery and quality of life.

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