Despite you and your doctors’ best efforts, sometimes transplant does not work. Your body may not accept the donated cells, or the disease may return. If the transplant doesn’t work, it is normal to have feelings of anger and grief. But remember that it is not your fault, and there may be other treatment options available for you. Your health care team will continue to care for you and offer you and your family support and guidance. Your doctor will talk to you about other treatment options. You are not alone.
Transplant may not work because of:
The cells you get during your transplant are called a graft. Graft failure occurs when the new cells do not make the new white blood cells, red blood cells, and platelets you need. This is also called “failure to engraft” or “non-engraftment”.
Graft failure is a serious but uncommon complication. Certain factors can increase a patient’s risk of graft failure. These factors include:
- A transplant where the number of donor cells available were limited, such as cord blood transplants
- A transplant using mismatched donor cells
- A transplant using T-cell depleted marrow. Sometimes doctors use T-cell depleted marrow to reduce a patient’s risk of graft-versus-host disease (GVHD) after transplant.
Potential treatment options for graft failure
The most common treatment for graft failure is another transplant. The second transplant may use cells from the same donor or from a different donor. Patients who have graft failure after a cord blood transplant cannot get more cells from the same cord blood unit. However, doctors may be able to use a different cord blood unit or an adult donor instead.
Other treatment options may include clinical trials, treatment with white blood cells from your donor (donor lymphocyte infusion), or supportive care. Ask your doctor about the different treatment options available to you.
Relapse is the return of a disease after a remission. The goal of transplant is to cure blood and other diseases. However, despite appropriate treatment, sometimes a disease relapses after transplant. Relapse is most common in the first year after transplant and the risk decreases as time passes.
Potential treatment options for relapse
If relapse happens, you have choices. Ask your doctor about other treatment options. These could include clinical trials, more treatment (possibly another transplant), or supportive care.
For more information on relapse, download When Cancer Returns from the National Cancer Institute.
Dealing with grief or loss
If transplant doesn’t work, patients and families may experience feelings of grief or loss. There is no single best way to work through grief. It may be helpful to talk with family, friends, a faith community, social worker or professional counselor to cope with grief. If you or your loved ones need help dealing with grief, talk to your transplant team to find out what resources are available to you.