You’ve likely already managed side effects from induction therapy, but high-dose melphalan used in an autologous stem cell transplant (ASCT) can cause more severe and long-lasting effects. While side effects vary, knowing what to expect and how to manage them can help you navigate recovery. 

Your transplant team has extensive experience in managing these issues, so reach out to them with any concerns—even minor discomforts should be addressed early.

Most side effects don’t appear immediately but tend to worsen around 10 days post-transplant, then gradually improve over several weeks. Below are some of the most common long term side effects: 

Fatigue

• Prioritize daily movement, even gentle walks.
• Stick to a consistent sleep schedule and avoid overexertion.
• If fatigue worsens despite exercise and nutrition, consult your doctor for other causes.

Insomnia

• Take steroids in the morning to reduce nighttime wakefulness.
• Establish a bedtime routine and limit screen time before bed.
• Consider meditation, relaxation techniques, or melatonin if sleep issues persist. 

Joint & Bone Pain

• Many patients experience pain due to chemotherapy, steroids, or pre-existing bone damage.
• Over-the-counter pain relievers (acetaminophen, NSAIDs) may help, but consult your doctor first.
• Physical therapy and gentle stretching can improve mobility.
• If spinal compression fractures occur, an orthopedic referral may be needed.

Neuropathy (Nerve Pain in Hands & Feet)

• Commonly caused by chemotherapy, resulting in tingling, numbness, or burning pain.
• Medications like gabapentin (Neurontin) or pregabalin (Lyrica) may help.
• Vitamin B12, B6, or alpha-lipoic acid supplements may provide relief.
• Massage therapy, acupuncture, and proper footwear can reduce discomfort.
• Discuss with your doctor if neuropathy worsens.