What if transplant doesn't work

Sometimes peripheral blood stem cell (PBSC) and bone marrow transplants do not work. Your body may not accept the donated cells. You might hear this called graft rejection or graft failure. Or, the disease may come back (relapse). It’s normal to have feelings of anger and grief if the transplant doesn’t work. It’s important to know that it’s not your fault, and there may be other treatment options available.

For some people, a clinical trial may offer a potential treatment option. If you think you may be eligible or your doctor has recommended exploring other treatment options after an unsuccessful transplant, our Jason Carter Clinical Trials Search and Support program can help you find a clinical trial.

Your doctor will talk to you about other treatment options. Remember that you are not alone.

The cells you get during your transplant are called a graft. In a successful transplant, the cells you received start growing and making new, healthy blood cells. This is called engraftment. Graft failure happens when these cells don't make the white blood cells, red blood cells and platelets your body needs. This is also referred to as "failure to engraft."

Graft failure is rare but serious. It may be caused by multiple factors such as infections, drugs (or medications) and your body or your body rejecting the graft.

If graft failure happens, there may be other treatment options. Ask your doctor about your options.

Relapse means your blood disease or cancer has come back after a transplant. It most often occurs within the first year but becomes less likely over time. Late relapse (more than two years after transplant) is possible, but is not common. Even if relapse happens, it doesn't mean you've run out of options.

Relapse risk can depend on your type of disease, overall health and how well the transplant worked.

Your doctor will explain potential next steps, such as joining a clinical trial, having more treatment or finding supportive care.

If you've experienced graft rejection, graft failure or relapse, you're not alone—and you're not without options. Your medical team will help you decide what comes next based on your health, type of disease and previous response to treatment.

Another transplant is the most common treatment for graft failure. A second transplant may use:

• Cells from the same donor
• Cells from a different donor
• A different cord blood unit or an adult donor if you had a cord blood unit. That’s because you can’t get more cells from the same cord blood unit.

Other treatment options may include clinical trials, treatment with white blood cells from your donor (donor lymphocyte infusion) and supportive care. Ask your doctor about your options.

If your disease comes back, your doctor might recommend:

• A clinical trial
• More treatment, like chemotherapy or CAR-T cell therapy
• Supportive care

These decisions are highly personal and should be made in collaboration with your transplant team, who will help weigh the risks and potential benefits.