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Non-Hodgkin lymphoma

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Potential side effects of biological therapy for non-Hodgkin lymphoma

Side effects can occur with any type of treatment for non-Hodgkin lymphoma (NHL), but not everyone has them or experiences them in the same way. Side effects of biological therapy will depend mainly on:

  • the type of drug(s)
  • the dose
  • the person's overall health

Side effects can happen any time during biological therapy. Some may happen during, immediately after or a few days or weeks after biological therapy. Most side effects go away after biological therapy is over. Late side effects can occur months or years after biological therapy. Some side effects may last a long time or be permanent.

It is important to report side effects to the healthcare team. Doctors may also grade (measure) how severe certain side effects are. Sometimes biological therapy needs to be adjusted if side effects are severe.

Flu-like symptoms

Flu-like symptoms are a common side effect of biological therapy drugs used to treat non-Hodgkin lymphoma (NHL). Symptoms include:

  • chills
  • fever
  • muscle or joint aches
  • nausea
  • tiredness or fatigue
  • headache

These symptoms often occur right after treatment, but lessen with time. Flu-like symptoms usually go away with continued therapy, once the body gets used to the drug. Other medications, such as acetaminophen (Tylenol), can help reduce these side effects. People should check with their doctor or the healthcare team if these symptoms persist or are bothersome.

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Nausea, vomiting and diarrhea

Nausea and vomiting can occur after treatment with most of the biological therapy drugs used for NHL. These side effects can last for a few days after the drugs are given. Doctors may prescribe medications for nausea and vomiting.

Diarrhea occasionally happens with biological therapy drugs. This is usually a short-term problem. Changes in diet and medications can be used to control diarrhea.

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Allergic reactions

Allergic reactions can occur with rituximab (Rituxan), ibritumomab (Zevalin) and alemtuzumab (Campath). An allergic reaction usually happens shortly after the drug is given for the first time. An antihistamine, like diphenhydramine (Benadryl), acetaminophen (Tylenol) and other drugs are often given before biological therapy drugs to decrease the chance of an allergic or hypersensitivity reaction. People receiving biological therapy drugs should report any difficulty breathing, shortness of breath, cough, rash, skin flushing, itchy skin, or throat or chest tightness to the healthcare team right away.

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Bone marrow suppression

Bone marrow suppression occurs mostly with the radioimmunoconjugate drug ibritumomab because of the radioactive substance attached to it. Bone marrow suppression can also occur with rituximab, alemtuzumab and interferon, although the effects may not be as severe. This can lead to:

  • infection caused by low white blood cell count (neutropenia)
    • Because of the increased risk of infection with some of these drugs, antibiotic or antiviral medications may be given to help prevent infections.
  • bruising and bleeding caused by low platelet count (thrombocytopenia)
  • fatigue, paleness and malaisemalaiseA general feeling of discomfort or illness. caused by low red blood cell count (anemia)

Blood counts usually recover on their own a few weeks after treatment is completed.

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Change in blood pressure

A person's blood pressure may change (more commonly it decreases rather than increases) and the person may feel lightheaded or dizzy after being given biological therapy drugs for NHL. This is not a common side effect. Blood pressure is monitored, especially when the drug is first started. Getting up slowly may help prevent dizziness and people should not drive a car or operate any machinery or tools if they feel dizzy. Report dizziness that occurs when standing or getting up or if it becomes bothersome.

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Heart problems

Shortness of breath, cough, swelling of feet or hands, and a fast or irregular heartbeat are uncommon side effects, but they can occur with many of the biological therapy drugs used to treat NHL. These may signal a heart problem because of a biological therapy drug and should be reported to the healthcare team right away.

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Second cancers

Although uncommon, there is some risk for developing myelodysplastic syndrome (bone marrow failure) or a second cancer, such as leukemia, as a late effect of the biological therapy drug ibritumomab. This risk is because this drug contains radioactive substances.

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Note: Other side effects may occur.  For more detailed information on specific drugs, go to sources of drug information.


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