The benefits of treatment are different for each person. For some people, chemotherapy can help stop the cancer coming back. For others, it can help control the cancer and ease its symptoms.
Your doctor will talk to you about the treatment that is right for you. This may be chemotherapy, another treatment, or a combination of treatments. If you have any questions, please ask your doctor or nurse. They will be happy to help.
You may also find the booklet ‘SACT, a guide’ helpful. It explains systemic anti-cancer therapy and the possible side effects in more detail.
Your treatment
Your doctor or nurse clinician has prescribed an immunotherapy treatment called obinutuzumab. The treatment can be given in a number of ways, including on its own or with chemotherapy as part of your lymphoma treatment. The treatment consists of the following:
On day 1 of each cycle, obinutuzumab is given through an infusion (drip) over a few hours. Each cycle lasts either 21 or 28 days, depending on whether it is given along with chemotherapy treatment.
For the first cycle only, when given in combination with chemotherapy, it is also given on day 8 and day 15.
You will have a routine blood test and medical review before the start of each cycle of treatment. This is so your team can monitor and manage any side effects as well as assess your response to treatment. Occasionally we may not be able to go ahead with your treatment until your blood counts are back to a safe level. If this happens, your treatment may be delayed.
Before you have your treatment with obinutuzumab, you will be given 2 paracetamol tablets and an intravenous (into the vein) antihistamine injection. These can help prevent any immediate allergic reactions.
If you are taking any other medicines
It is important to tell the doctor if you are taking medicine for any other condition such as high blood pressure. Some medicines can react with obinutuzumab (either weakening or strengthening the effect), so always tell your doctor about any other medicines or tablets you are taking.
This treatment can have serious or possibly life-threatening side effects. It is very important that you report side effects straight away. Don’t delay, if you feel unwell, please ring The Christie Hotline on 0161 446 3658. The lines are open 24 hours a day.
Increased risk of serious infection
You are vulnerable to infection while you are having treatment. Minor infections can become life-threatening in a matter of hours if left untreated.
Symptoms of infection include fever, shivering, sweats, sore throat, diarrhoea, discomfort when you pass urine, cough or breathlessness. We recommend that you use a digital thermometer so you can check your temperature. You can buy one from your local chemist.
If you feel unwell, you have symptoms of an infection or your temperature is 37.5ºC or above, or below 36ºC contact The Christie Hotline straight away.
Hepatitis B
You must tell your doctor at The Christie before starting obinutuzumab if you have previously been diagnosed with Hepatitis B. Speak to your doctor if you wish to discuss this further.
Possible side effects
Obinutuzumab can cause many different side effects. Some are more likely to occur than others. Everyone is different and not everyone gets all the side effects. Most side effects are usually temporary, but in some rare cases they can be life-threatening.
It is important to tell your hospital doctor or nurse about any side effects so they can be monitored and, where possible, treated. The side effects listed below relate to treatment with obinutuzumab alone.
If you are having obinutuzumab in combination with chemotherapy, we will give you information about possible side effects of the chemotherapy drugs you are having.
Common side effects (more than 1 in 10)
Infusion related reactions
The side effects of obinutuzumab can including chills, fever and shivering. If you have any of these side effects please tell your nurse straightaway. However, you will be monitored regularly.
Rarely, you may also develop a headache or sickness. If this happens or you notice any swelling around the eyes and face, feel dizzy or faint, or have any shortness of breath during the infusion, please tell the nurse or doctor immediately. This may be an allergic reaction and they may need to slow down or stop the drip.
You may feel tired and have a headache. These symptoms are related to your treatment and usually go when the infusion has finished. If you do not have any reactions to your first treatment, future abinutuzumab infusions may be given over a shorter period of time.
Fatigue (tiredness)
This treatment may make you feel tired and lacking in energy. It can be frustrating when you feel unable to cope with routine tasks. If you do feel tired, take rest and get help with household chores. If necessary, take time off work. Gentle exercise such as walking can be helpful.
Anaemia (low number of red blood cells)
While having this treatment you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these symptoms are a problem. You may need a blood transfusion.
Bruising or bleeding
This treatment can reduce the production of platelets which help the blood clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, bloodspots or rashes on the skin, bleeding gums or blood in your urine or stools. You may need a platelet transfusion.
Changes to kidney and bladder function
Obinutuzumab can cause changes to your kidney function. Your kidney function will be monitored with your routine blood tests. Drink plenty of fluids to prevent dehydration.
You may also experience changes to your bladder function. Tell your doctor or nurse if you notice any changes to the frequency you pass urine, if you notice any blood in your urine or you have any urinary incontinence.
Diarrhoea
Diarrhoea is a common side effect of your treatment. If you have watery diarrhoea and if the diarrhoea persists for more than 24 hours, contact The Christie Hotline on 0161 446 3658.
However, you must contact The Hotline straight away if:
you have a temperature/fever as well as diarrhoea
you have nausea/vomiting as well as diarrhoea
you still have diarrhoea after 48 hours.
Constipation
You may become constipated. Try to drink plenty of fluids and eat foods which are high in fibre. Tell your clinical team who may prescribe a suitable laxative. Please contact The Christie Hotline if your constipation lasts more than 3 days, or you experience pain in your tummy.
Uncommon infections
Obinutuzumab causes immune suppression and can increase the risk of uncommon or unusual infections such as chest infections and bladder infections. Your doctor will discuss this side effect before you start treatment.
Hair thinning
The hair on your head could become thinner, but you are unlikely to lose all the hair. Please remember that this is a temporary side effect and your hair will grow back when your treatment is completed. Very rarely, hair loss can be permanent.
The cancer information centre offers a coping with hair loss service to all patients where support, information and advice will be given. Drop in, contact 0161 446 8100 or email the-christie.informationcentre@nhs.net.
Information about the wig service can also be found here and vouchers for wigs can also be obtained for eligible patients. The wig room provides a drop in service.
The Maggie’s Centre can support you with hair loss by helping you consider the practicalities as well as the emotional impact. You can call into Maggie’s Monday to Friday, 9am to 5pm to speak with their professional team.
Maggie’s provide expert care and support to everyone with cancer and those who love them. Contact Maggie’s on 0161 641 4848 or email manchester@maggies.org
Uncommon side effects (less than 1 in 10)
Tumour lysis syndrome
This treatment may cause the rapid breakdown of lymphoma cells, which may lead to abnormalities in the blood called tumour lysis syndrome. This problem is more likely if you have a lot of disease or if your kidneys do not work as well as they should do. Your doctor will tell you if you are at risk.
You may be given a kidney-protective medicine called allopurinol for the first cycle of treatment, and your doctor may do additional blood tests to monitor this side effect.
We sometimes admit patients for the first treatment to give intravenous fluids and kidney-protective medication and twice daily monitoring of blood tests for 48 hours.
Mood changes
Obinutuzumab can affect your mood. This may result in mood swings and irritability. You may also have difficulty in sleeping. If you experience this side effect and find it hard to tolerate you should discuss it with your nurse or doctor.
Skin
Sometimes as a result of obinutuzumab, you may develop eczema. Ask your doctor for further advice. It may be necessary to use creams to help the discomfort.
Heart function
Obinutuzumab may cause changes in the muscle of the heart, which can affect how the heart works. The effect on the heart depends on the dose given. It is unusual for the heart to be affected if you receive standard doses. Tests to see how well your heart is working will sometimes be carried out before the drug is given.
Eye irritation
You may get a red eye or dry, gritty feeling in your eyes following treatment. If this happens, using hypromellose eye-drops available at any pharmacy, will help to ease the discomfort. If the problem persists, contact The Christie.
Your eyes may also water. This will improve in time and needs no specific treatment.
Flu-like symptoms/fever
Obinutuzumab may cause aching muscles and bones, occasionally high temperatures and night sweats. It can be frustrating when you feel unable to cope with routine tasks.
If you do feel tired, take rest when necessary. Gentle exercise such as walking can be beneficial.
Contact The Christie Hotline if you have a high temperature in order to assess whether this could be related to an infection.
Nose/throat irritation
You may experience some nose and throat irritation, such as sore throat, runny nose and sinusitis. Please tell the doctor or nurse looking after you, they may be able to provide you with some medications that may help.
Rare side effects (less than 1 in 100)
Irritation to the brain
Obinutuzumab can cause irritation to the brain. You may notice some muscle weakness, visual changes, difficulties speaking or pins and needles or numbness. Sometimes people get very drowsy and sleepy or may have visual hallucinations.
Please contact The Christie Hotline if you notice these symptoms. Your doctor or nurse can give you more information about this.
Gastrointestinal perforation
In very rare cases especially where the cancer affects the stomach or bowel, obinutuzumab has caused a hole called a perforation. If you develop sudden severe abdominal pain vomiting blood or notice blood in your stool, please call 999 without delay.
Serious and potentially life-threatening side effects
In a small proportion of patients, this treatment can result in very severe side effects which may rarely result in death. The team caring for you will discuss the risk of these side effects with you.
Sex, contraception and fertility
Sex and contraception
During sex, use a barrier form of contraception, such as condoms, during your chemotherapy treatment. Chemotherapy can harm an unborn baby. This also helps protect your partner from any chemotherapy drugs that may be present in semen or vaginal fluids. If you think you may be pregnant, tell your doctor straight away.
Fertility
This treatment may affect your ability to have children in the future, especially if it is given together with chemotherapy. Your doctor or nurse should have talked to you about this before treatment starts. If they have not, please ask them.
Late side effects
Some side effects may become evident only after a number of years. In reaching any decision with you about treatment, the potential benefit you receive from treatment will be weighed against the risks of serious long term side effects to the heart, lungs, kidneys and bone marrow.
With some drugs there is also a small but definite risk of developing another cancer. If any of these problems specifically applies to you, the doctor will discuss these with you and note this on your consent form.
Contacts
If you have any general questions or concerns about your treatment, please ring:
Haematology day unit – 0161 446 3924
Lymphoma clinical nurse specialists – 0161 446 8573
Your consultant’s secretary:
Professor Linton/Dr Phillips/Dr Gibb/Dr Broadbent/Dr Shotton – 0161 446 3753
Dr Hague/Professor Illidge/Dr Brocklehurst – 0161 446 3332
Dr Harris/Dr Chan – 0161 446 3302
Professor Bloor – 0161 446 3869
Palatine treatment ward – 0161 446 3925
For urgent advice, ring The Christie Hotline on 0161 446 3658 (24 hours a day, 7 days a week)