Side Effects of Treatment for Diffuse Large B-Cell Lymphoma

Side effects of treatment

● Side effects during treatment Based on the most common treatment, the R-CHOP regimen, let’s look at the possible side effects.

1. Drug-related side effects In the case of rituximab, symptoms such as fever during infusion, flushing of the face, flushing of the chest, and skin rash may occur. These are acute symptoms caused by the body’s hypersensitivity reaction to rituximab, a monoclonal antibody, and are called “infusion-related reactions.” They are usually managed by temporarily stopping the infusion, then restarting it at a slower rate and adding mild supportive medications. Infusion-related reactions to rituximab are generally common during the first cycle, and their frequency and severity decrease significantly from the second cycle onward. However, in a small number of cases, they can cause severe hypersensitivity reactions such as shortness of breath or shock, so the patient’s condition should be closely monitored during rituximab infusion.

Doxorubicin is an anthracycline anticancer drug and is an injectable solution with a reddish color. If some of the injected drug leaks outside the blood vessel, there is a risk of severe damage, including necrosis of the skin exposed to the drug. In some patients, to prevent this kind of side effect, a device called a chemoport, about the size of a coin, is implanted under the skin in the shoulder area, and a procedure is performed so that the injected solution entering the chemoport can be safely administered through the subclavian vein. If you feel pain or discomfort at the injection site when doxorubicin is being infused, you should immediately inform a nurse or other medical staff so that further infusion can be stopped and the condition of the blood vessel can be checked.

2. Infectious side effects due to treatment-induced leukopenia When chemotherapy begins, the drug causes lymphoma cells in the body to die, and at the same time normal white blood cells also decrease in number and function. White blood cells play an immune role in protecting the body from various microorganisms that enter from outside, such as bacteria, viruses, and fungi. In the case of the 3-week-cycle R-CHOP regimen, although there are slight individual differences, the white blood cell count in the blood usually drops significantly for several days starting about 10 to 14 days after each cycle of treatment. Treatments for diffuse large B-cell lymphoma, such as R-CHOP, generally do not cause leukopenia to be as severe or as prolonged as the high-dose chemotherapy used for acute leukemia, so most cases are resolved with appropriate treatment. However, if left unchecked for too long, or in older patients in poor general condition, it can lead to serious consequences.

● Side effects after treatment After treatment is completed, long-term side effects from medication use may appear. Doxorubicin is a drug with cardiac toxicity, but in a person whose heart function has been normal, actual impairment of cardiac function rarely occurs even after six cycles of treatment at the same level as R-CHOP. However, if a large amount of anthracycline agents such as doxorubicin has been administered over multiple sessions, or if heart function was already poor before treatment, heart failure may occur.

Vincristine is a drug that is essential in nearly all lymphoma treatments and can cause characteristic peripheral neuropathy. Even when the same dose of vincristine is used, the degree of peripheral neuropathy varies widely from person to person. If you have diabetes or already have peripheral neuropathy for another reason, discomfort from numbness or tingling in the hands and feet after treatment may be greater. In some cases, peripheral neuropathy worsens during treatment, and vincristine may be omitted in the later part of chemotherapy. Rarely, symptoms may persist for more than two years, but in most cases they gradually improve over time. There are oral medications that can help relieve symptoms, and they can be prescribed, but short-term prescriptions often do not lead to a major effect. If discomfort from numbness or tingling in the hands and feet occurs during or after treatment, consultation with the attending physician is necessary.

So far, I have explained the side effects of treatment for diffuse large B-cell lymphoma. In the next part, we will look at recurrence and metastasis of diffuse large B-cell lymphoma.

Source: Korea Centers for Disease Control and Prevention, National Health Information Portal