Patient information - Burkitt lymphoma - R-IVAC (rituximab, ifosfamide, etoposide, cytarabine) (2024)

Cycles thereafter:About 3 to 4 hours

Immediate (onset hours to days)

• Allergic reactions are uncommon but can be life threatening.
• If you feel unwell during the infusion or shortly after it, or:
  • get a fever, shivers or shakes
  • feel dizzy, faint, confused or anxious
  • start wheezing or have difficulty breathing
  • have a rash, itch or redness of the face

While you are in hospital: Tell your doctor or nurse immediately.

After you leave: Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department.

• You may have discomfort or a dull ache in your pelvis, back, arms or legs.
• To reduce the pain, take paracetamol before each injection.
• Tell your doctor or nurse as soon as possible if your pain is not controlled.

• You may get a fever, skin rash, aches and pains or increased sweating.
• These symptoms are caused by the drug cytarabine.
• Symptoms usually happen 6 to 12 hours after your dose, and may last until 24 hours after your treatment has finished.
• To reduce any pain or fever, take paracetamol, if needed.
• Don't take aspirin, ibuprofen or other similar anti-inflammatory medications unless your doctor tells you to.
• Tell your doctor or nurse if these symptoms do not get better after 24 hours.

• You may feel:
  • dizzy
  • sleepy
  • confused or agitated.
• You may also get:
  • headaches
  • loss of balance
  • hallucinations
  • seizure (fits).
• These symptoms are caused by the drug ifosfamide.
• If you are being treated as an outpatient, try to have someone stay at home with you during the days that you are having this medicine.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the symptoms listed above.

• This treatment can cause serious injury if it leaks from thearea where it is going into the vein.
• This can cause pain, stinging, swelling or redness at or near the site where the drug enters the vein.
• If not treated correctly, you may get blistering and ulceration.
• Tell your doctor or nurse immediately if you get any of the symptoms listed above during or after treatment.

• You may get:
  • blood in your urine, sometimes with blood clots
  • pain or burning when you urinate
  • the urge to urinate more than normal
  • stomach or pelvic pain or discomfort.
• When you go home, make sure you drink plenty of fluids (unless you are fluid restricted).
• Empty your bladder often.
• Tell your doctor or nurse as soon as possible if you notice any blood in your urine.

• You can take paracetamol if you have a headache.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get a very bad headache that is not helped by pain medication.

• Youmay feel sick (nausea) or be sick (vomit).
• Take your anti-sickness medication as directed even if you don’t feel sick.
• Drink plenty of fluids (unless you are fluid restricted).
• Eat small meals more frequently.
• Try foodthat doesnot require much preparation.
• Try bland foods like dry biscuits or toast.
• Gentle exercise may help with nausea.
• Ask your doctor or nurse for eviQ patient information - Nausea and vomiting during cancer treatment.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have uncontrolled vomiting or feel dizzy or light-headed.

• High doses of cytarabine can affect the nervous system.
• Tell your doctor or nurseimmediately, or go to the nearest hospital Emergency Department if you get any of the following symptoms during or soon after your treatment:
  • dizziness, drowsiness or double vision
  • agitation
  • difficulty walking in a straight line
  • difficulty writing with a pen or pencil
  • jerky movements
  • slow, slurred speech.

• Youmay get:
  • eye pain or irritation
  • blurred vision
  • watery or gritty eyes
  • sensitivity to light.
• You will be given eye drops to help prevent and control these symptoms. It is important to use these eye drops as directed.
• Protect your eyes from the weather (sun and wind) by wearing sunglasses, especially if you have lost your eyelashes.
• Tell your doctor or nurse if you get any of the symptoms listed above.

• You may find that food loses its taste or tastes different.
• These changes are likely to go away with time.
• Do your mouth care regularly.
• Chew on sugar-free gum or eatsugar-free mints.
• Add flavour to your food withsauces and herbs.
• Ask your doctor or nurse for eviQ patient information - Taste and smell changes during cancer treatment.

Early (onset days to weeks)

• This treatment lowers the amount of white blood cells in your body. The type of white blood cells that help to fight infection are called neutrophils. Having low level of neutrophils is called neutropenia. If you have neutropenia, you are at greater risk of getting an infection. It also means that your body can’t fight infections as well as usual. This is a serious side effect, and can be life threatening.
• Wash your hands often.
• Keep a thermometer at home and take your temperature regularly, and if you feel unwell.
• Do your mouth care regularly.
• Inspect your central line site (if you have one) daily for any redness, pus or swelling.
• Limit contact with people who are sick.
• Learn how to recognise the signs of infection.
• Ask your doctor or nurse for eviQ patient information - Infection during cancer treatment.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following signs or symptoms:
  • a temperature of 38°C or higher
  • chills, shivers, sweats or shakes
  • a sore throat or cough
  • uncontrolled diarrhoea
  • shortness of breath
  • a fast heartbeat
  • become unwell even without a temperature.

• This treatment lowers the amount of platelets in your blood. Platelets help your blood to clot. When they are low, you are at an increased risk of bleeding and bruising.
• Try not to bruise or cut yourself.
• Avoid contact sport or vigorous exercise.
• Clear your nose by blowing gently.
• Avoid constipation.
• Brush your teeth with a soft toothbrush.
• Don't take aspirin, ibuprofen or other similar anti-inflammatory medications unless your doctor tells you to.
• Tell your doctor or nurse if you have any bruising or bleeding.
• Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if you have any uncontrolled bleeding.

• You may not feel like eating.
• Try to avoid drinking fluids at meal times.
• Try to eat small meals or snacks regularly throughout the day.
• Try to eat food that is high in protein and calories.
• If you are worried about how much food you can eat, or if you are losing weight, ask to speak to a dietitian.

• You may feel very tired, have no energy, sleep a lot, and not be able to do normal activities or things you enjoy.
• Do not drive or operate machinery if you are feeling tired.
• Nap for short periods (only 1 hour at a time)
• Prioritise your tasks to ensure the best use of your energy.
• Eat a well balanced diet and drink plenty of fluids (unless you are fluid restricted).
• Try some gentle exercise daily.
• Allow your friends and family to help.
• Tell your doctor or nurse if you get any of the symptoms listed above.

• This treatment can cause changes to how your kidneys work.
• You will have blood tests to make sure your kidneys are working properly.
• You may need to drink more fluids while you are having treatment. Your doctor or nurse will tell you if you need to do this.
• Tell your doctor or nurse as soon as possible if you notice that your urine changes colour or you don't need to empty your bladder as often.

• You may have:
  • bleeding gums
  • mouth ulcers
  • a white coating on your tongue
  • pain in the mouth or throat
  • difficulty eating or swallowing.
• Avoid spicy, acidic or crunchy foods and very hot or cold food and drinks.
• Try bland and soft foods.
• Brush your teeth gently with a soft toothbrush after each meal and at bedtime. If you normally floss continue to do so.
• Rinse your mouth after you eat and brush your teeth, using either:
  • 1/4 teaspoon of salt in 1 cup of warm water, or
  • 1/4 teaspoon of bicarbonate of sodain 1 cup of warm water
• Ask your doctor or nurse for eviQ patient information -Mouth and throat problems during cancer treatment.
• Tell your doctor or nurse if you get any of the symptoms listed above.

• You may get a red, bumpy rash and dry, itchy skin.
• Moisturise your skin with a gentle non-perfumed moisturising cream like sorbolene or aqueous cream.
• Do not scratch your skin.
• Protect your skin from the sun by wearing sun-protective clothing, a wide-brimmed hat, sunglasses and sunscreen of SPF 50 or higher.
• Talk to your doctor or nurse about other ways to manage your skin rash.

Late (onset weeks to months)

• Your hair may start to fall out from your head and body.
• Hair loss usually starts 2 to 3 weeks after your first treatment.
• You may become completely bald and your scalp might feel tender.
• Use a gentle shampoo and a soft brush.
• Take care with hair products like hairspray, hair dye, bleaches and perms.
• Protect your scalp from the cold with a hat, scarf or wig.
• Protect your scalp from the sun with a hat or sunscreen of SPF 50 or higher.
• Moisturise your scalp to prevent itching.
• Ask your doctor or nurse about the Look Good Feel Better program

• You may feel dizzy, light-headed, tired and appear more pale than usual.
• Tell your doctor or nurse if you have any of these signs or symptoms. You might need a blood transfusion.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have any chest pain, trouble breathing, or feel like your heart is racing.

• You may notice that you are unable to concentrate, feel unusually disorganised or tired (lethargic) and have trouble with your memory.
• These symptoms usuallyimprove once treatment iscompleted.
• Ask your doctor or nurse for eviQ patient information – Memory changes and chemotherapy (chemo brain).
• Tell your doctor or nurse if you get any of the symptoms listed above.

• This treatment can affect your central nervous system. This can be very serious.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following symptoms:
  • trouble with your speech or vision
  • confusion or memory loss
  • changes in your personality
  • weakness in your arms and legs
  • poor balance or coordination
  • fits (seizures).

Delayed (onset months to years)

• Lung problems are rare, but can be serious. They may occur throughout treatment or after the completion of treatment.
• You may get:
  • shortness of breath
  • fever
  • dry cough
  • wheezing
  • fast heartbeat
  • chest pain.
• Your doctor will monitorhow well your lungs are working during your treatment.
• Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have chest pain or become short of breath.