Side Effect

Management

Infusion-related reaction

• This sometimes occurs during the first few doses.
• This is usually mild or moderate, but rarely can be more severe. 

• You will be given anti-allergy medications and Paracetamol before the infusion to prevent reactions.
• Inform the nurse immediately if you experience any of the following during the infusion:
  • Flu-like symptoms such as fever, chills dizziness, headache, and/or feeling warm or flushed
  • Red, warm, and itchy bumps on the skin
  • Swelling of the lips, tongue, or throat
  • Shortness of breath , wheezing, cough or sudden difficulty breathing
  • Back pain or chest pain
• If you do have a reaction, this is usually treated by slowing or stopping the drip until the reaction is over. Future infusions may also be given at a slower rate.

Decrease in white blood cell count. This may increase your chances of getting an infection.

• To reduce risk of infection:
  • Maintain good hand hygiene. Wash your hands before handling food and after using the toilet.
  • Avoid crowds and do not go near people who are sick. Wear a mask if necessary.
  • Eat freshly cooked food. Avoid raw meats, vegetables and eggs, or half-cooked or uncooked food.
• Proceed to the A&E department immediately if you have any signs of infection such as a fever of 38ºC and above, chills, bad sore throat, pain when you pass urine or have mouth sores or wounds that do not heal. 
  • Avoid taking Paracetamol to relieve fever as this may mask your fever and delay treatment of the infection.

Decrease in platelet count. Low platelet levels can increase your chance of bleeding. 

• To reduce your risk of bleeding: 
  • Be careful when using sharp objects such as scissors or knives.
  • Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding.
  • Try not to bruise, cut or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding.
• Proceed to the A&E department immediately if you have:
  • Bruising without a cause or bruises that get larger in size
  • Black, sticky stools
  • Blood in the urine
  • Coughing out blood or vomit that looks like coffee grounds
  • Bleeding which does not stop

Tumour lysis syndrome (TLS) may occur, which is a condition caused by cancer cells breaking down too quickly and releasing their contents into the blood. 

When there are too much minerals and waste products released from the dying cells, this may cause an imbalance of the minerals in your body and this may lead to organ damage.

TLS is a serious condition and needs to be treated as soon as possible.

• Keep well hydrated by drinking 6 to 8 glasses of water each day.
• Your doctor may also give you medicine to help prevent tumour lysis syndrome.
• Proceed to the A&E department immediately if you experience any unusually fast heartbeat, muscle weakness or cramps or pain, dark and cloudy urine, unusual tiredness or seizures.

Hepatitis B reactivation

Some people may have been infected by the Hepatitis B virus before – a virus which affects the liver.

Treatment with Obinutuzumab may cause the infection to return and cause more liver damage.

• Before starting treatment, you will do a blood test to check for the virus.
• You may be given medication to prevent the infection from returning while you are on treatment with Obinutuzumab.
• Proceed to the A&E department immediately if you experience any symptoms of virus reactivation such as fever, yellowing of the skin or eyes, abdominal pain with severe nausea or vomiting.

Problems with normal brain function, which may include symptoms such as:

• Changes in your mood or usual behaviour
• Feeling confused or having difficulty thinking 
• Memory loss
• Changes in your vision, speech, or walking
• Decreased strength or weakness on one side of the body

These could be symptoms of a rare but serious infection of the brain called Progressive Multifocal Leukoencephalopathy. 

• Proceed to the A&E department immediately.

Exercise

Light exercise is recommended as it helps to improve mobility, balance, and even emotional well-being. Avoid strenuous exercise, and rest when you are feeling tired.

Adequate hydration

Maintain adequate hydration with 2 to 3 litres of fluids per day unless you have been informed by your doctor to restrict fluids. This will decrease your chances of getting constipation and prevent dehydration.

Medical and dental treatment

If you need to go to the hospital for any reason other than cancer, always inform the doctors and nurses that you are receiving anti-cancer treatment.

Talk to your cancer doctor if you think you need dental treatment. Always inform your dentist that you are receiving anti-cancer treatment.

Seek support if you feel overwhelmed

It is normal to feel fearful or worried about your condition.

Do not be afraid to talk about your concerns with your healthcare team or loved ones.

There may be resources and support available to help you.