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R-Bendamustine chemotherapy 773

Information leaflet on R-Bendamustine chemotherapy 773

This leaflet provides information on a course of treatment called R-Bendamustine.  The leaflet will explain what this is and when and how it is given.  It will also tell you about common side effects that you may experience.  Contact telephone numbers and details of how to obtain further information on R- Bendamustine are given at the end of the leaflet.

This leaflet should be read alongside the ‘General information for patients receiving chemotherapy’ folder.  If you haven’t received this folder please ask your nurse for a copy.

What is R- Bendamustine treatment?

This is a treatment which consists of a combination of drugs which work in different ways to treat your cancer. 

1.    Rituximab (usually called Mabthera)
This is an artificially made antibody which attaches itself to lymphoma cancer cells.  It is not chemotherapy.  Mabthera helps your own immune system kill the cancer cells. 

This is the R part of the treatment.

2.    Chemotherapy treatment 
This part of your treatment consists of a chemotherapy drug called Bendamustine.  which is given through an infusion (drip):

Why am I having R- Bendamustine treatment? 

Your doctor has prescribed this treatment because this combination has been found to be effective in treating your type of cancer.

How often will I receive my chemotherapy?

For this treatment to be most effective, it is given at specific time intervals.  These are known as cycles.  A cycle of R- Bendamustine lasts for four weeks.  It is usual to have between six and eight cycles.  Your doctor will discuss with you the exact number of cycles you will receive.

In each four week cycle you will be given the Mabthera and the Bendamustine on the first day.  On the second day you will be given the Bendamustine on it’s own.

How long will I be in the hospital?

Your chemotherapy appointment will usually be on a different day to your clinic appointment.  

The Mabthera treatment will take approximately 4 hours for the first treatment and 2½ hours for following treatments. 
The chemotherapy treatment will take about 2 hours. 

Can I bring relatives and friends with me? 

Currently due to the need to ensure 2m space between patients during COVID-19 we do not usually allow anyone to stay with you during your treatment. If you have any concerns about this please speak to your team before your treatment starts. We may be able to make some exceptions but we will need to be aware of this before the day of treatment

How is the Mabthera given?

Before your Mabthera is started we will give you paracetamol and drugs called Piriton (chlorpheramine) and hydrocortisone.  These are given to prevent the side effects which can occur during the treatment.  

The Mabthera is given through a drip into a vein in the back of your hand or arm.  Alternatively it may be suggested that a fine tube called a PICC is inserted into one of the large veins in your upper arm.  This line can remain in place for the whole course of your treatment.  Your doctor or nurse will discuss this further with you.

We have a leaflet that tells you more about PICC lines. Please ask if you would like a copy. 

What are the side effects of Mabthera treatment?

Reactions during the treatment

Most side effects which can occur with Mabthera occur while the drug is infusing.  This is why the first treatment is given more slowly.  A nurse will monitor you closely during the treatment.  This will include having your temperature and blood pressure checked regularly. 

If you experience any of the following during the treatment please tell your nurse straight away:

  • Feeling hot and feverish
  • Chills or shivering
  • Headache
  • Dizziness or faintness
  • Problems with breathing
  • Itchy skin
  • Tickling of the throat 

If any of these occur we will slow down or stop the Mabthera until you feel better.  The treatment can then start again, usually without any further problems.

Side effects following treatment 

You may suffer from tiredness, headaches or dizziness. Please tell your doctor at your next clinic visit if these are a problem for you.  You should not drive on the day of treatment or while you are affected by these side effects.

How will my chemotherapy be given?

We will give you some anti sickness medicines.  The chemotherapy will then be given through the drip. 

What are the possible side effects?

There are a number of possible side effects which can occur. The doctor, nurses and pharmacy team can give you advice or answer any questions you may have.

Hair loss

You should not lose your hair with this chemotherapy, although hair thinning may occur.  If this affects you, please ask about a wig or other options. 

Sickness

Nausea and vomiting are uncommon these days as we give you anti-sickness medicines which are usually extremely effective.  If you are sick more than once in 24 hours despite taking regular anti-sickness medicine contact Velindre Cancer Centre.  The telephone number is at the end of the leaflet.

Infection

You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.  

If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening. 

Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade or if your temperature is below 35.5°.  The telephone number is at the end of the leaflet.

Effects on your bowels

Bendamustine can cause either constipation or diarrhoea.  If you have constipation it may be relieved by drinking plenty of fluids and eating enough fibre.  Your doctor can prescribe medication to relieve constipation.

If you have diarrhoea it is important that you drink plenty of fluids.  Medication is available to control diarrhoea.  If you have 4 or more bowel movements in 24 hours above what is normal for you, you should contact Velindre Cancer Centre immediately.  The telephone number is on page 9. 

Tiredness and fatigue 

You may feel more tired than usual.  It is important to listen to your body and rest if you need to, but carry out your normal activities if you feel able.  Some people find it beneficial to take gentle exercise as well as rest, and we would recommend that you continue to be as active as possible within your limitations

Sore mouth

Your mouth may become sore or you may notice small ulcers.  Please follow the advice on caring for your mouth in the general chemotherapy leaflet.  Your doctor may prescribe mouthwashes or medication to prevent or clear any infection

Allergic type reaction

A small number of patients experience an allergic type reaction.  If this occurs you may feel hot or flushed, itchy, light-headed or generally unwell whilst receiving your bendamustine. This can be easily treated.  Please tell your nurse immediately if you experience any of the above symptoms.

Heart problems

Very rarely some people having bendamustine chemotherapy experience heart problems.  If you have a heart condition or you take any heart medication, please tell your doctor before you start chemotherapy.  

If you do have any chest pain or feel your heart is beating faster than normal you should seek urgent medical attention.  

Blood pressure

Bendamustine can sometimes cause high blood pressure.  You should let your doctor know if you are already being treated for high blood pressure before starting treatment.  Your blood pressure will be checked regularly. 

Effect on your lungs

A small number of people may experience lung problems following bendamustine treatment.  If you develop a dry cough or notice that you are short of breath please tell your doctor

Skin changes

Bendamustine  may cause an itchy rash in some patients.  Medication is available to treat this.  If this occurs please contact Velindre Cancer Centre for advice.  

Blood transfusions

After treatment with bendamustine, any blood and platelets you are given should first be treated with radiation. This lowers the risk of the donated blood cells reacting against your own. It won’t damage the blood or make you radioactive.  
Your doctor will record in your medical notes that you should only be given irradiated blood products. They’ll also give you a card to carry in case you’re treated at another hospital. Keep this card with you at all times and remind your hospital team that you need irradiated blood or platelets. 

Blood clots

A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further.  It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.  

Blood clots can be very serious.  However, most clots can usually be successfully treated with drugs to thin the blood.  Your doctor or nurse can give you more information

Other information

Women sometimes find that chemotherapy treatment affects their periods.  They could become heavier, lighter or even stop altogether.  

It is important you do not become pregnant or father a child whilst having chemotherapy treatment as chemotherapy could damage the unborn baby.  

Chemotherapy may affect your ability to have children in the future.  If you have concerns, please discuss this with your doctor or nurse. 

Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.

Manufacturer’s patient information leaflets

Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at www.medicines.org.uk. Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy

Contact telephone numbers

Velindre Cancer Centre 029 2061 5888

Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night. For example you should phone if you:

  • Are sick more than once in 24 hours
  • Have a temperature of 37.5°C or above 
  • Have diarrhoea

Pharmacy department 029 2061 5888 ext 6223
Monday – Friday 9am – 5pm for queries about your medicines

Macmillan freephone Helpline 0808 808 0000
7 days a week 8am – 8pm for general queries on cancer

Tenovus freephone 0808 808 1010
cancer helpline 
7 days a week 8am – 8pm for general queries on cancer

This information is also available in Welsh

This leaflet was written by health professionals.  The information contained in this leaflet is evidence based.  The leaflet has been approved by doctors, nurses and patients.  It is reviewed and updated every 2 years.