This page tells you about the biological therapy ibritumomab and its possible side effects. There are sections about
- What ibritumomab is
- How ibritumomab works
- How you have ibritumomab
- Tests during treatment
- About side effects
- Radiation safety after ibritumomab
- Common side effects
Ibritumomab is a type of monoclonal antibody. Monoclonal antibodies are a type of biological therapy. Ibritumomab has a radioactive substance called yttrium (pronounced it-tree-um) attached to it. It targets a protein called CD20. Non Hodgkin lymphoma cells have this CD20 protein on their surface. The ibritumomab sticks to all the CD20 protein it finds and delivers the radiation to these cells, which then die. Because the treatment targets the lymphoma cells, you only have a small amount of radioactive substance with each treatment.
You have ibritumomab as an injection into a vein or through a drip (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
In the treatment schedule for lymphoma, you have a dose of a drug called rituximab the first week. The following week you have another dose of rituximab followed by the ibritumomab. You have the ibritumomab over 10 minutes. You only have one dose.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We've listed the side effects associated with ibritumomab. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having ibritumomab with other medicines.
Tell your doctor or nurse straight away if any of the side effects get severe.
After your treatment, you have a small amount of radioactive substance in your bodily fluids including your urine, stools, saliva, sperm and possibly vaginal fluids. This lasts for about a week after treatment. To protect other people from the radioactivity you should wash your hands carefully after going to the toilet and clear up any spills. You, or your partner, should also wear a condom during sex.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of infection due to a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Tiredness and weakness (fatigue) after treatment – most people find their energy levels are back to normal within 6 months to a year
- Abdominal (tummy) pain
- Inflammation of the lining of the nose and upper part of the throat, causing a stuffy nose and sometimes nose bleeds
- Flu like symptoms, including a high temperature (fever), a cough, and chills – taking paracetamol can help
- Feeling sick and occasionally being sick – this is usually well controlled with anti sickness medicines
- Diarrhoea is usually mild but do tell your doctor or nurse as you can have medicines to control it
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
Between 1 and 10 in every 100 people have one or more of these.
- Aching muscles, bones or joints
- A rash or blistering of the skin, which may be itchy – this may begin a few days or a few months after the treatment
- A reaction to ibritumomab during infusion, causing flu like symptoms such as a fever, chills and shivering (rigors), a headache and feeling sick. Your doctor or nurse will give you medicines beforehand to try to prevent a reaction. If you have one, your nurse will slow or stop your drip for a while. Rarely some people have a more severe reaction, with wheezing, an itchy rash and a drop in blood pressure.
- Loss of appetite
- Acute myeloid leukaemia or blood disorders called myelodysplastic syndromes occur in up to 5 out of 100 people (5%) a few years after having ibritumomab
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a year afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don't breastfeed during this treatment because the drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Chemo Care website at chemocare.com.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at yellowcard.mhra.gov.uk.
Question about cancer? Contact our information nurse team