Managing Side Effects of Treatment

Side effects associated with treatment for Waldenstrom macroglobulinemia (WM) depend upon many factors. It’s important to work closely with your hematologist/oncologist to learn about what side effects to expect and how to manage them. Discussing side effect management with your cancer care team and developing a good support system – with family, friends, and peer support group members – before starting therapy can help you cope with treatment-related side effects.

What factors influence the side effects of treatment?

Reactions to treatment vary from person to person. Treatment side effects depend upon several things, including the types and dosage of medications you receive and whether you have other medical conditions, such as diabetes or kidney disease.

It’s important to keep in mind that not every person gets every side effect.  And the severity of side effects can vary greatly, even among people receiving the same type of treatment. Talk with your cancer care team about:

    • Which side effects are most common with your treatment;
    • What you can do to lessen or prevent them;
    • How long they might last; and
    • When you should contact your doctor.

What are some common side effects of WM treatment?

Most of the preferred treatment regimens for Waldenstrom macroglobulinemia consist of a targeted therapy – like rituximab (Rituxan®) or ibrutinib ((Imbruvica®) – often given in combination with chemotherapy. The more common side effects of the drugs used in these treatment regimens follow.

Chemotherapy: Side effects

Chemotherapy medicines attack cells that divide quickly, which is why they work against WM cells. However, there are healthy cells in the body that divide quickly as well. They exist in the bone marrow (where new blood cells are made), line the mouth and intestine, and grow hair. Damage to these healthy cells is what causes the side effects of chemotherapy.

Common side effects of chemotherapy include:

    • Nausea and vomiting
    • Diarrhea or constipation
    • Mouth sores
    • Hair loss
    • Low blood cell counts
    • Fatigue (from having too few red blood cells)
    • Increased risk of infection (from having too few white blood cells)
    • Bleeding (from having too few platelets)
    • Fever of unknown origin

Fortunately, there are many ways to reduce and even prevent certain side effects. There are medications that help prevent and manage nausea, vomiting and other gastrointestinal side effects. Low blood cell counts can be treated with blood transfusions or blood cell stimulating agents. And antibiotics, anti-fungal agents, and/or anti-viral agents can be used to prevent infections during the treatment and post-treatment periods.

Targeted therapy: Side effects

Drugs referred to as “targeted therapy” target and attack specific types of cancer cells. They tend to harm normal cells less than traditional chemotherapy, so the side effects are usually less harsh. There are many types of targeted drugs, and their side effects largely depend on the type of drug that’s given and what it targets.

Side effects of the targeted drugs used in the preferred treatment regimens for WM follow. For detailed information including side effect management, self-care tips, and when to call your doctor, click on the drug name to access the corresponding IWMF Fact Sheet.

    • Rituximab (Rituxan®): A targeted therapy classified as a monoclonal antibody. Rituximab can sometimes cause a rapid, short-term increase in IgM levels, called IgM flare. This increase in IgM can cause the blood to thicken, leading to hyperviscosity syndrome. Some people may need to have plasmapheresis  before starting treatment with rituximab to reduce the risk of symptomatic hyperviscosity. Other options are to hold the rituximab while giving the other drugs in the regimen to lower your IgM level or to start the rituximab at a lower dosage.
    • Ibrutinib (Imbruvica®): A targeted therapy classified as a tyrosine kinase inhibitor (TKI). Common side effects (occurring in greater than 30 percent of patients) include nausea, diarrhea, fatigue, muscle and bone pain, low blood cell counts, bruising, and upper respiratory infection. Less common, but more serious side effects include other cancers (especially skin cancer), heart rhythm problems, and tumor lysis syndrome. This syndrome is caused by the breakdown products of cancer cells. It can lead to kidney failure and other serious health problems.
    • Bortezomib (Velcade®): A targeted therapy classified as a proteasome inhibitor. Bortezomib can cause peripheral neuropathy (a feeling of “pins and needles,” usually in the hands and feet). It can reactivate shingles, a painful skin rash caused by the same virus that causes chicken pox. Shingles usually appears as a stripe of blisters on one side of the body or face. To reduce this risk, your doctor may recommend getting the shingles vaccine and/or taking the antiviral medicine acyclovir before starting treatment.

More information and specific strategies on managing treatment-related side effects can be found at:

It’s important to communicate with your cancer care team during treatment. Discuss any new symptoms you experience, such as pain, bruising, bleeding, or fever, as well as emotional problems such as anxiety or depression. Even if you’re not sure a problem is related to treatment, it’s best to bring it to your doctor’s attention so you get the care and treatment you need.