Relapsed/Refractory DLBCL Treatment Side Effects

Diarrhea

It's important to get diarrhea under control before it leads to other problems, such as dehydration or electrolyte imbalance. Chemotherapy can cause it, as can some immunotherapy and targeted therapy drugs. Your doctor may recommend an over-the-counter or prescription medication to treat it. You should also:

• Drink plenty of liquid to stay hydrated.
• Avoid foods that are acidic, spicy, fatty, or sweet. 
• Avoid drinks with caffeine, alcohol, or carbonation.
• Try a bland diet like BRAT (bananas, rice, applesauce, toast).
• Ask your doctor if you should have a sports drink or other product to replace electrolytes. 

If you also have a fever along with diarrhea, or it goes on more than a day, be sure to call the doctor. 

Low Appetite

Good nutrition is helpful when you're fighting cancer, but many treatments can make you lose your appetite. If the problem is a digestive side effect such as nausea, treating that should help. Other strategies to increase your food intake include:

• Divide your daily calories into several small meals and snacks.
• Don't fill up with liquid at meals.
• Focus on protein.
• Get some physical activity, if you're up to it.
• Ask your doctor about nutritional supplement drinks.

In some situations, your doctor might recommend a medication to increase your appetite. They can also put you in touch with a registered dietitian who can help you come up with an eating plan during your DLBCL treatment.

Hair Loss

It doesn't always happen, but hair loss is a side effect of certain types of chemotherapy. You might be able to prevent it by wearing a special cooling cap during treatment sessions. If not, know that your hair will most likely grow back after you're finished with treatment.

In the meantime, you can choose to wear a wig or a hat, or embrace being bald. Ask your doctor whether topical or oral minoxidil might be a good option for you to promote hair growth.

Mouth Sores

Damage done by chemotherapy to the fast-growing cells that line your lips, mouth, gums, tongue, and throat often causes painful sores that come and go during treatment and can last for weeks after you're finished. They can also be a side effect of radiation and CAR T therapy. Mouth sores make it hard to eat and can lead to infections.

These tips can help ease the pain:

• Blend your food or cut it into small pieces.
• Avoid spicy, salty, or acidic foods and also foods with hard edges, like chips.
• Eat chilled or frozen foods.
• Drink through a straw.
• Avoid alcohol and alcohol-based mouthwashes.
• Rinse your mouth after eating.
• Swish with salt water.
• Brush your teeth gently, but don't neglect your dental health.
• Don't smoke.

Your doctor may be able to give you a medicated rinse to numb or coat the inside of your mouth to make you more comfortable while your sores heal.

Infection Risk

Many of the treatments you might have for relapsed or remitting DLBCL kill healthy B cells along with cancerous ones, which weakens your immune system for a time and makes you more likely to get sick. This can be serious and may last months after your treatment is over. 

Your doctor may give you antibiotics or antiviral medications to take before, during, or after treatment, or medications to help your body make more white blood cells. If you have a stem cell transplant, you may need to be isolated to avoid germs or stay in the hospital so staff can watch you closely while you rebuild your immunity. In some cases, you might get an infusion of infection-fighting antibodies, also called immunoglobulins.

To help protect yourself from infection:

• Wash your hands often.
• Stay away from people who are sick.
• Wear a mask in public.
• Try to avoid breaking your skin. If you do, keep the cut clean.
• Pay attention to your dental health.
• Practice good food safety: Wash produce, cook food thoroughly, and don't take a chance with old leftovers or expired items. 

Even a normally mild infection can become dangerous when you're fighting cancer, so let your doctor know right away if you develop a fever, chills, or other infection symptoms like a cough or diarrhea.

Also, ask your doctor about vaccines to protect you from common infectious diseases. If you have an autologous stem cell transplant, you'll also lose your immunity to diseases you were vaccinated against as a child and should consider a new series.

Brain Fog

Several types of DLBCL treatment can affect the way your thinking and memory work, including chemotherapy and CAR T therapy. This usually goes away when your treatment is finished. Your doctor may treat you with steroids to help manage this side effect, but for mild cognitive problems, try to:

• Stay physically active.
• Follow a routine.
• Make lists and other written reminders.
• Focus on one task at a time.
• Put off important decisions until you're thinking more clearly.
• Exercise your brain with puzzles or games.
• Get enough sleep.
• Ask for help.

Nerve Damage

Treatments for relapsed or refractory DLBCL, including chemotherapy with platinum-based drugs and certain kinds of immunotherapy and targeted therapy, can damage your nerves. This can lead to pain, tingling, or numbness that may last even after your treatment has ended.

For nerve discomfort that doesn't go away on its own, your doctor can give you several types of medications, including topical and oral pain relievers, the anti-seizure drug gabapentin, and the antidepressant duloxetine.

When to Call the Doctor

Besides the increased risk of infection, some other possible side effects from relapsed or refractory DLBCL treatment can be very serious or even life-threatening. Let your doctor know right away if you have symptoms.

Tumor lysis syndrome

This can happen any time a large number of cancer cells die quickly. Waste products including uric acid, potassium, and phosphate flood your bloodstream faster than your kidneys can remove them. That can cause heart, kidney, and nerve problems. Symptoms include:

• Muscle cramps or twitching
• Irregular heartbeat
• Nausea, vomiting, or diarrhea
• Seizures

Tumor lysis syndrome can be a side effect of CAR T therapy and chemotherapy. The solution is medication to flush the cancer cell waste products out of your blood, although you might need intravenous fluids in severe cases. You can help avoid it by staying well-hydrated during treatment. 

Cytokine release syndrome

This can happen when CAR T therapy or other kinds of immunotherapy kick your immune system into overdrive. You may have a high fever and flu-like symptoms. This side effect can be treated with steroids and cytokine-blocking drugs.

Infusion reactions

Drugs you get through an infusion can cause a reaction, including monoclonal antibodies and some types of chemotherapy. This can be mild or very serious. 

Let the nurse or technician know right away if you:

• Feel lightheaded
• Have chest pain or a racing pulse
• Have trouble breathing
• Feel your face or tongue swell 

You may get medication before each infusion to try to prevent a reaction.

Late Effects

Some possible side effects from treatments for relapsed or refractory DLBCL can appear many years after you're cancer free. These include:

• Heart disease
• Infertility
• Bone loss
• Other cancers
• Early menopause
• Lung damage
• Cataracts
• Hearing loss or ringing in your ears
• Overactive or underactive thyroid

It's important to have regular checkups to watch for signs of these problems. You can also help lower your risk of developing them by following a healthy lifestyle, including eating well, exercising, and not smoking.