Patient information - Burkitt lymphoma - R-IVAC (rituximab, ifosfamide, etoposide, cytarabine) (2024)

Your treatment

The treatment schedule below explains how the drugs for this treatment are given.

R-IVAC (rituximab, ifosfamide, etoposide, cytarabine)
This treatment protocol alternates withthe dose modified R-CODOX-Mprotocoland may continuefor up to 4 cycles of chemotherapy in total.Your doctor will advise you of the number of treatments you will have.
Day	Treatment	How it is given	How long it takes
1	Rituximab(ri-TUX-i-mab)	By a drip into a vein	1st cycle:About 4 to 6 hours Cycles thereafter:About 3 to 4 hours
	Cytarabine (sye-TARE-a-been)	By a drip into a vein	About 3 hours TWICE a day
	Etoposide (e-TOE-poe-side)	By a drip into a vein	About 1 hour
	Mesna(MES-na)	By a drip into a vein	About 15 minutes (day 1 only)
	Ifosfamide (eye-FOS-fa-mide)	By a drip into a vein	About 2 hours
	Mesna	By a drip into a vein	For 24 hours
2	Cytarabine	By a drip into a vein	About 3 hours TWICE a day
	Etoposide	By a drip into a vein	About 1 hour
	Ifosfamide	By a drip into a vein	About 2 hours
	Mesna	By a drip into a vein	For 24 hours
3 and 4	Etoposide	By a drip into a vein	About 1 hour
	Ifosfamide	By a drip into a vein	About 2 hours
	Mesna	By a drip into a vein	For 24 hours
5	Etoposide	By a drip into a vein	About 1 hour
	Ifosfamide	By a drip into a vein	About 2 hours
	Mesna	By a drip into a vein	For 24 hours
	Methotrexate (meth-o-TREX-ate)	By injection into your spine	About 2 hours
6	Mesna	By a drip into a vein	For 24 hours
6	Calcium folinate (Leucovorin) (loo-koe-VOR-in)	Take orally for ONE dose only, 24 hours after the methotrexateinjection.
7	Granulocyte Colony Stimulating Factor (G-CSF)	By injection under the skin	About 5 minutes

After completion of chemotherapy, you may require a further two doses of rituximab. Your doctor will determine whether this is appropriate.

When to get help

Anticancer drugs (drugs used to treat cancer) can sometimes cause serious problems. It is important to get medical help immediately if you become unwell.

Patient information - Burkitt lymphoma - R-IVAC (rituximab, ifosfamide, etoposide, cytarabine) (1)

IMMEDIATELY go to your nearest hospital Emergency Department, or contact your doctor or nurse if you have any of the following at any time:

Emergency contact details

Ask your doctor or nurse from your treating team who to contact if you have a problem

a temperature of 38ºC or higher
chills, sweats, shivers or shakes
shortness of breath
uncontrolled vomiting or diarrhoea
pain, tingling or discomfort in your chest or arms
you become unwell.

Daytime:

Night/weekend:

Other instructions:

During your treatment immediately tell the doctor or nurse looking after you if you get any of the following problems:

leaking from the area where the drugs are being given
pain, stinging, swelling or redness in the area where the drugs are being givenor at any injection sites
a skin rash, itching, feeling short of breath, wheezing, fever, shivers, or feeling dizzy or unwell in any way (allergic reaction).

Other information about your treatment

Changes to your dose or treatment delays

Sometimes a treatment may be started at a lower dose or the dose needs to be changed during treatment. There may also be times when your treatment is delayed.This can happen if your doctor thinks you are likely to have severe side effects, if you get severe side effects, if your blood counts are affected andcausing delays in treatment, or if you are finding it hard to cope with the treatment. This is called a dose reduction, dose change or treatment delay. Your doctor will explain if you need any changes or delays to your treatment and the reason why.

Blood tests and monitoring

Anti-cancer drugs can reduce the number of blood cells in your body. You will need to have regular blood tests to check that your blood cell count has returned to normal. If your blood count is low, your treatment may be delayed until it has returned to normal. Your doctor or nurse will tell you when to have these blood tests.

Central venous access devices (CVADs)

Your treatment will be given through a central venous access device (CVAD). Your doctor or nurse will explain this to you.For more information see the eviQ patient information sheets on CVADs.

Medications for blood pressure

Rituximab may lower your blood pressure. Tell your doctor if you are taking any blood pressure medications. Your doctor may advise you to temporarily stop your blood pressure medications before your rituximab infusions.

Other medications given during this treatment

Rituximab premedication:before your treatment with rituximab you will need to take some tablets called a premedication to help prevent you from having a reaction to the rituximab.

Anti-sickness (anti-nausea) medication: you may be given some anti-sickness medication.Make sure you take this medicationas your doctor or nurse tells you, even if you don’t feel sick. This can help to prevent the sickness starting.

Eye drops: you will be given eye drops to help prevent sore eyes. You will start using the eye drops before you have your first dose of cytarabine and continue to use the eye drops until 72 hours after your last dose of cytarabine.

Prophylaxis medication: youmay need to take some medications to prevent infection and to help prevent or reduce some of the side effects of your treatment. Your doctor or nurse will tell you how and when to take these medications.

G-CSF: you will be given injection(s) of a drug called G-CSF (also called filgrastim, lipegfilgrastim or pegfilgrastim) under your skin. This helps to boost your white blood cell count. Your white blood cells help to fight infection. Lipegfilgrastim and pegfilgrastim are given once. Filgrastim is given for several days until your white blood cells recover.Follow this link to read more information on how to give this injection.

Side effects

Cancer treatments can cause damage to normal cells in your body, which can cause side effects. Everyone gets different side effects, and some people will have more problems than others.

The table below shows some of the side effects you may get with this treatment. You are unlikely to get all of those listed and you may also get some side effects that have not been listed.

Tell your doctor or nurse about any side effects that worry you. Follow the instructions below and those given to you by your doctor or nurse.

Immediate (onset hours to days)
Allergic reaction	Allergic reactions are uncommon but can be life threatening. If you feel unwell during the infusion or shortly after it, or: get a fever, shivers or shakes feel dizzy, faint, confused or anxious start wheezing or have difficulty breathing have a rash, itch or redness of the face While you are in hospital: Tell your doctor or nurse immediately. After you leave: Contact your doctor or nurse immediately, or go to the nearest hospital Emergency Department.
Bone pain after G-CSF injection	You may have discomfort or a dull ache in your pelvis, back, arms or legs. To reduce the pain, take paracetamol before each injection. Tell your doctor or nurse as soon as possible if your pain is not controlled.
Flu-like symptoms from cytarabine	You may get a fever, skin rash, aches and pains or increased sweating. These symptoms are caused by the drug cytarabine. Symptoms usually happen 6 to 12 hours after your dose, and may last until 24 hours after your treatment has finished. To reduce any pain or fever, take paracetamol, if needed. Don't take aspirin, ibuprofen or other similar anti-inflammatory medications unless your doctor tells you to. Tell your doctor or nurse if these symptoms do not get better after 24 hours.
Brain swelling (encephalopathy)	You may feel: dizzy sleepy confused or agitated. You may also get: headaches loss of balance hallucinations seizure (fits). These symptoms are caused by the drug ifosfamide. If you are being treated as an outpatient, try to have someone stay at home with you during the days that you are having this medicine. Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the symptoms listed above.
Pain or swelling at injection site (extravasation)	This treatment can cause serious injury if it leaks from thearea where it is going into the vein. This can cause pain, stinging, swelling or redness at or near the site where the drug enters the vein. If not treated correctly, you may get blistering and ulceration. Tell your doctor or nurse immediately if you get any of the symptoms listed above during or after treatment.
Bladder irritation (haemorrhagic cystitis)	You may get: blood in your urine, sometimes with blood clots pain or burning when you urinate the urge to urinate more than normal stomach or pelvic pain or discomfort. When you go home, make sure you drink plenty of fluids (unless you are fluid restricted). Empty your bladder often. Tell your doctor or nurse as soon as possible if you notice any blood in your urine.
Headache	You can take paracetamol if you have a headache. Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get a very bad headache that is not helped by pain medication.
Nausea and vomiting	Youmay feel sick (nausea) or be sick (vomit). Take your anti-sickness medication as directed even if you don’t feel sick. Drink plenty of fluids (unless you are fluid restricted). Eat small meals more frequently. Try foodthat doesnot require much preparation. Try bland foods like dry biscuits or toast. Gentle exercise may help with nausea. Ask your doctor or nurse for eviQ patient information - Nausea and vomiting during cancer treatment. Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have uncontrolled vomiting or feel dizzy or light-headed.
Nervous system changes from cytarabine	High doses of cytarabine can affect the nervous system. Tell your doctor or nurseimmediately, or go to the nearest hospital Emergency Department if you get any of the following symptoms during or soon after your treatment: dizziness, drowsiness or double vision agitation difficulty walking in a straight line difficulty writing with a pen or pencil jerky movements slow, slurred speech.
Eye problems from cytarabine	Youmay get: eye pain or irritation blurred vision watery or gritty eyes sensitivity to light. You will be given eye drops to help prevent and control these symptoms. It is important to use these eye drops as directed. Protect your eyes from the weather (sun and wind) by wearing sunglasses, especially if you have lost your eyelashes. Tell your doctor or nurse if you get any of the symptoms listed above.
Taste and smell changes	You may find that food loses its taste or tastes different. These changes are likely to go away with time. Do your mouth care regularly. Chew on sugar-free gum or eatsugar-free mints. Add flavour to your food withsauces and herbs. Ask your doctor or nurse for eviQ patient information - Taste and smell changes during cancer treatment.

Early (onset days to weeks)
Infection risk (neutropenia)	This treatment lowers the amount of white blood cells in your body. The type of white blood cells that help to fight infection are called neutrophils. Having low level of neutrophils is called neutropenia. If you have neutropenia, you are at greater risk of getting an infection. It also means that your body can’t fight infections as well as usual. This is a serious side effect, and can be life threatening. Wash your hands often. Keep a thermometer at home and take your temperature regularly, and if you feel unwell. Do your mouth care regularly. Inspect your central line site (if you have one) daily for any redness, pus or swelling. Limit contact with people who are sick. Learn how to recognise the signs of infection. Ask your doctor or nurse for eviQ patient information - Infection during cancer treatment. Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following signs or symptoms: a temperature of 38°C or higher chills, shivers, sweats or shakes a sore throat or cough uncontrolled diarrhoea shortness of breath a fast heartbeat become unwell even without a temperature.
Low platelets (thrombocytopenia)	This treatment lowers the amount of platelets in your blood. Platelets help your blood to clot. When they are low, you are at an increased risk of bleeding and bruising. Try not to bruise or cut yourself. Avoid contact sport or vigorous exercise. Clear your nose by blowing gently. Avoid constipation. Brush your teeth with a soft toothbrush. Don't take aspirin, ibuprofen or other similar anti-inflammatory medications unless your doctor tells you to. Tell your doctor or nurse if you have any bruising or bleeding. Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if you have any uncontrolled bleeding.
Appetite loss (anorexia)	You may not feel like eating. Try to avoid drinking fluids at meal times. Try to eat small meals or snacks regularly throughout the day. Try to eat food that is high in protein and calories. If you are worried about how much food you can eat, or if you are losing weight, ask to speak to a dietitian.
Tiredness and lack of energy (fatigue)	You may feel very tired, have no energy, sleep a lot, and not be able to do normal activities or things you enjoy. Do not drive or operate machinery if you are feeling tired. Nap for short periods (only 1 hour at a time) Prioritise your tasks to ensure the best use of your energy. Eat a well balanced diet and drink plenty of fluids (unless you are fluid restricted). Try some gentle exercise daily. Allow your friends and family to help. Tell your doctor or nurse if you get any of the symptoms listed above.
Kidney damage	This treatment can cause changes to how your kidneys work. You will have blood tests to make sure your kidneys are working properly. You may need to drink more fluids while you are having treatment. Your doctor or nurse will tell you if you need to do this. Tell your doctor or nurse as soon as possible if you notice that your urine changes colour or you don't need to empty your bladder as often.
Mouth pain and soreness (mucositis)	You may have: bleeding gums mouth ulcers a white coating on your tongue pain in the mouth or throat difficulty eating or swallowing. Avoid spicy, acidic or crunchy foods and very hot or cold food and drinks. Try bland and soft foods. Brush your teeth gently with a soft toothbrush after each meal and at bedtime. If you normally floss continue to do so. Rinse your mouth after you eat and brush your teeth, using either: 1/4 teaspoon of salt in 1 cup of warm water, or 1/4 teaspoon of bicarbonate of sodain 1 cup of warm water Ask your doctor or nurse for eviQ patient information -Mouth and throat problems during cancer treatment. Tell your doctor or nurse if you get any of the symptoms listed above.
Skin rash	You may get a red, bumpy rash and dry, itchy skin. Moisturise your skin with a gentle non-perfumed moisturising cream like sorbolene or aqueous cream. Do not scratch your skin. Protect your skin from the sun by wearing sun-protective clothing, a wide-brimmed hat, sunglasses and sunscreen of SPF 50 or higher. Talk to your doctor or nurse about other ways to manage your skin rash.

Late (onset weeks to months)
Hair loss (alopecia)	Your hair may start to fall out from your head and body. Hair loss usually starts 2 to 3 weeks after your first treatment. You may become completely bald and your scalp might feel tender. Use a gentle shampoo and a soft brush. Take care with hair products like hairspray, hair dye, bleaches and perms. Protect your scalp from the cold with a hat, scarf or wig. Protect your scalp from the sun with a hat or sunscreen of SPF 50 or higher. Moisturise your scalp to prevent itching. Ask your doctor or nurse about the Look Good Feel Better program
Low red blood cells (anaemia)	You may feel dizzy, light-headed, tired and appear more pale than usual. Tell your doctor or nurse if you have any of these signs or symptoms. You might need a blood transfusion. Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have any chest pain, trouble breathing, or feel like your heart is racing.
Chemo brain (chemotherapy-related cognitive impairment)	You may notice that you are unable to concentrate, feel unusually disorganised or tired (lethargic) and have trouble with your memory. These symptoms usuallyimprove once treatment iscompleted. Ask your doctor or nurse for eviQ patient information – Memory changes and chemotherapy (chemo brain). Tell your doctor or nurse if you get any of the symptoms listed above.
Changes in the way your brain works [progressive multifocal leukoencephalopathy (PML)]	This treatment can affect your central nervous system. This can be very serious. Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get any of the following symptoms: trouble with your speech or vision confusion or memory loss changes in your personality weakness in your arms and legs poor balance or coordination fits (seizures).

Delayed (onset months to years)
Lung problems	Lung problems are rare, but can be serious. They may occur throughout treatment or after the completion of treatment. You may get: shortness of breath fever dry cough wheezing fast heartbeat chest pain. Your doctor will monitorhow well your lungs are working during your treatment. Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have chest pain or become short of breath.

Delayed (onset months to years)

Lung problems

Lung problems are rare, but can be serious. They may occur throughout treatment or after the completion of treatment.
You may get:
- shortness of breath
- fever
- dry cough
- wheezing
- fast heartbeat
- chest pain.
Your doctor will monitorhow well your lungs are working during your treatment.
Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have chest pain or become short of breath.

General advice for people having cancer treatment

Chemotherapy safety

Learn how to keep you and your family safe while you are having anticancer drugs.
See our patient information sheet - Chemotherapy safety at home.

Blood clot risk

Cancer and anticancer drugs can increase the risk of a blood clot (thrombosis).
Tell your doctor if you have a family history of blood clots.
A blood clot can cause pain, redness, swelling in your arms or legs, shortness of breath or chest pain.
If you have any of these symptoms go to your nearest hospital Emergency Department.

Medications and vaccinations

Before you start treatment, tell your doctor about any medications you are taking, including vitamins or herbal supplements.
Don’t stop or start any medications during treatment without talking to your doctor and pharmacist first.
Paracetamol is safe to take if you have a headache or other mild aches and pains. It is recommended that you avoid taking aspirin, ibuprofen and other anti-inflammatory type medications for pain while you are having treatment. However, if these medications have been prescribed by your doctor, do not stop taking them withoutspeaking with your doctor.
Vaccinations such as flu and tetanus vaccines are safe to receive while having treatment. Do not have any live vaccines during your treatment or for 6 months after it finishes. If you are unsure, check with your doctor before you have any vaccinations.
People you live with should be fully vaccinated, including having live vaccines according to the current vaccination schedule. Extra care needs to be taken with hand washing and careful disposal of soiled nappies for infants who have recently received the rotavirus vaccine.

Other medical and dental treatment

If you go to hospital or any other medical appointment (including dental appointments), always tell the person treating you that you are receiving anticancer drugs.
Before you have any dental treatment, talk to your doctor.

Diet and food safety

While you are receiving this treatment, it is important that you try to maintain a healthy diet.
Grapefruit and grapefruit juice can interact withyour medication and should be avoided while you are on this treatment.
Speak to your doctor or nurse about whether drinking alcohol is safe with your treatment.
If you have any concerns about recent weight loss or weight gain or questions about your diet, ask to speak to a dietitian.
There are some foods that may cause infection in high risk individuals and should be avoided. For further information on foods to avoid and food hygiene please ask for a copy of the Listeria and food brochure.

Fertility

Some cancer treatments can reduce your fertility. This can make it difficult or impossible to get pregnant or father a child.
Talk to your doctor or nurse before you start any treatment. Depending on your situation there may be fertility sparing options available to you and/or your partner, discuss these with your doctor or nurse.

Pregnancy and breastfeeding

Some cancer treatments can be dangerous to unborn babies. Talk to your doctor or nurse if you think there is any chance that you could be pregnant.
Do not try to get pregnant or father a child during this treatment. Contraception should be used during treatment and after stopping treatment. Ask your doctor or nurse about what type of contraception you should use.
If you are planning pregnancy/fatherhood after completing this treatment, talk to your doctor. Some doctors advise waiting between 6 months and 2 years after treatment.
Do not breastfeed if you are on this treatment, as anti-cancer medications can also pass into breast milk.

Sex life and sexuality

The desire to have sex may decrease as a result of this treatment or its side effects.
Your emotions and the way you feel about yourself may also be affected by this treatment.
It may help to discuss your concerns with your partner anddoctor or nurse.

Risk of developing a second cancer

Some anticancer treatments can increase your chance of developing a second cancer, this is rare. Your doctor will discuss with you the specific risks of your treatment.

Quitting smoking

It is never too late to quit smoking. Quitting smoking is one of the best things you can do to help your treatment work better.
There are many effective tools to improve your chances of quitting.
Talk to your treating teamfor more information and referral to a smoking cessation support service.

Staying active

Research shows that exercise, no matter how small, has many benefitsfor people during and after cancer treatment.
Talk to your doctor before starting an exercise program. Your doctor can advisewhether you need a modified exercise program.

For more information about cancer treatment, side effects and side effect management see our Patient and carerssection.

Where to get more information

Telephone support

Call Cancer Council on 13 11 20 for cancer information and support
Call the Leukaemia Foundation on 1800620420(MontoFri9am – 5pm)
Call the Lymphoma Nurse Support Line on 1800 953 081 (Mon to Fri 9am - 5pm)
Call the Myeloma Australia Support Line on 1800 693 566 (Mon to Fri 9am - 5pm)

Haematology,transplant and cellular therapyinformation

Arrowbonemarrowtransplantfoundation– arrow.org.au
AustralasianMenopauseSociety– menopause.org.au
Chris O'Brien Lifehouse- Total Body Irradiation -mylifehouse.org.au/departments/radiation-oncology/total-body-irradiation/
Healthy Male Andrology Australia –healthymale.org.au/
International Myeloma Foundation – myeloma.org
LeukaemiaFoundation –leukaemia.org.au
LymphomaAustralia– lymphoma.org.au
Myeloma Australia – myeloma.org.au
NSWAgencyforClinicalInnovation,Blood&MarrowTransplantNetwork –aci.health.nsw.gov.au/networks/bmtct
NSW Agency for Clinical Innovation- aci.health.nsw.gov.au/projects/immune-effector-cell-service
NCCNGuidelines for Patients Immunotherapy Side Effects:CAR T-Cell Therapy - nccn.org/patientresources/patient-resources/guidelines-for-patients
TalkBloodCancer – cmlsupport.org.uk/organisation-type/social-media-groups

General cancer information and support

Australian Rare Cancer (ARC) Portal –arcportal.org.au/
Beyond Blue – beyondblue.org.au
Cancer Australia – canceraustralia.gov.au
Cancer Council Australia– cancer.org.au
Cancer Voices Australia – cancervoicesaustralia.org
CanTeen – canteen.org.au
Carers Australia – carersaustralia.com.au
Carer Help -carerhelp.com.au
eviQ Cancer Treatments Online–eviQ.org.au
Is a clinical trial an option for me? -cancer.nsw.gov.au/about-cancer/document-library/i-have-cancer-is-a-clinical-trial-an-option-for-me
Food Standards Australia New Zealand: Listeria & Food Safety – foodstandards.gov.au/publications/listeriabrochuretext
LGBTQI+ People and Cancer - cancercouncil.com.au/cancer-information/lgbtqi
Look Good Feel Better– lgfb.org.au
Patient Information -patients.cancer.nsw.gov.au
Radiation Oncology Targeting Cancer - targetingcancer.com.au
Redkite – redkite.org.au
Return Unwanted Medicines – returnmed.com.au
Staying active during cancer treatment –patients.cancer.nsw.gov.au/coping-with-cancer/physical-wellbeing/staying-active

Quit smoking information and support

Quitting smoking is helpful even after you have been diagnosed with cancer. The following resources provide useful information and support to help you quit smoking. Talk to your treating team about any other questions you may have.

Call Quitline on 13 QUIT (13 78 48)
iCanQuit – iCanQuit.com.au
Patient Information -patients.cancer.nsw.gov.au/coping-with-cancer/physical-wellbeing/quitting-smoking
Quitnow – quitnow.gov.au