Mitoxantrone is a chemotherapy drug used to treat acute myeloid leukemia, non-Hodgkin lymphoma, advanced breast cancer, and advanced primary liver cancer.

HOW IS MITOXANTRONE ADMINISTERED?

Mitoxantrone is given in the chemotherapy day unit or during a hospital stay. A chemotherapy nurse will give it to you.

Before the day of treatment, a nurse will take a blood sample from you to see if you are fit for chemotherapy.

You will also be able to see a doctor or nurse before having chemotherapy. They will ask you how you have been feeling. If the results of your blood test are good on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will give you medication for nausea and, sometimes, steroids administered intravenously. Chemotherapy drugs may be given in the following ways:

• Through a thin tube (line) inserted into a vein in the arm or hand by a nurse
• Through a tube that goes below the skin of your chest to a nearby vein (central line)
• Through a thin tube that is placed in a vein of the arm and goes up through a vein toward the chest (PICC)

Your nurse will give you mitoxantrone (a blue liquid) as an injection directly into your cannula or line along with a drip (infusion).

Administering chemotherapy

DRUG LEAKAGE OUTSIDE THE VEIN

If this happens when you are receiving mitoxantrone, it can damage the tissue surrounding the vein. This is called extravasation. Inform the nurse immediately if you have stinging, pain, redness, or swelling around the vein. Extravasation is not common, but if it happens it is important that it be treated quickly.

If you have any of these symptoms after you get home, contact your doctor or nurse immediately.

YOUR MITOXANTRONE CYCLE

You will have chemotherapy as part of a course or cycle, consisting of several treatment sessions and lasting several months. Your doctor or nurse will tell you how many cycles you are likely to have.

POSSIBLE SIDE EFFECTS OF MITOXANTRONE

You may experience some of the side effects mentioned here, though it is rare for a patient to have all of them. If you receive other chemotherapy drugs, you may have other side effects that are not mentioned here. Always inform your doctor of the effects you experience.

Your doctor can prescribe medication to help control some of the side effects. It is very important to take the medication exactly as your doctor says for it to have the highest chance of working well. Your nurse will advise you on managing the side effects. After treatment, the side effects start to get better.

RISK OF INFECTION

Mitoxantrone may lower the number of white blood cells in your blood. This will make you more susceptible to infection. Your nurse can tell you when you might have the lowest levels of these cells. When the number of white blood cells is low, this is called neutropenia.

Contact your hospital immediately if any of the following happens:

• your temperature goes above 38 ° C
• you suddenly feel unwell, even if your temperature is normal.
• You have symptoms of infection, which may include sore throat, coughing, or the need to urinate frequently.

The number of white blood cells normally increases gradually, returning to normal before your next chemotherapy session. You will have a blood test before your next chemotherapy. If your white blood cells are still low, your doctor may postpone the treatment for a short period of time.

BRUISING AND BLEEDING

Mitoxantrone may lower the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any unexplained bleeding or bruising. This includes nosebleeds, bleeding gums, blood spots, or skin eruptions (rashes). Some people may require additional platelets.

ANEMIA

Mitoxantrone may lower the number of red blood cells in your blood. Red blood cells transport oxygen throughout the body. If you have a low number of red blood cells, you may be tired and short of breath. Tell your doctor or nurse if you feel like this. If you are very anemic, it's possible you will require a blood transfusion.

DISCOLORED URINE

Your urine may take on a bluish-green color for a maximum of 48 hours after having the treatment. This is because of the color of mitoxantrone.

NAUSEA

This can happen on the first few days after chemotherapy. Your doctor will prescribe you antiemetic drugs to help prevent or control your nausea. It is easier to prevent nausea than it is to treat it once it has begun.

If you still have nausea or are vomiting, get in touch with the hospital as soon as possible. They can give you advice and change your medication to one that works better.

TIREDNESS

Feeling very tired is a common side effect. Fatigue is often worst toward the end of treatment and for a few months after the treatment has finished. Try to pace yourself and rest as much as you need to. Help balance this with a bit of light exercise, such as short walks. If you feel drowsy, don't drive or operate heavy machinery.

LOSS OF APPETITE

You may lose your appetite during the treatment. Try to eat in small quantities and have frequent meals. Don't worry if you don't eat much for a day or two. If your appetite doesn't get any better after a few days, tell your nurse or dietitian. They can give you nutritional supplements or good-tasting meal-replacement drinks.

SORENESS OF THE MOUTH

You may have a sore mouth or mouth ulcers, which could make you more prone to getting a mouth infection. Lightly brush your teeth and/or dentures in the morning and night and after meals. Use a soft-bristle toothbrush. Your nurse might ask you to rinse your mouth out regularly or use mouthwash. It is important that you follow all the instructions you are given and that you drink a lot of fluids.

Tell your nurse or doctor if you have any mouth problems. They can prescribe you drugs to prevent or treat infections of the mouth and to treat any kind of pain.

DIARRHEA

Your doctor can prescribe medicines to control diarrhea. Let them know if your diarrhea is severe or if it doesn't get better. Make sure you drink at least two liters of fluids each day if you have diarrhea.

CONSTIPATION

Mitoxantrone can cause constipation. Drinking at least two liters of fluids each day will help if this is the case. Try to eat more high-fiber foods such as fruit, vegetables, and whole-grain bread and get some light exercise.

HAIR LOSS

Your hair may thin out, though it is unlikely you will lose all of the hair on your head. Hair loss normally starts after your first or second cycle of chemotherapy. It is almost always temporary, and the hair will continue to grow after you finish your treatment. Your nurse can give you advice on how to cope with losing your hair.

CHANGES IN THE KIDNEYS AND LIVER

Mitoxantrone can affect the way the kidneys and liver function. These changes are normally mild and return to normal after the treatment. You will have blood tests done before the chemotherapy to see how your kidneys and liver are functioning.

ELEVATED LEVELS OF URIC ACID (tumor lysis syndrome)

Mitoxantrone can make cancer cells decompose rapidly. This releases uric acid (a waste product) into the blood. Excess uric acid may cause joint swelling and pain, known as gout.

Your doctor can give you allopurinol to help keep this from happening. Drinking at least two liters of fluids each day will also help. You will have periodic blood tests done to check your levels of uric acid.

EYE PROBLEMS

You may have soreness in your eyes, and your doctor can prescribe drops to help. If your eyes become red and inflamed (conjunctivitis), tell your doctor, as you may need antibiotic drops.

Mitoxantrone can make the whites of your eyes take on a slightly bluish tinge. This disappears once the treatment is over.

CHANGES IN YOUR NAILS

Your nails may become fragile and break more easily. They may turn a bluish color. These changes tend to go away within months of the completion of your treatment. Though rare, your nails can fall out, though they will grow back after the treatment is over.

EFFECTS ON THE NERVOUS SYSTEM

Mitoxantrone can affect the nervous system. You may feel anxious or restless, have trouble sleeping or experience mood swings. Tell your doctor or nurse immediately if you have any of these symptoms. It is important not to drive or operate machinery if you notice these effects.

LESS COMMON SIDE EFFECTS OF MITOXANTRONE

CHANGES IN THE HEART

This treatment can affect the way the heart works, though this is usually temporary. You may have tests done before, during, and after your treatment to see how your heart is working.

If you have pain or pressure in your chest, feel out of breath, or notice that your heart is beating faster at any time during or after treatment, let your doctor know immediately. These symptoms could be caused by other conditions, but it important to have them looked at by a doctor.

CHANGES TO THE LUNGS

Mitoxantrone can cause changes in the lungs. You are more likely to have these if you have previous lung problems. Always let your doctor know if you have wheezing, coughing, fever, or if you are out of breath. If necessary, tests can be done to check your lungs.

SECOND CANCER

In rare cases, mitoxantrone can increase the risk of developing a second cancer such as leukemia years down the road. Overall, however, the benefits of the treatment far outweigh this risk. Your doctor can talk to you about this.

MORE INFORMATION ABOUT MITOXANTRONE

BLOOD CLOT RISK

Cancer and chemotherapy increase the chances of a blood (thrombosis). The symptoms include pain, reddening or swelling in a leg, difficulty breathing, and pain in the chest. Get in touch with your doctor immediately if you have any of these symptoms.

OTHER DRUGS

Some medicines can interact with chemotherapy or be harmful if they are taken alongside chemotherapy. This includes medications that can be purchased in a store or pharmacy. Tell your doctor the medicines you are taking, including over-the-counter medications, complementary therapies, and herbal medicines.

ALCOHOL

Your doctor will advise you against drinking alcohol while taking mitoxantrone, as it can interact with the medication.

FERTILITY

Mitotane may affect your fertility. If this worries you, you can talk to your doctor before beginning treatment.

CONTRACEPTION

Your doctor will advise you not to become pregnant during the treatment. This is because the drugs can harm developing babies. It is important to use contraception during chemotherapy and for a few months after the treatment ends.

SEX

If you have sex within the first few days after chemotherapy, it is necessary to use a condom. This is to protect your partner in case there is chemotherapy in semen or vaginal fluid.

BREASTFEEDING

Women are recommended not to breastfeed during treatment and for a few months after chemotherapy has concluded. This is in case the chemotherapy enters their breast milk.

MEDICAL AND DENTAL TREATMENT

If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are having chemotherapy.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always let your dentist know that you are having chemotherapy.