Bendamustine Hydrochloride (Bendeka®, Treanda®)

This medication may cause burning or pain, even when given correctly by trained staff. Sometimes, the medication can leak out of the vein and cause damage to nearby tissue. Let your provider know right away if where your medication is (or was) given becomes red, swollen, or painful. 

Extravasation can be treated differently depending on the medication, so do not put anything on the area unless your provider tells you to.

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

White blood cells (WBC) help your body fight infection. While you are having treatment for cancer, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:
•    Hand washing: both yours and your visitors is the best way to prevent the spread of infection.a disease
•    Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
•    When working outside, wear clothes that protect you, like long pants and gloves.
•    Do not handle pet waste.
•    Keep all cuts and scratches clean.
•    Shower or bathe daily.
•    Brush your teeth at least twice a day.
•    Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
•    Ask your providers before scheduling dental appointments or procedures.
•    Ask your providers before you or someone you live with has any vaccines. 

Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.

Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor. 

• Do not use a razor (an electric razor is fine).
• Do not do activities that can cause injury or bleeding.
• Talk to your provider before taking any non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding. 
• Use a soft-bristle toothbrush to brush your teeth. Ask your provider about flossing or using toothpicks. 

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.  

Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first, as your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.

Fatigue can cause exhaustion, feeling worn out and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.

This medication increases your risk for infection. You should let your provider know right away if you have:

• A fever. Call for a temperature over 100.4°F or 38°C or as directed by your provider.
• Sore throat or cold.
• Shortness of breath.
• A cough.
• Burning with urination.
• A sore that doesn't heal.

The most common infection related to this medication is a urinary tract infection. Symptoms may be:

• Having to go to the bathroom often.
• A strong urge to urinate.
• Burning with urination.

Tips for preventing infection:

• Washing your hands is the best way to prevent the spread of infection.
• Ask your visitors to wash their hands too.
• Avoid large crowds and people who are sick (i.e., those who have a cold, fever, or cough, or live with someone who is sick).
• When working in your yard, wear protective clothing, like long pants and gloves.
•  Do not handle pet waste.
• Keep your cuts and scratches clean.
• Shower or bathe daily and do frequent mouth care like brushing and flossing.
• Do not cut your cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Talk to your provider before scheduling dental appointments or procedures.
• Ask your provider before you or someone you live with gets any vaccinations.

Some people may get a rash, scaly skin, or red, itchy bumps from this medication. Tell your provider if you notice any of these changes in your skin, since it could be a reaction. Your provider may suggest:

• Using an alcohol-free moisturizer on your skin and lips, and do not use moisturizers with perfumes or scents. 
• Keep the area clean to avoid infection, especially if it cracks or bleeds.
• Using a topical medication (applied to the skin) if the itching bothers you.

Be sure to talk with your provider about how to care for your skin.

Tumor Lysis Syndrome (TLS) is a side effect that happens when tumor cells die too quickly, and their waste overwhelms the body. You may be given a medication (allopurinol) and IV fluids to help prevent this. TLS can affect your kidney function. Your provider will monitor your kidney function with blood work. Symptoms may be:

• Nausea.
• Vomiting.
• Diarrhea.
• Lethargy (feeling tired, drowsy, sluggish).
• Little or no urine output.

Tell your provider right away if you have any of these symptoms.

This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:

• Yellowing of your skin or eyes.
• Dark or brown urine.
• Pain in your abdomen (belly).

Tell your provider if you have any of these symptoms.

Progressive Multifocal Leukoencephalopathy (PML) is a rare but very serious brain infection. The symptoms of PML may come on slowly over weeks or months. They may be:

• Changes in mood or usual behavior.
• Confusion.
• Thinking problems.
• Loss of memory.
• Changes in vision, speech, or walking.
• Decreased strength or weakness on one side of your body.

If you have any of these symptoms, tell your provider right away.