Gemtuzumab Ozogamicin (Mylotarg™)
Pronounce: gem-TOO-zoo-mab oh-zog-a-MY-sin
Classification: Monoclonal antibody/Antibody drug conjugate
About Gemtuzumab Ozogamicin (Mylotarg™)
An antibody is a protein made by your body to help your immune system find and stop bacteria and viruses from attacking your body. A monoclonal antibody is an antibody made in a lab that can attach to certain cancer cells in your body. Your immune system then attacks and kills the cancer cell that it is attached to. Monoclonal antibodies work with your immune system to kill cancer cells by: Getting your immune system to attack cancer cells, blocking cell growth, or blocking other things the cancer cells need. Ask your provider about the type of monoclonal antibody you are taking and how it works.
This medication is an anti-CD33 antibody combined with a calicheamicin and a drug linker. A drug linker helps attach the antibody to the targeted cells, helpimg it to enter and cause DNA damage to the cancer cell, killing it.
How to take Gemtuzumab Ozogamicin
This medication is given by an intravenous (IV, directly into a vein) infusion. This medication can be given alone or in combination with other medications. The dose is based on a combination of your height and weight. How often you receive the medication will be decided by your provider. Before each dose, you will be given acetaminophen, diphenhydramine, and a corticosteroid to help prevent any reactions.
Possible Side Effects
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.
Liver Toxicity
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.
This medication can also cause a serious side effect called veno-occlusive disease, also known as hepatic sinusoidal obstruction syndrome. This is caused when blood flow through the small veins of the liver is blocked. Call your provider right away if you have yellowing of the skin or eyes, discomfort in the upper abdomen, weight gain, or fluid build-up in the belly.
Fatigue
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.
Infection and Low White Blood Cell Count (Leukopenia or Neutropenia)
This medication can cause serious infections, with or without a decrease in white blood cell counts.
White blood cells (WBC) help your body fight infection. While you are having cancer treatment, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (a 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.
- Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or if someone you live with has 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.
Low Platelet Count (Thrombocytopenia) and Severe Bleeding (Hemorrhage)
This medication can lead to serious bleeding. 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.
QT Prolongation
QT prolongation is when your heart is not working how it should, and it can cause slow or abnormal heartbeats or an abnormal heart rhythm. Tell your provider right away if you feel abnormal heartbeats or if you feel dizzy or faint.
Nausea and/or Vomiting
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.
Constipation
Constipation is when you have less bowel movements than usual or are having trouble passing stool. To relieve constipation, you can include fiber in your diet (fruits like prunes, apples, peaches, and pear nectars/juices), drink 8 to 10 glasses of non-alcoholic fluids a day, and stay active. Taking a stool softener once or twice a day can prevent constipation. If you do not have a bowel movement for 2 to 3 days, call your provider.
Fertility
This medication may affect your fertility. It can cause changes to your menstrual cycle or sperm. You may want to consider sperm banking or egg harvesting if you might wish to have a child in the future. Talk about your options with your provider before treatment.
Reproductive Concerns
There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.
If you can become pregnant, you will need to use effective birth control during treatment and for 6 months after the last dose of this medication, even if your menstrual cycle has stopped or changed. If you can get someone pregnant, you will need to use effective birth control during treatment and for 3 months after the last dose of this medication, even if you believe you are not producing sperm. You should not breastfeed during treatment and for 1 month after the last dose of this medication.
Important but Less Common Side Effects
Infusion-Related Side Effects
Some people may have a reaction during infusion of this medication. These can be:
- Chills.
- Fever.
- Low blood pressure.
- Nausea.
- Vomiting.
Your provider will monitor you for symptoms of infusion-related reactions.