NCCN Guidelines for Patients
Acute Lymphoblastic Leukemia, Version 1.2017
Side effects of TKIs
Some side effects listed below are caused by only
one TKI. Others are caused by all or most TKIs but
differ in how likely they are to occur. Some common
side effects of TKIs are low blood cell counts,
abnormal bleeding, fatigue, nausea and vomiting,
diarrhea, and stomach or belly pain.
These drugs may cause swelling due to fluid buildup
around the eyes or in the hands and feet. Fluid may
also collect around the lungs. Other common side
effects include skin rashes, headaches, and muscle,
bone, and joint pain. A rare but serious side effect
that may happen with TKIs is a change in the rhythm
of your heartbeat.
Other rare but serious side effects may be caused by
certain TKIs. For example, dasatinib may cause fluid
buildup around the lungs. Nilotinib may cause the
amount of sugar (glucose) in the blood to be higher
than normal. Serious side effects of ponatinib include
heart problems, blood clots, narrowing of blood
vessels, heart attack, and stroke. Liver problems or
inflammation of the pancreas may also happen.
Monoclonal antibodies are another type of targeted
therapy used for ALL. A monoclonal antibody is a
type of immune system protein that is made in a lab.
Monoclonal antibodies attach (bind) to proteins on
cancer cells. Most monoclonal antibodies can bind to
only one protein.
Blinatumomab is one of the newer treatments for
ALL. It is a monoclonal antibody that may be used for
certain patients with B-cell ALL after other treatments
didn’t work well.
Blinatumomab is a special kind of antibody that can
bind to two proteins at the same time. It binds to a
protein called CD19 that is found on immature B-cells
and some leukemia cells. It also binds to a protein
called CD3 that is found on normal T-cells. T-cells
are part of the body’s immune system. By binding to
these two proteins, blinatumomab links the T-cells
to the leukemia cells. This helps the immune system
find and kill the leukemia cells.
Blinatumomab is a liquid that is slowly injected into
a vein over 28 days. This is called a continuous
infusion. Blinatumomab should only be given in a
cancer center that has experience with this drug. You
may need to stay in the hospital for the first few days
Side effects of this drug are fever, skin rash, nausea,
diarrhea, constipation, swelling of the hands and feet,
headache, and shaking (tremor). It can also cause
low white blood cell counts, which increases the risk
Though uncommon, a severe reaction during
the infusion may happen. This can cause trouble
breathing, headache, feeling dizzy or lightheaded,
low blood pressure, fever, chills, and face swelling.
Other less common but serious side effects are
seizures, trouble speaking or slurred speech, passing
out, confusion, and loss of balance.
Rituximab is a monoclonal antibody that may be
used to treat certain patients with B-cell ALL. It binds
to a protein called CD20. This protein is found on
the surface of normal and abnormal B-cells. And, it
is found on the leukemia cells of about half of adults
with B-cell ALL.
When rituximab binds to CD20, it sends a signal to
the cell to die. It also marks the cells for destruction
by the immune system. Rituximab is not used alone
to treat ALL. Instead, it is added to a chemotherapy
combination regimen. It is given as a liquid that is
slowly injected into a vein.