A10.

Summary of adverse events associated with specific drugs for lymphoma treatment

Drug name	Adverse events	Mechanism	Treatment
Rituximab (CD20)	Transfusion reaction	Specific antigenic antibody reaction between rituximab and CD20 of lymphocyte	Pretreatment: acetaminophen and diphenhydramine 30 min before transfusion; Transfusion should be stopped once severe transfusion reaction occurs, and transfusion could be continued only if all symptoms disappear and laboratory results turn to normal, with an infusion speed less than half of the previous speed. Stopping treatment should be considered once the same reaction occurs.
	Cutaneous and mucous reaction (Stevens-Johnson syndrome, blister bullosa dermatitis and toxic epidermal necrolysis)	Delayed III type hypersensitivity (allergic reaction)	Methylprednisolone pulse treatment
	HBV reactivation	HBV reactivation can be found in drug therapy, thus severe results like fulminant hepatitis can be induced.	Patients who are expected to chemotherapy or riuximab should first test HBsAg. With a positive result, viral load detection and appropriate treatment should be conducted before tumor therapy. With HBV DNA ≤2,000 IU or chemotherapy less than one year, lamivudine or telbivudine can be used as antiviral therapy. Otherwise, entecavir or tenofovir as antiviral therapy
Anthracyclines	Delayed cardiotoxicity	Anthracyclineschelate iron ion to activate oxygen free radical, especially hydroxyl free radicals. Resulting lipid peroxidation of myocardial cell membrane and damaging cardiac mitochondria DNA	Detect and prevent cardiotoxicity resulted from anthracyclines; The maximal dosage should be controled: the maximum permissible accumulated dose is 450−550 mg/m2; Radiotherapy or combined therapy should less than 350−400 mg/m2; With EPI as 900−1,000 mg/m2, less than 800 mg/m2 for patients who have used ADM; THP as 950 mg/m2; DNR as 550 mg/m2; MIT as 160 mg/m2, less than 120 mg/m2 for patients who have used ADM.
HD-MTX (MTX ≥500 mg/m2)	Increasing of level of serum ALT and renal insufficiency	Damaging normal cell metabolisms, with folinic acid as a treatment	Transfusion, diuresis, alkalization of urine should be conducted before and after treatment; After HD-MTX transfusion, folinic acid treatment for 2−3 d to reduce toxic effect of MTX.