Gemtuzumab ozogamicin (Mylotarg®) with daunorubicin and cytarabine (DA)
What is gemtuzumab ozogamicin (Mylotarg®) with daunorubicin and cytarabine?
Gemtuzumab ozogamicin with daunorubicin and cytarabine is a combination of cancer drugs. It is used to treat acute myeloid leukaemia (AML).
Gemtuzumab ozogamicin is also called Mylotarg®. It is a type of cancer drug treatment called an antibody drug conjugate (ADC). ADCs link together a monoclonal antibody (a type of targeted therapy) with a chemotherapy drug. In this information, we use the term gemtuzumab to mean gemtuzumab ozogamicin.
Daunorubicin and cytarabine are both chemotherapy drugs. The combination of daunorubicin and cytarabine is sometimes called DA.
It is best to read this information with our general information about cancer drug treatments and the type of cancer you have.
Your cancer team will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
More information about this treatment
This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.
You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.
Having gemtuzumab with daunorubicin and cytarabine
Gemtuzumab, daunorubicin and cytarabine are each given as a drip or an injection into a vein (intravenously). You usually have the treatment during a stay in hospital.
During your course of treatment, you will meet someone from your cancer team, such as a:
- blood cancer doctor (haematologist)
- chemotherapy nurse or specialist nurse
- specialist pharmacist.
This is who we mean when we mention doctor, nurse or pharmacist in this information.
During your treatment, you will have regular blood tests. This is to check that it is safe for you to have treatment. If your blood results are okay, the pharmacy team will prepare your cancer drugs.
Your nurse will usually give you anti-sickness drugs before the cancer drugs. They may also give you other medicines to help prevent an allergic reaction. You will have your cancer treatment through one of the following:
- a central line – a fine tube that goes under the skin of the chest and into a vein close by
- a PICC line – a fine tube that goes into a vein in the arm and up into a vein in the chest
- an implantable port (portacath) – a disc that goes under the skin on the chest or arm and into a vein in the chest
- a cannula – a short, thin tube the nurse puts into a vein in the arm or hand.
Your nurse will give you:
- gemtuzumab as a drip (infusion) over 2 hours
- daunorubicin as a slow injection or an infusion
- cytarabine as a slow injection or an infusion.
Your cancer team will explain more detail about how each drug will be given.
Your course of treatment
Your white blood cell count needs to be below a certain level before starting treatment. If your white blood cell count is very high you may be given a drug called hydroxycarbamide to reduce it before starting treatment with gemtuzumab with daunorubicin and cytarabine.
Gemtuzumab with daunorubicin and cytarabine is given in treatment cycles. After each cycle of treatment, you will have a bone marrow biopsy. This helps your doctors plan your next treatment.
Each cycle is usually about 28 days long, but it may be longer depending on your bone marrow biopsy results. With the first cycle, you have treatment for the first 7 days. After this, you usually have treatment on the first 3 or 4 days of each cycle.
You will have 1 or 2 cycles of treatment with gemtuzumab with daunorubicin and cytarabine to get rid of the leukaemia cells. This is called induction treatment.
After this you have 1 or 2 more cycles of treatment to help reduce the risk of the leukaemia coming back. This is called consolidation treatment. Some people may be able to have consolidation treatment as an out-patient, but this is not suitable for everyone.
For each cycle of treatment, your cancer team will explain:
- which days you have treatment
- which drugs you have on each day
- how each drug will be given.
These vary with each cycle of treatment.
About side effects
We explain the most common side effects of this treatment here. We also include some that are less common.
You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here.
Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you:
- drugs to help control some side effects
- advice about managing side effects.
It is important to take any drugs exactly as explained. This means they will be more likely to work for you.
Serious and life-threatening side effects
Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.
Contact the hospital
Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
Side effects while treatment is being given
Some people may have side effects while they are having this treatment or shortly after they have it.
Allergic reaction
Some people have an allergic reaction while having this treatment. Before treatment, you will have medicines to help prevent or reduce any reaction.
Signs of a reaction can include:
- feeling hot or flushed
- shivering
- itching
- a skin rash
- feeling dizzy or sick
- a headache
- feeling breathless or wheezy
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, they can treat it quickly.
Sometimes a reaction happens a few hours after treatment. If you develop any of these signs or feel unwell after you get home, contact the hospital straight away on the 24-hour number.
Always call 999 if swelling happens suddenly or you are struggling to breathe.
The drug leaks outside the vein
Sometimes cancer drugs that are given into a vein may leak outside the vein. If this happens, some drugs can damage the tissue near the vein. This is called extravasation. Extravasation is not common, but it is important that it is dealt with quickly. If you have any of the following symptoms around the vein during or after your treatment, tell your nurse straight away:
- stinging
- pain
- swelling
- if you have white skin, the area may become red
- if you have black or brown skin, the area may become darker.
Red urine
Your urine may be a pink-red colour for up to 48 hours after you have your treatment. This is caused by daunorubicin and is not harmful.
Cytarabine syndrome
Cytarabine may cause some symptoms, usually about 6 to 12 hours after it has been given. Symptoms can include:
- a high temperature or chills
- a rash
- pain in the eyes, bones, tummy or chest.
This is called cytarabine syndrome. Your doctor, nurse or pharmacist may give you medicines such as steroids, to help prevent or treat it.
If you have any of these symptoms, tell your nurse, doctor or pharmacist.
Most common side effects
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.
An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:
- a temperature above 37.5°C
- a temperature below 36°C
- you feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- breathlessness
- diarrhoea
- needing to pass urine (pee) often, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
Your white blood cell count will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- nosebleeds
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin.
If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:
- very low in energy
- breathless
- dizzy and light-headed.
If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Effects on the liver
This treatment can affect how the liver works. You will have regular blood tests to check this. Sometimes liver changes can be serious. Contact the hospital straight away on the 24-hour number if you have any of these symptoms:
- yellow skin or eyes
- feeling very sleepy
- dark urine (pee)
- unexplained bleeding or bruising
- pain in the right side of your tummy (abdomen).
If you have black or brown skin, changes in your skin colour may be less noticeable. You might first notice the whites of your eyes look yellow, or that the colour of your urine has changed.
Raised blood sugar levels
This treatment may raise your blood sugar levels and increase the risk of diabetes.
You will have regular blood tests to check this.
Contact the hospital on the 24-hour number if you have these symptoms during treatment or after it ends:
- feeling thirsty all the time
- needing to pass urine (pee) more often than usual
- feeling more tired than usual.
- losing weight without trying.
If you have diabetes, your blood sugar levels may be higher than usual. You may need advice and support from your GP or diabetes team about managing this.
Changes in blood pressure
This treatment can affect your blood pressure. Your blood pressure may become higher or lower than normal. Tell your nurse, doctor or pharmacist if you have headaches or feel dizzy. These can be signs of blood pressure changes.
Feeling sick
The nurses will give you anti-sickness drugs regularly. This will help prevent or control sickness during your treatment in hospital. If you feel sick or are sick (vomit), tell your nurse or doctor straight away. They can change the anti-sickness treatment. Or they might change the way you have it to something that works better for you.
Diarrhoea
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual.
If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:
- taking anti-diarrhoea medicines
- drinking enough fluids to keep you hydrated and to replace lost salts and minerals
- any changes to your diet that might help.
They might also ask you for a specimen of your stool to check for infection.
Tummy pain
You may get pain in your tummy (abdomen), or have indigestion. Your doctor, nurse or pharmacist can give you advice or treatment to help. Contact the hospital straight away on the 24-hour number if your symptoms do not go away, or get worse.
Constipation
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help.
If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away.
Loss of appetite
This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
Contact the hospital straight away on the 24-hour number, if:
- a sore mouth or throat affects how much you can drink or eat
- your mouth, tongue, throat or lips have any blisters, ulcers or white patches.
They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:
- drink plenty of fluids
- avoid alcohol and tobacco
- avoid food or drinks that irritate your mouth and throat.
Hair loss
Your hair will get thinner. Or you may lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair. Hair loss usually starts after your first or second treatment.
If you want to cover up hair loss, there are different ways you can do this. Your nurse will give you information about coping with hair loss.
Remember to protect your skin from the sun. Use suncream with a sun protection factor (SPF) of at least 30 on your scalp. Or cover up with a hat or scarf.
Hair loss is almost always temporary. Your hair will usually grow back after treatment ends.
Skin changes
Chemotherapy can affect your skin. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.
This treatment can also:
- cause a rash, which may be itchy
- make your skin darker in some areas
- make any area treated with radiotherapy become red or sore. If you have white skin the area will become red and if you have black or brown skin the area might become darker.
- make you more sensitive to the sun.
Your skin may burn more easily during treatment and for several months after. Use a sun cream of at least SPF 30. SPF stands for sun protection factor. Cover up with clothing and wear a hat.
Always tell your doctor, nurse or pharmacist about any skin changes. They can give you advice or prescribe creams or medicines to help. Changes to your skin are usually temporary and improve when treatment ends.
Fluid build-up
This treatment can cause a build-up of fluid in the body. This will slowly get better after treatment ends. Contact the hospital on the 24-hour number if you:
- are gaining weight
- have swelling in your face, legs or ankles.
They can give you advice and treatment to help.
Feeling tired (fatigue)
This treatment can make you feel very tired and you will need a lot of rest. You may get tired easily for some months after treatment ends. Gentle exercise, like short walks, can help you feel less tired. The tiredness will slowly get better.
If you feel sleepy, do not drive or use machinery.
Effects on the heart
This treatment can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.
If the treatment is causing heart problems, your doctor may change the type of treatment you are having.
Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:
- breathlessness
- dizziness
- changes to your heartbeat (palpitations)
- swollen feet and ankles.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor.
Always call 999 if you have:
- chest pain, pressure, heaviness, tightness or squeezing across the chest
- difficulty breathing.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor, nurse or pharmacist if you develop:
- a cough that does not go away
- wheezing
- breathlessness.
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
Other side effects
Effects on the eyes
Cytarabine may make your eyes feel sore, red, dry or itchy. Your cancer team will prescribe steroid eye drops to help prevent this. It is important to use these exactly as explained.
Contact the hospital on the 24-hour number if:
- your eyes get red and inflamed (conjunctivitis)
- you have pain in your eyes
- you notice any change in your vision.
Tumour lysis syndrome (TLS)
Some people are at risk of developing a condition called tumour lysis syndrome (TLS). The risk is highest at the beginning of treatment. TLS happens when treatment makes large numbers of cancer cells die and break down quickly. This releases lots of waste products into the blood and can affect the kidneys and heart.
TLS can be prevented or treated. You will have regular blood tests to check for TLS. You may have:
- extra fluids through a drip
- medicines such as allopurinol tablets or rasburicase through a drip.
Drinking at least 2 litres (3½ pints) of fluid a day will also help.
Problems passing urine (peeing)
Some people find it difficult to pass urine (pee) after having cytarabine. If this is a problem for you, tell your doctor or nurse straight away, or contact the hospital on the 24-hour number.
Effects on the kidneys
This treatment can affect how the kidneys work. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your kidneys are working. Contact the hospital on the 24-hour number if you:
- have blood in your urine (pee)
- are passing less urine or peeing less often than usual.
Drinking fluids helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.
If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.
Nail changes
This treatment can affect your nails. They may grow more slowly or break more easily. You might notice ridges or white or dark lines across your nails. These changes usually disappear as the nails grow out after treatment. Sometimes nails can become loose or fall off. Tell your doctor, nurse or pharmacist about any changes to your nails.
If the skin around your nails becomes sore and swollen, contact the hospital straight away on the 24-hour number. These might be signs of an infection.
Muscle or joint pain
You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor, nurse or pharmacist. They can give you painkillers and advice. They can also tell you if any of the painkillers you usually take are suitable.
Tell them if the pain does not get better. Having warm baths and resting regularly may help.
Effects on the brain
Rarely, this treatment causes a brain condition that can be serious. You can make a full recovery from this. But it must be diagnosed and treated quickly.
This condition can cause:
- a headache that does not get better
- drowsiness or confusion
- changes in eyesight
- fits (seizures).
If you have any of these symptoms, it is important to either:
- contact the hospital straight away on the 24-hour number
- go to the hospital straight away.
You should not drive yourself to hospital.
Second cancer
This treatment can increase the risk of developing a second cancer years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor, nurse or pharmacist can give you more information.
Other important information
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:
- throbbing pain or swelling in a leg or arm
- reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
- suddenly feeling breathless or coughing.
Always call 999 if you have:
- chest pain
- difficulty breathing.
A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.
Other medicines
Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop, pharmacy or online
- vitamins or supplements
- herbal drugs and complementary or homeopathic therapies
- recreational drugs – for example, cannabis.
Vaccinations
Cancer doctors usually recommend that people with cancer have vaccinations for flu and coronavirus (covid). They may also recommend other vaccines, such as Shingrix® for shingles. These all help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.
You should not have live vaccines if your immune system is weak. This includes if you are having or recently had chemotherapy, radiotherapy or other cancer treatments that affect your immune system. Live vaccines can make you unwell because they contain a very weak version of the illness they protect you against. There are several live vaccines, including the yellow fever vaccine.
It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.
Contraception
Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:
- what types of contraception to use
- how long after treatment you should continue to use contraception.
Breastfeeding
You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk.
Your doctor, nurse or pharmacist can give you more information.
Changes to periods
If you have periods, these may become irregular or stop while you are having this treatment. They might return after treatment, but this does not always happen. Your menopause may start sooner than it would have done. Your doctor, nurse or pharmacist can give you more information.
Fertility
Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.
Sex
It is possible that small amounts of chemotherapy may be passed on through vaginal fluids or semen. If you have sex in the first few days after treatment, your cancer team will usually advise using condoms or a dental dam to protect your partner.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.
If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for more detailed information. The leaflet lists all known side effects.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.
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We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
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