Remestemcel-L-rknd (Ryoncil®)

How to Take Remestemcel-L-rknd (Ryoncil®)

This medication is given by intravenous (IV, into a vein) injection. Your dose is based on your body size. Before infusion, you will be given steroids and antihistamine as a premedication to help lessen an infusion-related reaction to the medication You will be monitored closely during your treatment.

Tell your care team about all the medications you take, including prescription and over-the-counter medications, vitamins, and herbal supplements.

Possible Side Effects of Remestemcel-L-rknd

There are a number of things you can do to manage the side effects of remestemcel-L-rknd.  Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Infection (Viral/Bacterial)

This medication can cause life-threatening infections, with or without a decrease in white blood cell counts. You should let your provider know right away if you have a fever (temperature greater than 100.4°F/38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (such as those who have a cold, fever, or cough, or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bathe daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your oncology care team before scheduling dental appointments or procedures.
• Ask your oncology care team before you, or someone you live with has any vaccinations.

Fever

Fever can be a side effect of this medication. However, fever (temperature > 100.4°F or 38°C) can be a sign of infection. You should always call your care provider if you develop a fever while on treatment.

Liver Toxicity

This medication can cause liver toxicity, which your oncology care team may monitor using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, or you have pain in your abdomen, as these can be signs of liver toxicity.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your oncology care team know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.

• Do not use a razor (an electric razor is fine).
• Avoid contact sports and activities that can result in injury or bleeding.
• the over-the-counterDo not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), etc. as these can all increase the risk of bleeding. Please consult with your healthcare team regarding use of these agents and all over the counter medications/supplements while on therapy.
• Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Hemorrhage (Bleeding)

You may experience minor bleeding, such as a nosebleed. Serious bleeding has also occurred in patients treated with this medication, including coughing up blood, bleeding into the stomach, blood in stool, vomiting blood, bleeding in the brain (stroke), nosebleeds, and blood in the urine. While a nosebleed may not seem like much of a concern, you should notify your healthcare team right away if you develop bleeding of any kind.

Peripheral Edema

Peripheral edema is swelling of the extremities caused by the retention of fluid. It can cause swelling of the hands, arms, legs, ankles, and feet. The swelling can become uncomfortable. Notify your oncology care team if you are experiencing any new or worsening swelling.

Abdominal (Belly) Pain

This medication can cause you to have pain in your abdomen (belly). Call your provider if this pain becomes severe, or if you have a hard time eating, drinking, or doing daily activities.

High Blood Pressure

This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked regularly during therapy. Any hypertension should be treated appropriately. If hypertension cannot be controlled, the medication may be stopped. Report any headaches, vision changes, or dizziness to your oncology care team.

Less common, but important side effects can include:

• Ectopic tissue formation: MSCs can form into different kinds of cells. As a result, it can cause the growth of cartilage, fat cells, or bone where they don’t normally grow. Your care team will monitor you for this side effect.
• Infusion-Related Reactions: Infusion-related reactions could include changes in blood pressure or headaches. You will receive medications before the infusion to help prevent these reactions. Tell your care team right away if you notice any of these symptoms, as they may need to slow or stop the infusion. 

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. Talk with your team before breastfeeding while taking this medication.