Thiotepa

Thiotepa (Tepadina^®) is used to treat some blood cancers and several other types of cancer. It is given before a stem cell transplant or bone marrow transplant.

It is best to read this information with our general information about chemotherapy and the type of cancer you have.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have 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.

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. 

Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.

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.

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.

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.

This treatment will reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

Thiotepa can increase your risk of sepsis. Sepsis is a serious and potentially life-threatening complication of an infection. We have further information about sepsis. 

If you are having a stem cell or bone marrow transplant, you will probably be looked after in a single room for a few weeks. This is to reduce your risk of infection. Your nurse will give you drugs to help prevent or to treat an infection, if you have one. They will take your temperature regularly and check you for signs of an infection. 

The number of white blood cells should gradually increase after the stem cell or bone marrow transplant. You will have regular blood tests to check this. You may be given medication to help increase the white cell count.

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 
• unexpected bleeding from the vagina. 

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. 

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.

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.

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.

This treatment can raise your blood sugar levels and increase the risk of diabetes. 

Signs of raised blood sugar include:

• feeling thirsty
• needing to pass urine (pee) more often than usual
• feeling more tired than usual. 

Tell your doctor or nurse if you have these symptoms. They can do tests to check your blood sugar level and give you advice.

If you already have diabetes, your blood sugars may be higher than usual. You may need to check them more often, or make changes to your diabetic treatment. Your diabetic doctor or nurse will talk to you about how to manage this.

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.

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.

This treatment can cause inflammation in the gullet, stomach, or bowel.

You may get pain or discomfort in your tummy (abdomen), feel bloated or have indigestion.

Contact the doctor on the 24-hour emergency number the hospital has given you or go to the hospital straight away if you have:

• severe tummy pain or a fever.
• blood or mucus in your stools (poo)
• dark or tar-like (sticky) stools  

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 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. 

Rarely, this treatment can cause a serious skin reaction that needs to be treated immediately in hospital. Contact the hospital straight away on the 24-hour number if you have any of these symptoms: 

• a skin rash that is spreading
• blistering or peeling skin 
• flu-like symptoms, such as a high temperature and joint pain 
• sores on your lips or in your mouth.

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. 

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.

Your eyes may become red and inflamed (conjunctivitis). Your doctor may prescribe eye drops to help prevent this. It is important to use these as instructed.

It can also cause blurry vision. Always tell your doctor or nurse if you have pain or notice any change in your vision. You should not drive or operate machinery if you notice changes to your eyesight. 

This treatment may cause hearing changes, including hearing loss. You may have ringing in the ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds. Hearing changes may get better after this treatment ends. But this does not always happen. If you notice any changes in your hearing, tell your doctor, nurse or pharmacist.

Thiotepa may cause high blood pressure. A nurse will check your blood pressure regularly during treatment. If you have headaches, nosebleeds or feel dizzy, let your doctor know. Your doctor can usually prescribe tablets to control high blood pressure. Let your doctor know if you already have high blood and are taking tablets for it.

This treatment may affect how your liver works. This is usually mild but sometimes liver problems can cause the skin or the whites of the eyes to become yellow.

You will have regular blood tests before, during and after treatment to check how well your liver is working. You may be given drugs to help prevent or treat liver problems.

Thiotepa can irritate your bladder and cause pain when you pass urine. Tell your doctor or nurse if this happens. 

This treatment can affect the nervous system. Tell your doctor or nurse straight away on the 24-hour contact number if you notice any of these symptoms:

• numbness or tingling in your arms or legs
• problems with moving
• loss of balance or co-ordination
• loss of memory or concentration
• feeling confused
• feeling anxious or restless

You should not drive or operate machinery if you have these symptoms.

Thiotepa can cause fits (seizures). Tell your doctor straightaway if you have had a fit.

You may get pain in your back, muscles or joints. If this happens, tell your doctor so they can give you painkillers.

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.

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.

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.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and 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.

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. 

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.

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.

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.