ChIVPP

You usually have ChlVPP in a chemotherapy day unit or clinic as an outpatient.

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.

Before or on the day of each treatment, you will have a blood test. This is to check that it is safe for you to have treatment.

You will meet with a doctor, nurse or pharmacist before you have treatment. They will talk to you about your blood results and ask how you have been feeling. 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. You will have the drug vinblastine through 1 of the following:

• a cannula – a short, thin tube the nurse puts into a vein in the arm or hand
• 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 is put into a vein in the arm and goes up into a vein in the chest
• an implantable port (portacath) – a disc that is put under the skin on the chest or arm and goes into a vein in the chest.

Chlorambucil and prednisolone are tablets. Procarbazine is a capsule. The nurse or pharmacist will also give you these tablets and capsules to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you.  

Your cancer team may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they tell you to.

You should take your chlorambucil tablets on an empty stomach. Take them 1 hour before a meal. Or wait 3 hours after eating and then take them.

You should take prednisolone in the morning with food. This helps prevent indigestion or trouble sleeping at night.

Procarbazine capsules can be taken with or without food. There are certain foods and drinks you need to avoid when taking procarbazine and for 2 weeks after you have stopped taking it.  

Make sure you:

• swallow them whole with a glass of water
• do not chew, open, break or crush them
• take them at the same time every day.

If you forget to take a dose of:

• chlorambucil, you should contact the hospital for advice 
• prednisolone, take the missed dose as soon as possible within the same day unless it is time for your next dose  
• procarbazine, take the missed dose as soon as you remember unless your next dose is due within 2 hours.  In this case, you should skip the missed dose and take your next dose at your regular time. Always tell your doctor if you have missed a dose.  

Do not take a double dose of any forgotten tablets or capsules.

Other things to remember about your capsules/tablets:

• Wash your hands after taking them.
• Other people should avoid direct contact with them.
• You and your carer should wear gloves to handle your pee (urine) or sick (vomit) for up to 48 hours after you take procarbazine.
• Keep them in the original package and at room temperature, except for chlorambucil, away from moisture, heat and direct sunlight. Chlorambucil tablets should be stored in the fridge  
  Keep them safe, where children cannot see or reach them.
• If you are sick (vomit) just after taking them, do not take an extra dose. Take your next dose at the usual time. If you are sick just after taking the tablets or capsules, contact the hospital – do not take another dose. 
• Do not throw away unused capsules or tablets. Return them to your cancer team at the hospital.

When taking procarbazine, and for 2 weeks after you have stopped treatment, you should avoid:

• mature cheese (including processed cheeses)
• broad bean pods
• pickled herring
• salami, bologna and pepperoni sausage
• Oxo^®, Bovril^®, Marmite^® and other beef or yeast extracts
• over ripe fruit
• any other foods that are pickled, smoked ‘hung’ or ‘matured’
• alcohol
• non-alcoholic beers and wines.

This is because they can cause a reaction. Signs of a reaction include:

• feeling sick
• headaches
• sweating and flushing
• drowsiness
• dizziness
• a rash, which may be itchy
• sudden rise in blood pressure

This type of reaction is not common. But if you notice any of these symptoms, contact the hospital for advice. Your doctor, nurse or pharmacist can give you more advice on types of food and drink to avoid. 

You usually have a course of up to 8 cycles of ChlVPP over a few months. Your cancer team will discuss your treatment plan with you. They may give you a copy of the plan to take home.

Each cycle of ChlVPP is usually 28 days (4 weeks):

• On days 1 to 14, you usually take chlorambucil, procarbazine and prednisolone.
• On days 1 and 8, you are given vinblastine into a vein.

For the rest of the 28-day cycle, there is a rest period with no treatment. Then you start the next cycle on day 1 again. 

Some people have an allergic reaction while having this treatment. 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.

Sometimes cancer drugs, such as vinblastine, 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.  

These side effects happen to less than 10 in 100 people (less than 10%) who have this treatment. Some of them are much rarer than this but they are still important to know about. Rare means a side effect that happens to less than 1 in 1,000 people (less than 0.1%).

Steroids can make you feel hungrier than usual. You may gain weight. This is useful if you have a poor appetite. But it can be an unwanted side effect for some people. Your appetite should go back to normal when you stop taking steroids. If you are worried about gaining weight, talk to your doctor or nurse.

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 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. 

You may get pain in your tummy (abdomen) or have indigestion. Your doctor, nurse or pharmacist can give you advice or treatment to help. Steroids can irritate the stomach. Taking them with food can help. 

If you develop sudden or severe tummy pain, contact the hospital on the 24-hour number straight away.

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.

Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it ends. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired. 

If you feel sleepy, do not drive or use machinery.

Your hair may get thinner. But you are unlikely to lose all the hair from your head. Hair loss usually starts after your first or second treatment. It is almost always temporary, and your hair will usually grow back after treatment ends. 

Your nurse can talk to you about ways to cope with hair loss.

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.

Rarely, this treatment can cause a serious skin reaction that needs to be treated immediately in hospital. 

Do not take any more of this treatment and 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.

Steroids can affect your mood. You may feel anxious or restless, have mood swings or have problems sleeping. Taking your steroids in the morning may help you to sleep better. Tell your doctor or nurse if you have any of these side effects.

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.

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.

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

You will have regular blood tests to check this. 

Signs of raised blood sugar include:

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

Contact the hospital on the 24-hour number if you have these symptoms during treatment or after it ends.

If you already 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.

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.

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.

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).

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. 

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.