ChlVPP is a chemotherapy treatment used to treat Hodgkin lymphoma (HL).
This information should ideally be read with our general information about cancer and Hodgkin lymphoma.
The drugs used in ChlVPP
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ChlVPP is named after the initials of the drugs used:
You have ChlVPP as an outpatient, so you can go home again after it’s done. A chemotherapy nurse will give it to you. During treatment, you will see a cancer doctor, a blood specialist (haematologist), a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
The nurse will put a short, thin tube (cannula) into a vein in your arm or hand.
Before giving you chemotherapy, the nurse will give you anti-sickness drugs as an injection into the cannula or as tablets.
Your nurse will then give you vinblastine through the cannula as a drip (infusion) over about 5–10 minutes. Your cannula will be removed after this. You have the rest of your treatment as tablets or capsules.
When the chemotherapy is being given
Some people may have side effects when the chemotherapy is being given:
The drug leaks outside the vein
If this happens when you’re having vinblastine, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common but if it happens it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Before you leave hospital, the nurse or pharmacist will give you chemotherapy drugs to take at home. They may also give you other drugs to prevent side effects such as sickness or infection. Take all your tablets exactly as explained. This is important as it makes sure they work as well as possible for you.
Taking your chemotherapy tablets
You will be given chlorambucil, procarbazine and prednisolone tablets to take when you are at home. Always take your tablets exactly as explained.
You’ll usually be advised to take prednisolone with breakfast in the morning. It’s important not to take it on an empty stomach as it can cause indigestion.
You’ll need to avoid alcohol and certain foods on days when you take procarbazine, and for 48 hours after taking it.
If you are sick just after taking the tablets, contact the hospital. You may need to take another dose. If you forget to take a tablet, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.
Other things to remember about your tablets:
Keep all tablets in their original package, away from heat and direct sunlight.
Keep chlorambucil in the fridge.
Keep tablets safe and out of the reach of children.
Return any remaining tablets to the pharmacist if your treatment is stopped.
Your course of ChlVPP
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of ChlVPP takes 28 days (four weeks).
On day 1 you have an infusion of vinblastine.
On days 1–14 you take chlorambucil, procarbazine and prednisolone tablets.
On day 8 you have a second infusion of vinblastine.
After you have finished all your tablets, you have a rest period with no chemotherapy for the next fourteen days (days 15-28). At the end of 28 days, you start your second cycle of ChlVPP.
You will usually have between 6–8 cycles over 6–8 months. Your doctor or nurse will tell you the number of cycles you are likely to have.
Possible side effects of ChlVPP
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We explain the most common side effects of ChlVPP here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
ChlVPP can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
ChlVPP can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you.
Vinblastine may make you constipated and cause tummy pain. Drinking at least two litres of fluids (three and a half pints) every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and take regular, gentle exercise.
If you haven’t had a bowel motion for two days, contact the hospital for advice. Your doctor can prescribe laxatives to help you. Always contact the hospital straight away if you are constipated and have tummy pain, or if you are being sick.
Tummy pain and/or indigestion
Steroids can irritate the stomach lining. Let your nurse or doctor know if you have pain in your tummy or indigestion. They can prescribe drugs to help reduce stomach irritation.
Take steroids with food to help protect your stomach.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Your hair may thin but you’re unlikely to lose all the hair from your head. Hair thinning usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Your skin may darken. It will return to its normal colour after you finish treatment.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Mood and behaviour changes
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 sleep better.
Tell your doctor or nurse if you have any of these side effects. They may change your treatment slightly if the side effects become a problem.
Appetite changes and weight gain
You may notice you feel hungrier than usual while taking prednisolone, and this can make you want to eat more. If you’re concerned about gaining weight, you can speak to your doctor, specialist nurse or dietitian.
Numb or tingling hands or feet
These symptoms are caused by the effect of vinblastine on the nerves. It’s called peripheral neuropathy. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but in some people they may never go away. Talk to your doctor if you are worried about this.
Vinblastine may cause pain in your jaw. Tell your nurse or doctor if you notice this.
Build up of fluid
You may put on weight or your ankles and legs may swell. This is because of fluid building up. It is caused by steroids and is more common if you are taking them for a long time. Tell your doctor or nurse if this happens to you. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling will decrease after your treatment ends.
Raised blood sugar levels
Steroids can raise the levels of sugar in your blood. Your nurse will check your blood regularly for this. They may also test your urine for sugar. Symptoms of raised blood sugar include feeling thirsty, needing to pass urine more often and feeling tired. Tell your doctor or nurse if you have these symptoms.
If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this. You may need to adjust the dose of your insulin or diabetes tablets.
Raised levels of uric acid in the blood
ChlVPP may cause the lymphoma cells to break down quickly. This releases uric acid (a waste product) into the blood. Too much uric acid can cause swelling and pain in the joints, which is called gout.
Your doctor may give you tablets called allopurinol to help prevent this. Drinking at least two litres of fluid a day will also help. You will have regular blood tests to check your uric acid levels.
Changes in the way the kidneys and liver work
ChlVPP can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests before chemotherapy to check how well your kidneys and liver are working.
Less common side effects of ChlVPP
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Rarely, chemotherapy drugs can cause an allergic reaction. Signs of a reaction can include: a rash, feeling itchy, wheezing, shortness of breath, swelling of your face or lips, or feeling unwell. If you develop any of these symptoms, contact the hospital on the numbers you’ve been given immediately or go to the nearest accident and emergency department.
It’s important to tell your doctor or nurse straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Other information about ChlVPP
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Interaction with alcohol and some foods
When you’re taking procarbazine, it’s best to avoid alcohol, alcohol-free beers and wines, and certain foods. They can cause a reaction, which can make you feel sick and cause headaches, sweating, drowsiness and breathing problems. Avoid foods such as mature cheeses, salami, and yeast or beef extracts (Oxo ®, Bovril ® and Marmite ®). Your nurse, doctor or pharmacist will give you more advice on foods to avoid.
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
ChlVPP may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
Anyone who has Hodgkin lymphoma should be given blood and platelet transfusions that have been treated with radiation (irradiated). This lowers the risk of the donated blood cells reacting against your own. Your hospital team should give you a card to carry or a MedicAlert ® to wear so hospital staff are aware in case of an emergency.
This section has been compiled using a number of reliable sources, including:
Perry MC. The Chemotherapy Source Book. 5th edition. 2012. Lippincott Williams and Wilkins.
electronic Medicines Compendium (eMC). medicines.org.uk (accessed November 2013).
With thanks to Man-Chie Chow, Lead Pharmacist Haemato-Oncology, who reviewed this edition.
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