This information is about a chemotherapy treatment for multiple myeloma called MPT.
You will see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
The drugs that are used
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MPT is named after the initials of the drugs used. These are:
Melphalan (Alkeran®), a chemotherapy drug that's used in the treatment of multiple myeloma and other types of cancer.
Prednisolone, a steroid used with cancer treatment to help destroy cancer cells and make other chemotherapy drugs, such as melphalan, more effective.
Thalidomide (Thalidomide Celgene®), a drug that's mainly used to treat myeloma. It’s thought to work by stopping cancers from developing new blood vessels.
Melphalan and prednisolone are given as tablets. Thalidomide is given as a tablet or capsule. You’ll be given these three drugs to take at home.
Before starting treatment, you'll have an outpatient appointment. You’ll need to have a blood test either on the same day or a few days beforehand. If you’re of childbearing age, you'll also be asked to have a pregnancy test to check you’re not pregnant. This is because taking thalidomide can cause severe abnormalities in developing babies.
You will be seen by a doctor, specialist nurse or a pharmacist and if the results of your blood tests are normal and your pregnancy test is negative, the pharmacy will prepare your drugs for you to take home. All of this may take a couple of hours. You will also be given anti-sickness (anti-emetic) drugs to take home with you.
MPT is taken as follows:
Melphalan tablets are taken once a day for the first four or seven days of your treatment. The tablets should be swallowed whole on an empty stomach, one hour before a meal. Melphalan tablets should be stored in a fridge.
Prednisolone tablets are also taken once a day for the first four or seven days of your treatment. The tablets should be swallowed with plenty of water and must be taken with food, such as breakfast or with a drink of milk in the morning.
Thalidomide capsules are usually taken once a day every night throughout the course of your chemotherapy treatment. The capsules should be taken with plenty of water. You may be asked by your doctor to gradually increase the dose of your thalidomide capsules to a maximum dose.
Your doctor or nurse at the hospital will give you specific instructions on what dose of each drug you should take, and how and when to take them. It’s important that you carefully follow their instructions.
How often treatment is given
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The drugs are usually given as a course of several sessions (cycles). Each cycle lasts 28 or 42 days and is repeated 6-12 times over a period of 6-18 months to make up a course of treatment. This means that after 28 or 42 days, you will again take your melphalan and prednisolone tablets for four or seven days. Your doctors will closely monitor you and take regular blood tests throughout your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone having MPT.
We have outlined the most common side effects but haven’t included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
It’s important to avoid getting pregnant or fathering a child while you’re taking thalidomide, as it causes severe abnormalities in developing babies.
Before staring thalidomide, women are asked to have a pregnancy test to check that they aren’t pregnant. You’ll also be advised to use a very effective form of contraception and given advice on the types of contraception recommended.
Men taking thalidomide are advised to use a condom during sex if their female partner is not already using effective contraception or is pregnant. Your doctor will tell you more about this.
Men and women are asked to use contraception for four weeks before starting treatment and for four weeks after treatment has finished.
Because thalidomide causes birth defects, you will usually have to take part in a risk-management programme. You’ll need to sign a consent form and may have to be registered with the company that makes the drug.
Your specialist can only prescribe four weeks of thalidomide at a time. So you’ll need to go to the hospital to get it prescribed and to sign a new consent form every month.
If a woman suspects that she may have become pregnant while taking thalidomide, or she has had heterosexual intercourse without using an effective method of contraception, she should stop taking the thalidomide and inform her doctor straight away.
Risk of developing a blood clot
As thalidomide increases your risk of developing a blood clot, you'll be given drugs to help prevent blood clots forming during MPT treatment. The most commonly used drugs are warfarin or aspirin, which are taken as tablets, or a preparation of low molecular weight heparin, which is taken as a daily injection.
If you have a daily injection of a heparin preparation, you can be taught how to give this to yourself or your doctors can arrange for a district nurse to visit you at home.
If you’re taking warfarin tablets, you’ll need to have regular blood tests. Depending on the results of your blood tests, your doctor may vary the dose of your warfarin.
You should let your hospital or doctor know immediately if you develop pain, swelling or redness in one of your calves, or if you suddenly become breathless or have chest pain during your treatment. This could be a sign of a blood clot, which needs urgent treatment.
Lowered resistance to infection (neutropenia)
MPT can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia. This begins seven days after treatment and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before each cycle of MPT to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.
Bruising and bleeding
MPT can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
MPT can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Numbness or tingling in hands or feet
This is due to the effect of thalidomide on the nerve endings and is known as peripheral neuropathy. You may also notice that you have difficulty with fiddly tasks like doing up buttons. If you notice any of these side effects, tell your doctor straight away. You will usually be advised to stop taking the thalidomide or the dose may be reduced. This is necessary to prevent the symptoms from getting worse.
These symptoms may be permanent, or they may improve slowly with time.
Feeling sick (nausea) and being sick (vomiting)
Some people feel sick during treatment, although this is usually mild. If you do feel sick, it may happen while you’re taking your melphalan tablets and can last for a few days afterwards. You should take the anti-sickness (anti-emetic) drugs you have been given. These should prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
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 taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Dizziness on standing
Thalidomide may make you feel dizzy for a few moments if you stand up too quickly. This is caused by a temporary fall in blood pressure. Move slowly from lying to sitting and then sitting to standing. Tell your doctor if you have ever had any blood pressure problems and about any medicines you are taking.
MPT can cause changes in the way your liver works, although your liver will return to normal when the treatment has finished. Your skin and the whites of your eyes may become yellow (jaundiced). The doctor will take regular blood samples to check your liver is working properly.
Irritation of the stomach lining
Prednisolone can irritate the lining of the stomach and may cause a stomach ulcer or make one worse. You should take the tablets with a meal or a drink of milk to reduce this side effect. Tell your doctor if you have indigestion, or pain or discomfort in the tummy (abdomen). You may be prescribed medication to reduce irritation of the stomach.
Raised blood sugar
Occasionally prednisolone can cause your blood sugar level to rise. During treatment you’ll have regular blood tests to check this. Your urine may also be tested for sugar.
Tell your doctors know if you get very thirsty or if you’re passing more urine than usual. This can be a sign that your blood sugar level is rising.
Ankle swelling and fluid retention
You may find that your ankles swell, particularly if you have been standing still or sitting down for a time. Putting your feet up when you’re sitting helps reduce this. Talk to your doctor about medicines that may help. If the swelling is uncomfortable, your doctor may be able to prescribe elastic stockings to keep it under control.
A skin rash can sometimes occur while you are having treatment with MPT. It’s important to let your doctor know if this happens. Your doctor can prescribe medicine to help with this.
Less common side effects
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Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Some people find that sucking on ice soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. You may find our section on mouth care during chemotherapy helpful.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Constipation or diarrhoea
MPT can cause constipation or diarrhoea. Constipation can usually be helped by drinking plenty of fluids, eating more fibre and doing gentle exercise. You may need to take medicine (laxative) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Diarrhoea can usually be easily controlled with medicine, but tell your doctor if it’s severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Hair loss is rare, but your hair may thin or occasionally fall out completely. If this happens, it usually begins about 3-4 weeks after starting treatment, although it may occur earlier. This is temporary and your hair will start to grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Melphalan can cause an allergic reaction but this is unlikely to happen when melphalan is taken as tablets. Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, dizziness, a headache, breathlessness, anxiety and a need to pass urine. Tell your doctor or nurse straight away if you have any of the symptoms mentioned above.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
Loss of periods in women
Because of the effect of chemotherapy on the ovaries, women may find that their periods become irregular and may eventually stop. In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
If you’re admitted to hospital for a reason not related to your cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
Things to remember about your tablets
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It’s important to take your tablets/capsules at the right times as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you are taking a course of chemotherapy tablets/capsules that should not be stopped or restarted without advice from your cancer specialist.
Keep the thalidomide capsules and prednisolone tablets in the original packaging and store them at room temperature away from heat and direct sunlight. Melphalan tablets should be kept dry and stored in the refrigerator.
Keep the tablets/capsules in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets/capsules to the pharmacist. Do not flush them down the toilet or throw them away.
If you are sick just after taking the tablets/capsules tell your doctor as you may need to take another dose. Don't take another tablet/capsule without telling your doctor first.
If you forget to take a tablet/capsule, don't take a double dose. Let your doctor know and keep to your regular dose schedule.
When planning overseas travel, check whether the country you are visiting has any special requirements regarding thalidomide. For example, Australia requires you to provide a letter from your doctor explaining why you are taking the drug.
This section is based upon our MPT chemotherapy factsheet which has been compiled using information from a number of reliable sources including:
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).
Chu E, et al. Physicians’ cancer chemotherapy drug manual 2009. 2009. Bartlett Publishers.
Gullatte M. Clinical Guide to Antineoplastic Therapy. A Chemotherapy Handbook. 2nd edition. 2007. Oncology Nursing Society.
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
UpToDate. Patient information: Multiple myeloma treatment. www.uptodate.com (accessed November 2011).