MPT is a chemotherapy treatment used to treat myeloma.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
MPT is named after the initials of the drugs used. These are:
Melphalan - a chemotherapy drug
Prednisolone - a steroid
Thalidomide - a targeted therapy drug, not a chemotherapy drug.
Before you start treatment with thalidomide your doctor will talk to you about contraception. This is because thalidomide can cause birth defects in children. We have more information below about contraception and MPT.
You have MPT treatment at home as all the drugs are taken as tablets or capsules. During your treatment, you will usually 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 first 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 your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Taking your tablets at home
The nurse or pharmacist will give you all your tablets to take when you are at home. You may also be given some other tablets to take.
Always take all your tablets exactly as explained. This is important to make sure they work as well as possible for you.
You should swallow all the tablets or capsules whole, with plenty of water:
Take melphalan one hour before meals.
Take prednisolone with or after breakfast.
Take thalidomide an hour after food, preferably late evening.
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 the prednisolone and thalidomide in the original package at room temperature away from heat and direct sunlight.
Keep the melphalan in the fridge.
Keep all the drugs safe and out of the reach of children.
Return any remaining tablets to the pharmacist if your treatment is stopped.
Before you go home the nurse or pharmacist will also give you anti-sickness drugs to take. Take all your tablets exactly as explained.
Your course of MPT
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of MPT is given over 28 days (four weeks).
Melphalan and prednisolone are taken either for the first four days or for the first seven days of the cycle. Your doctor or nurse will explain exactly how you should take your MPT treatment. Thalidomide is taken every day of the cycle. Your doctor may gradually increase the dose you take.
At the end of the 28 days, you start your second cycle of MPT. This is exactly the same as the first cycle. Your doctor or nurse will tell you the number of cycles you are likely to have.
Possible side effects of MPT
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We explain the most common side effects of MPT 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. If you are having other chemotherapy drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have. 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
MPT 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
Chemotherapy 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)
Chemotherapy 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).
Blood clot risk
Thalidomide and chemotherapy can increase the chance of a blood clot (thrombosis). You may be given drugs, usually tablets, to help prevent a blood clot during treatment.
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.
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. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
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 your tablets with food to help protect your stomach.
Thalidomide may make you constipated. 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 some regular gentle exercise.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Steroids can make you feel much hungrier than usual and you may gain weight. Your appetite will go back to normal when you stop taking them. If you’re worried about gaining weight, talk to your doctor or nurse.
Raised blood sugar levels
Prednisolone can raise your blood sugar levels. 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 your insulin or tablet dose.
Mood and behaviour changes
Steroids can affect your mood. You may feel anxious or restless, have mood swings or problems sleeping. Taking your steroids in the morning may help you sleep better at night.
Tell your doctor or nurse if you have any of these side effects. They may make some changes to your treatment if the side effects become a problem.
Effects on the nervous system
Thalidomide can affect the nervous system. You may feel drowsy or confused. It can help to take your tablets in the evening. Tell your doctor or nurse straight away if you notice any of these symptoms. It’s important not to drive or operate machinery if you notice these effects.
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. Thalidomide can cause a rash, which may be itchy.
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.
Build up of fluid
Your ankles and legs may swell because of fluid building up. Tell your doctor or nurse if fluid builds up. Talk to your doctor about medicines that may help. If the swelling is uncomfortable, they may prescribe support stockings to help. If your ankles and legs swell it can help to put your legs up on a foot stool or cushion. The swelling gets better after your treatment ends.
Numb or tingling hands or feet
These symptoms are caused by the effect of thalidomide on nerves. It’s called peripheral neuropathy. You may also 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.
Your hair may thin but you’re unlikely to lose all the hair from your head. This 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.
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.
MPT may cause headaches. If this happens, let your doctor or nurse know. They can give you painkillers.
Low blood pressure
Thalidomide can cause a temporary fall in your blood pressure. This can make you feel dizzy for a few moments if you stand up too quickly. Tell your doctor or nurse if you have ever had any problems with your blood pressure. It can help to move slowly from lying to sitting and from sitting to standing.
Changes in the way the kidneys and liver work
MPT 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 MPT
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Effects on the lungs
MPT can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
It’s important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about MPT
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Contraception and MPT
Thalidomide can cause severe abnormalities in developing babies and chemotherapy drugs may also harm a developing baby. It’s very important not to get pregnant or father a child during and for a few months after treatment.
Your doctor or specialist nurse will explain this and give you written information about the risks of thalidomide. They will give you advice on the type of contraception to use and for how long to take it. Because of the possible birth defects thalidomide can cause, you have to take part in a pregnancy prevention programme. This means signing a consent form to say you understand the risks and you agree to use contraception for a set length of time. You may need to register with the company that makes the drug.
Women of childbearing age taking thalidomide will have a pregnancy test first to check they aren’t pregnant. This will be repeated every four weeks until a month after treatment finishes. You’ll only be prescribed four weeks of thalidomide at a time. Women should start using effective contraception four weeks before starting treatment. The combined contraceptive pill isn’t recommended because it increases the chance of a blood clot.
Men taking thalidomide are advised to use a condom during sex with a woman of childbearing age or with a pregnant woman.
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.
Chemotherapy 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.
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.
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.
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. Explain you are taking chemotherapy tablets that no one should stop or restart without advice from your cancer doctor. 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.
This section has been compiled using information from a number of reliable sources, including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed July 2013).
Perry MC. The Chemotherapy Source Book. 5th edition. 2012 Lippincott Williams and Wilkins.
With thanks to: Catherine Loughran, Lead Pharmacist Haematology, who reviewed this edition.
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