This information is about a chemotherapy treatment for myeloma called VAD.
The drugs that are used
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VAD is named after the initials of the drugs used, which are:
How treatment is given
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VAD chemotherapy can be given to you as a day patient or during a short stay in hospital. Before you start treatment you'll need to have a blood test, either on the same day or a day or two beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy. All of this may take a couple of hours.
VAD chemotherapy is usually given in one of the following ways:
through a thin, plastic tube that is inserted under the skin and into a vein near your collarbone (central line)
through a fine tube inserted into a vein in the crook of your arm (PICC line).
In some situations, it may be given through a fine tube inserted into a vein, usually in your hand or arm (cannula).
Your doctor or nurse will explain more about this to you.
Before the chemotherapy you'll be given an anti-sickness (anti-emetic) drug by injection through your central or PICC line, or as tablets.
Vincristine (a colourless fluid) and doxorubicin (a red fluid) are then given together by infusion into your central or PICC line using a small portable pump. The pump is used to give a controlled amount of the drugs into your bloodstream over a set period of time. It's small enough to be carried in a belt or holster so that you can carry on doing the things you normally do.
Once the pump is connected to your line you can go home with it. Before you go home you should be given instructions on how to look after the pump. Your nurses will explain how to care for it and what to do if something goes wrong.
When the infusion is finished there may be some fluid left in the pump. This may be normal, as some types of pumps need to be overfilled to get the correct dose. You can check with your nurse or pharmacist whether you have this type of pump.
If you're having the chemotherapy through a cannula you'll need to stay in hospital until the treatment has finished.
Before you go home you'll be given dexamethasone tablets to take. It's important to take the tablets exactly as directed by your doctor.
You'll also be given a supply of anti-sickness tablets to take home with you. It's important to take these regularly as directed even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it starts.
How often treatment is given
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Your doctor may use the word 'regimen' (eg the VAD regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of the treatment that you are receiving.
On the first day of your treatment you'll begin the infusion of vincristine and doxorubicin. The infusion is given continuously for four days. You'll also be given dexamethasone tablets to take for four days.
On the fifth day you'll return to the hospital to have your pump disconnected. If you have a cannula, the infusion will finish and the cannula can be removed. You'll be given another four-day course of dexamethasone to take from the ninth day of your treatment (days 9-12) and again from the 17th day of treatment (days 17-20).
After this you will have a rest period, with no treatment for the next eight days. This completes what is called a cycle of your chemotherapy treatment. Each cycle lasts for 28 days (four weeks). After the rest period you will start the next cycle of your treatment, which will be exactly the same.
Usually 4-6 cycles are given over a period of 4-6 months. This makes up a course of 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 below won't affect everyone who is having this treatment.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you do notice any effects that aren't below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
VAD 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'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia 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 38ºC (100.4ºF)
you suddenly feel unwell even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising and bleeding
VAD 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 may need to have a platelet transfusion if your platelet count is low.
VAD 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.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea or 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.
Numbness or tingling in the hands or feet
This is due to the effect of vincristine on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly a few months after the treatment has finished. Sometimes symptoms can persist, talk to your doctor if this happens.
This usually starts 3-4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start to grow again 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.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing.
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.
Your urine may become a pink-red colour. This may last up to 48 hours after you’ve had your treatment. It is normal and is due to the colour of the doxorubicin.
Less common side effects
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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.
Irritation of the stomach lining
Dexamethasone 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, pain or discomfort in the tummy (abdomen). You may be prescribed medication to reduce irritation of the stomach.
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.
Abdominal pain and constipation
VAD can cause pain in your tummy (abdomen) and constipation. Let your doctor know if you develop pain. It can usually be controlled with mild painkillers.
Constipation can usually be helped by drinking plenty of fluids, eating more fibre and doing some exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
You may notice you feel hungrier than usual while taking steroids, 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. You might also like to read our information about weight management.
VAD can cause diarrhoea. This 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.
Raised blood sugar
Occasionally, dexamethasone 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 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.
Dexamethasone may affect the salt and water balance in your body. You may notice that your ankles and/or fingers swell. Some people have a bloated feeling in the abdomen. Let your doctor know if this happens. This is usually only a problem with long-term steroid treatment.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat. You might find our information about taking care in the sun useful.
Sometimes, areas of skin that have been treated with radiotherapy may become red and sore. Tell your doctor if this happens.
The colour of your nails may change. They may become darker and white lines may appear on them. These usually grow out over several months once the treatment has finished.
Behavioural changes and mood swings
Occasionally, steroids can cause mood swings, difficulty sleeping and anxiety or irritability. Let your doctor know if there are any changes in your behaviour that are worrying you. Difficulty with sleeping may be helped by taking the steroids in the early part of the day, but discuss this with your doctor first.
Changes in the way your heart works
This is very rare with standard doses of doxorubicin but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and sometimes before each treatment.
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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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
You may have a sudden feeling of warmth and some reddening in your face. This can happen for a short period of time while the drug doxorubicin is being given.
Leakage into the tissue around the vein (extravasation)
If this happens when doxorubicin or vincristine is being given, the tissue in that area can become damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Your ability to become pregnant or father a child is likely to be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having VAD as it may harm the developing baby. It’s important to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
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 the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so 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 dexamethasone tablets
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It’s important to take your tablets at the right times as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you're taking a course of steroid tablets that should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in their original packaging, and store them at room temperature away from heat and direct sunlight.
Keep the tablets in a safe place and out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away.
If you're sick just after taking the tablets 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, don't take a double dose. Let your doctor know and keep to your regular dose schedule.
This section is based on our VAD chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).