Thiotepa is a chemotherapy drug given before a stem cell transplant or bone marrow transplant. Thiotepa is used to treat leukaemia, lymphoma and myeloma.
This information should ideally be read with our general information on chemotherapy and your type of cancer.
You will have thiotepa during a stay in hospital. It is given in combination with other chemotherapy drugs. During treatment, your cancer doctor or haematologist (a specialist who treats blood cancers) will monitor you carefully. You’ll also see a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Your nurse gives you anti-sickness drugs before your chemotherapy. Thiotepa is then given in one of the following ways:
through a fine tube that goes under the skin of your chest and into a vein close by (central line)
through a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you thiotepa as a drip. They usually run the drip through a pump, which gives you the treatment over a set time.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy. This may include an allergic reaction. Your nurse will check you for signs of this and if you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms. They may give you steroids to help reduce the risk of a reaction.
Possible side effects of thiotepa
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We explain the most common side effects of thiotepa 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 side effects. It is very important to take them 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
This treatment will 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.
You will probably be looked after in a single room for a few weeks to reduce your risk of infection. Your nurse will give you drugs to help prevent or to treat an infection, if you have one.
They will take your temperature regularly and check you for signs of an infection. The number of white blood cells should gradually increase after the stem cell or bone marrow transplant. You will have regular bloods test taken to check this.
Bruising and bleeding
Thiotepa can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your nurse if you have any bruising or bleeding such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need a drip to give you extra platelets.
Anaemia (low number of red blood cells)
Thiotepa 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 of your chemotherapy. The nurses will give you anti-sickness drugs regularly. They may also give you a steroid drug called dexamethasone to help. If you still feel sick, tell your nurse or doctor. They can change the anti-sickness drug to one that works better for you.
Loss of appetite
You may lose your appetite during your treatment. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you food supplements or meal replacement drinks.
You will feel very tired and need a lot of rest. Try to take some gentle exercise, such as short walks, which will help. You’ll probably tire easily for some months after your treatment, but this will gradually get better.
Your mouth may become sore and you may get ulcers. This makes you more likely to get an infection in your mouth. It’s important to follow the advice your nurse gives you. They may ask you to use mouthwashes regularly and give you medicines to prevent or treat mouth infections and reduce any soreness. Gently clean your teeth and/or dentures morning and night and after meals. Tell your nurse or doctor if you have any problems with your mouth.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it doesn’t get better.
Thiotepa may make you constipated and cause tummy pain. Let your nurse know if this happens. They can give you medicine to help your bowels move (laxatives).
Thiotepa can irritate your stomach. Tell your doctor if you have a pain in your tummy (abdomen) or indigestion. Rarely, thiotepa may cause a stomach ulcer. Let them know if you notice any blood when your bowels move or if your stool is dark or tarry.
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. 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.
Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops. Thiotepa may rarely affect your vision. Always tell your doctor or nurse if you notice any changes in your vision.
Some people may have ringing in the ears (tinnitus). Tell your doctor if you notice any changes to your hearing.
Changes in the way the liver works
The treatment can cause changes in the way your liver works. These will usually go back to normal after treatment finishes. You will have regular blood tests to check how well your liver is working.
Muscle and/or joint pain
You may get pain in your joints or muscles for a few days after chemotherapy. Tell your doctor if this happens so they can prescribe painkillers. Let them know if the pain does not get better.
Less common side effects of thiotepa
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Changes in the way the heart works
Thiotepa can affect the way the heart works. You may have tests to see how well your heart is working before, during, and sometimes after treatment.
If you have pain or tightness in your chest, feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions, but it’s important to get them checked by a doctor.
Changes to your lungs
Thiotepa can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, a 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.
Effects on the nervous system
Thiotepa can affect the nervous system. You may feel anxious or restless, drowsy or confused. Tell your doctor or nurse straight away if you notice any of these symptoms.
Thiotepa can increase the risk of developing a second cancer years later. But the benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.
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.
Additional information about thiotepa
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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. Tell your nurse or 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.
Thiotepa can 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 for about a year after treatment. It’s important to use effective contraception. You can talk to your doctor or nurse about this.
Changes to your periods
Chemotherapy can stop the ovaries working. In some women, this is temporary, but for others it is permanent and they start the menopause.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses about your 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.
This section has been compiled using information from a number of reliable sources including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed July 2013).
Munker R, Hildebrandt GC, Lazarus HM, Atkinson K. The BMT Data Book including Cellular Therapy. 3rd Edition. 2013. Cambridge University Press.
Perry MC. The Chemotherapy Source Book. 5th edition. 2012. Lippincott Williams and Wilkins.
With thanks to Penny Daynes, Oncology/Haematology Pharmacist reviewed this edition.
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