ChlVPP is named after the initials of the drugs used:
- Chl – chlorambucil
- V – vinblastine
- P – procarbazine
- P – pednisolone – a steroid
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.
Sometimes a reaction can happen a few hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.
The drug leaks outside the vein
If the drug leaks outside the vein, it can damage the surrounding tissue. This is called extravasation. Extravasation is not common but if it happens it is important to treat it quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the contact telephone number they gave you.
You will be given ChlVPP in the chemotherapy day unit. A chemotherapy nurse will give it to you.
During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist 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 your blood cells are at a safe level to have chemotherapy.
You will see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemo-therapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse usually gives you anti-sickness (anti-emetic) drugs before the chemotherapy. Vinblastine can be given through:
- a short thin tube the nurse puts into a vein in your arm or hand (cannula)
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
You will have the chlorambucil, procarbazine and prednisolone as tablets and capsules.
Your course of chemotherapy
You usually have a course of several cycles of treatment over a few months. Your nurse or doctor will discuss your treatment plan with you. They may give you a copy of the treatment plan to take home with you.
Each cycle of ChlVPP takes 28 days (4 weeks).
- On days 1 and 8 you have vinblastine as a drip (infusion) over about 5 to 10 minutes.
- On days 1 to14 you take chlorambucil tablets, procarbazine capsules and predniso-lone tablets. Some people may take them for a shorter time.
After you finish your tablets and capsules, you have a rest period. This means you do not have any chemotherapy for the next 14 days (days 15 to 28). After your rest period you start your second cycle of ChlVPP.
You will usually have 6 to 8 cycles over a few months. Your doctor or nurse will tell you the number of cycles you are likely to have.
Taking your tablets and capsules
You will be given chlorambucil tablets, procarbazine capsules and prednisolone tablets to take at home. Always take them exactly as explained. This is important to make sure they work as well as possible for you.
They must be swallowed whole with a glass of water. They should not be chewed, opened or crushed. Take them at the same time every day.
Chlorambucil should be taken on an empty stomach. This means taking it 1 hour before food or 3 hours after food.
You will usually be advised to take prednisolone with breakfast in the morning. It is important not to take it on an empty stomach, as it can cause indigestion and stomach problems.
You should avoid alcohol and certain foods on days when you take procarbazine, and for a short time after taking it. See below for more details. Your doctor or nurse can also talk to you about this.
If you forget to take the tablets or capsules, you should take the missed dose as soon as possible unless the next dose of the tablet or capsule you have missed is nearly due. If you are not sure whether to take a
tablet or capsule, always contact the hospital for advice. Do not take a double dose unless your doctor tells you to.
Other things to remember about your tablets and capsules:
- Wash your hands after taking your tablets and capsules.
- Other people should avoid direct contact with the chemotherapy drugs.
- Keep them in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of sight and reach of children.
- If you are sick just after taking the capsules or tablets, contact the hospital. Do not take another dose.
- If your treatment is stopped return any unused tablets and capsules to the pharmacist.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection.
If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This treatment 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 that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment 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. This is called a blood transfusion.
You may feel sick in the first few days after this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24-hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
This treatment can cause constipation. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (31/2 pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
Tummy pain or indigestion
Steroids can irritate the stomach lining. Tell your doctor or nurse if you have pain in your tummy (abdomen) or indigestion. They can give you drugs to help reduce stomach irritation. Take your tablets with food to help protect your stomach.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.
Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth.
Your hair may get thinner but you are unlikely to lose all the hair from your head. Hair loss usually starts after your first or second treatment. It is almost always temporary and your hair will usually grow back after treatment ends. Your nurse can talk to you about ways to cope with hair loss.
ChlVPP 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 usual colour after you finish treatment.
During treatment and for several months afterwards, you will be more sensitive to the sun. Your skin may burn more easily. You can still go out in the sun, but use sun cream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.
This treatment may cause a skin rash. Rarely, this can become severe. If you develop a skin rash contact the hospital for advice as soon as possible.
Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when you finish treatment.
Mood and behaviour changes
Steroids can affect your mood. You may feel anxious or restless, and have mood swings or problems sleeping. Taking your steroids in the morning may help you sleep better at night.
If you have any of these side effects, tell your doctor or nurse. They may make some changes to your treatment. It is best not to drive or operate machinery if you feel like this.
Appetite changes and weight gain
You may feel more hungry than usual while taking prednisolone. If you are concerned about gaining weight, you can speak to your doctor, nurse or dietitian.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. 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 for some people they may never go away. Talk to your doctor if you are worried about 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. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling will go down 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 pee (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.
Effects on the kidneys
This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys are working.
It is important to drink at least 2 litres (3½ pints) of fluids each day to help protect your kidneys.
Effects of alcohol and some foods
Alcohol and some food can cause a reaction when you are taking procarbazine. They can make you feel sick and cause headaches, sweating, drowsiness and breathing problems. It is best to avoid:
- alcohol free beers and wines
- mature cheeses
- salami, pepperoni and bologna sausage
- yeast or beef extracts (Oxo®, Marmite® and Bovril®)
- over-ripe fruit
- any pickled, fermented, smoked and matured foods
Your doctor, nurse or pharmacist will give you more advice on foods to avoid.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- pain, redness or swelling in a leg or arm
- chest pain.
If you have any of these symptoms, contact a doctor straight away.
A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
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.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.
Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.
While you are taking this treatment and for 6 months after it finishes you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Some cancer drugs can affect whether you can get pregnant or make someone pregnant.
If you are a woman, your periods may become irregular or stop. This may be temporary, but for some women it is permanent. Your menopause may start sooner than it would have done.
If you have sex during this course of chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
Muscle, bone or jaw pain
Vinblastine may cause pain in your muscles, bones or jaw. Tell your nurse or doctor if you notice this.
Dizziness or seizures
Rarely this treatment can cause dizziness or fits (seizures). Tell your doctor if this happens. It is important you do not drive if you notice these effects.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
- a fever (high temperature)
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
This treatment can increase the risk of developing a second cancer years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.