Hyper-CVAD

Hyper-CVAD is a combination of chemotherapy given with a steroid drug. 

Hyper-CVAD is used to treat some types of non-Hodgkin lymphoma (NHL) and acute lympho-blastic leukaemia (ALL). It is best to read this information with our general information about chemotherapy, steroids and the type of cancer you have. 

Hyper is short for “hyper-fractionated”, meaning you have more than 1 treatment of the same drugs in a day. CVAD is the initials of combination of some of the drugs used:

Hyper-CVAD treatment also includes 2 other chemotherapy drugs:

This means it is sometimes called hyper-CVAD/MTX-cytarabine. But most people call it hyper-CVAD. 

Hyper-CVAD is sometimes given with a targeted therapy called rituximab as part of a treatment called R-hyper-CVAD. We have separate information about rituximab.

Your cancer doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

More information about this treatment

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

How hyper-CVAD is given

You will be given hyper-CVAD during a stay in hospital or in the chemotherapy day unit. A chemotherapy nurse will give it to you. 

During a course of treatment, you usually see a:

  • blood cancer doctor (haematologist)
  • chemotherapy nurse or a specialist nurse
  • specialist pharmacist. 

This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before or on the day of each treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is safe for you to have chemotherapy. You will also have blood tests regularly while on treatment. 

You will speak to a doctor, nurse or pharmacist before you have chemotherapy. They will talk to you about your blood results and ask how you have been feeling. If your blood results are okay, the pharmacy team will prepare your chemotherapy. 

Your nurse usually gives you anti-sickness (anti-emetic) and other drugs before the chemotherapy to help prevent side effects. 

The chemotherapy drugs can be given into a vein. The dexamethasone (steroid) is either given as tablets or as an injection into a vein. 

The nurse will give you the different chemotherapy drugs one at a time. 

When you have treatment into a vein, the  drugs can be given through: 

  • a cannula – a short, thin tube the nurse puts into a vein in your arm or hand
  • a central line – a fine tube that goes under the skin of your chest and into a vein close by
  • a PICC line – a fine tube that is put into a vein in your arm and goes up into a vein in your chest
  • an implantable port (portacath) – a disc that is put under the skin on your chest or arm and goes into a vein in your chest.

Intrathecal chemotherapy

In some types of lymphomas or leukaemias, cancer cells can pass into the fluid that surrounds the brain and spinal cord. This is called cerebrospinal fluid. 

You may be given methotrexate and cytarabine into the cerebrospinal fluid to prevent or treat this. This is called intrathecal chemotherapy. The drugs are given during a procedure called a lumbar puncture. This can be done in an outpatient department, or in hospital. Your cancer doctor or nurse will tell you more about this if you are having treatment given this way.

Your course of chemotherapy

You usually have a course of up to 8 cycles of treatment over a few months. Each cycle of hyper-CVAD usually lasts 21 days.

Hyper-CVAD is usually given in 2 different schedules. They are called schedule A and schedule B. You will start with schedule A and then have schedule B. This repeats 4 times, unless you are having hyper-CVAD before a stem cell transplant, then it will usually repeat 2 times. 

You may have a treatment called R-hyper-CVAD. This treatment is when hyper-CVAD is given with rituximab. It may be given differently to the schedules below.

Your doctor, nurse or pharmacist will talk to you about how the treatment will be given. They may give you a copy of a treatment plan to take home.

Schedule A (cycles 1, 3, 5 and 7)

Day 1

You will have dexamethasone and 2 infusions of cyclophosphamide as a drip into the vein. Each cyclophosphamide infusion takes 2 hours and they are given 12 hours apart. 

You will have a drip into the vein (infusion) of fluids before and after cyclophosphamide and possibly a drug called mesna (Uromitexan®) to prevent bladder irritation. 

Day 2

Same as day 1. 

Day 3

Same as day 1. 

Day 4

You will have dexamethasone. You will also have drips into the vein (infusions) of vincristine and doxorubicin. Vincristine takes 10 minutes. The time can vary for doxorubicin.

Days 5 to 10

No treatment.

Days 11 to 14

You have vincristine again on day 11 and dexamethasone every day on days 11-14.

Days 15 to 21

No treatment.

Schedule B (cycles 2, 4, 6 and 8)

Day 1

You have methotrexate as a drip (infusion) into the vein over 24 hours. You will have infusions of fluids before and after methotrexate.

Day 2

You will usually have a drug called leucovorin (folinic acid) as a drip into the vein. This is called an infusion. It is given to reduce the side effects of methotrexate. You have continue to have leucovorin and infusions of fluids until the methotrexate is out of your system. You will have blood tests to check this. 

You also have 2 infusions of cytarabine given 12 hours apart.

Day 3

You have 2 more infusions of cytarabine given 12 hours apart. 

Days 4 to 21

No chemotherapy treatment. 

Infusions of leucovorin (folinic acid) and fluids may still continue on day 4 until the methotrexate is out of your system.

About side effects

We explain the most common side effects of this treatment here. We also include some that are less common.

You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

  • drugs to help control some side effects
  • advice about managing side effects. 

It is important to take any drugs exactly as explained. This means they will be more likely to work for you. 

Serious and life-threatening side effects

Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

Side effects of intrathecal chemotherapy

The side effects of having a lumbar puncture and intrathecal chemotherapy can be different from those mentioned in this information. Your doctor or nurse will talk to you about this. 

When methotrexate and cytarabine are given this way, it can cause: 

  • headaches
  • dizziness
  • tiredness
  • blurred vision
  • loss of balance for a few hours. 

Tell your nurse or doctor straight away if you have any of these.

It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we do not mention here.

Contact the hospital

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Side effects while treatment is being given

Some people may have side effects while they are being given the chemotherapy or shortly after they have it:

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include: 

  • feeling hot or flushed 
  • shivering
  • itching
  • a skin rash
  • feeling dizzy or sick
  • a headache
  • feeling breathless or wheezy
  • 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, they can treat it quickly. 

Sometimes a reaction happens a few hours after treatment. If you develop any of these signs or feel unwell after you get home, contact the hospital straight away on the 24-hour number.

The drug leaks outside the vein

The drug may leak outside the vein. If this happens it can damage the tissue around the vein. This is called extravasation. Extravasation is not common but if it happens it is important that it is dealt with quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein. 

Facial flushing

You may suddenly feel warm and your face may get red when you have doxorubicin. This should only last a few minutes.

Red or pink urine

Your urine (pee) may be pink-red colour during and up to 48 hours after doxorubicin treatment. This is because of the colour of the drug. It is not harmful.

If this carries on for longer, or you think you have blood in your urine, tell your doctor or nurse straight away.

Cytarabine syndrome

Cytarabine may cause some symptoms 6 to 12 hours after it has been given. This is called cytarabine syndrome. Signs can include: 

  • a high temperature or chills 
  • a rash 
  • pain in the eyes, bones, tummy or chest. 

You may be given medicines before treatment to help prevent this from happening or to reduce any reaction.  

Tell your nurse or contact the hospital straight away if you have any of these symptoms.

Common side effects

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 sometimes called neutropenia.

Your doctor may give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given 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
  • your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

  • feeling shivery and shaking
  • a sore throat
  • a cough 
  • breathlessness
  • diarrhoea
  • needing to pass urine (pee) a lot, or discomfort when you pass urine.

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, until your cell count increases.

You may be given a drug called G-CSF. This encourages the body to make more white blood cells. You have it as a small injection under the skin.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

  • nosebleeds
  • bleeding gums
  • heavy periods
  • blood in your urine (pee) or stools (poo)
  • tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you 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. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

  • very low in energy
  • breathless 
  • dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Feeling sick

Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

Changes in appetite

This treatment can affect your appetite. Don’t worry if you do not eat much for a day or 2. But if your appetite does not come back after a few days, or if you are losing weight, tell your nurse or dietitian. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

Steroids can make you feel hungrier than usual and cause weight gain. Your appetite will go back to normal when you stop taking them. 

If you are worried about your weight, talk to your doctor or nurse.

Changes to your taste

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

  • sucking sugar-free sour or boiled sweets
  • eating cold foods
  • eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.

Feeling tired (fatigue)

This treatment can make you feel very tired and you will need a lot of rest. You may get tired easily for some months after treatment ends. Gentle exercise, like short walks, can help you feel less tired. The tiredness will slowly get better. 

If you feel sleepy, do not drive or use machinery.

Muscle or joint pain

You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor, nurse or pharmacist. They can give you painkillers and advice. They can also tell you if any of the painkillers you usually take are suitable. 

If you have muscle or joint pain, try:

  • placing a heat pad or covered hot water bottle against the painful area
  • taking warm baths
  • planning your activities to include regular rests.

Jaw pain

Vincristine may cause pain in your jaw. If you notice this, tell your nurse or doctor.

Hair loss

Your hair will get thinner. Or you may lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair. Hair loss usually starts after your first or second treatment.

If you want to cover up hair loss, there are different ways you can do this. Your nurse will give you information about coping with hair loss

Remember to protect your skin from the sun. Use suncream with a sun protection factor (SPF) of at least 30 on your scalp. Or cover up with a hat or scarf.

Hair loss is almost always temporary. Your hair will usually grow back after treatment ends.

Sore mouth and throat

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

Contact the hospital straight away on the 24-hour number, if:

  • a sore mouth or throat affects how much you can drink or eat 
  • your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

  • drink plenty of fluids
  • avoid alcohol and tobacco
  • avoid food or drinks that irritate your mouth and throat.

Tummy pain or indigestion

You may get pain in your tummy (abdomen), or have indigestion. Your doctor can give you drugs to help improve these symptoms. Tell them if the pain gets worse or does not get better.

Steroids can also irritate the stomach. It may help to take the steroid tablets with food.

Diarrhoea

This treatment may cause severe diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. If you have a stoma, it will be more active than usual. 

Your doctor, nurse or pharmacist may give you anti-diarrhoea drugs to take at home. 

If you have diarrhoea or a mild increase in stoma activity, follow their advice about: 

  • taking anti-diarrhoea drugs 
  • how much and what type of fluids to drink 
  • any changes to your diet that might help. 

Contact the hospital straight away on the 24-hour number if:

  • you have diarrhoea at night 
  • you have uncomfortable stomach cramps
  • you have diarrhoea 4 or more times in a day 
  • you have a moderate increase in stoma activity 
  • the anti-diarrhoea drugs do not work within 24 hours.

You may need to give a stool sample, or go to hospital to have fluids through a drip or antibiotics.

Constipation

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. 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 on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

Bladder irritation

Cyclophosphamide may irritate your bladder and cause discomfort when you pass urine (pee). Make sure you drink plenty of fluids during, and the 24 hours after, chemotherapy. Follow the advice of your cancer team about how much fluid to drink.

You may be given treatment to prevent bladder irritation such as:

  • extra fluid through a drip (infusion)
  • a drug called mesna 

Mesna tablets contain lactose. If you are lactose intolerant, tell your doctor or nurse.  

It is important to empty your bladder regularly and to try to pass urine (pee) as soon as you feel the need to go.

Tell your doctor or nurse, or contact the hospital, straight away if you feel any discomfort or stinging when you pass urine, or if you notice any blood in it.

Raised blood sugar levels

This treatment can raise your blood sugar levels and increase the risk of diabetes. 

Signs of raised blood sugar include:

  • feeling thirsty
  • needing to pass urine (pee) more often than usual
  • feeling more tired than usual. 

Tell your doctor or nurse if you have these symptoms. They can do tests to check your blood sugar level and give you advice.

If you already have diabetes, your blood sugars may be higher than usual. You may need to check them more often, or make changes to your diabetic treatment. Your diabetic doctor or nurse will talk to you about how to manage this.

Skin changes

This treatment may affect your skin. It may cause a rash, which might be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. During treatment and for some time after, your skin may be more sensitive to sunlight so it is important to wear sun cream with at least a sun protection factor (SPF)of 30, a sunhat, and cover up in the sun. Your skin may darken. But it will return to its normal colour after you finish treatment. If you have had radiotherapy, the area that was treated may become red or sore.

Rarely, a much more serious skin condition can develop. You may have a skin rash which then blisters, and your skin can peel. You may also feel unwell with flu-like symptoms such as a high temperature and joint pain. If you have any of these symptoms, contact your doctor or hospital straight away.

Always tell your doctor or nurse about any changes to your skin. They can give you advice and may prescribe creams or medicines to help. Skin changes usually improve when treatment finishes.

Nail changes

This treatment can affect your nails. They may grow more slowly or break more easily. You might notice ridges or white or dark lines across your nails. These changes usually disappear as the nails grow out after treatment. Sometimes nails can become loose or fall out.

If the skin around your nails becomes sore and swollen, contact the hospital straight away on the 24-hour number. These might be signs of an infection.

Tips to look after your nails:

  • Keep your nails clipped short and clean. 
  • Avoid using very hot water when washing your hands or bathing.
  • Moisturise your nails and cuticles regularly.
  • Avoid false nails, gels or other acrylics during treatment – it is okay to use water-based nail polish. 
  • Wear gloves to protect your nails when working in the house or garden.
  • If your toenails are affected, wear well-fitting shoes, or shoes with open toes to cushion them.

Tell your doctor or nurse about any changes to your nails. They can give you advice or arrange for you to see a podiatrist. They are a foot care specialist.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.

If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.

Build-up of fluid

Steroids may cause your ankles and legs to swell. This is because of fluid building up. Tell your doctor or nurse if fluid builds up. 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 the treatment ends.

Eye problems

This treatment may make your eyes feel sore, red and itchy. This is called conjunctivitis. Your doctor will prescribe eye drops to help prevent this. It is important to use the eye drops as your doctor tells you.

This treatment may also make your eyes more sensitive to light and cause blurry vision. Always tell your doctor or nurse if you have eye pain or notice any change in your vision.

Effects on the kidneys

This treatment can affect how the kidneys work. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your kidneys are working. Contact the hospital on the 24-hour number if you:

  • have blood in your urine (pee) 
  • are passing less urine or peeing less often than usual.

Drinking fluids helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.

Effects on the liver

This treatment may affect how your liver works. This is usually mild. You will have blood tests to check how well your liver is working.

Mood and behaviour changes

Steroids, such as dexamethasone, can affect your mood. You may feel anxious or restless, have mood swings. Tell the doctor or nurse straight away if you have any of these side effects. 

Steroids can also affect your sleep. Having the dexamethasone earlier in the day may help you sleep better. 

Less common side effects

Tumour lysis syndrome (TLS)

Some people are at risk of developing a condition called tumour lysis syndrome (TLS) during this treatment. When treatment makes large numbers of cancer cells die and break down quickly, they release lots of waste products into the blood. This can affect how well the kidneys work. It may also cause problems with the heart rhythm.

TLS can be prevented. You will have regular blood tests to check for TLS. If you are at risk of TLS, you may have:

  • extra fluids through a drip
  • medicines such as rasburicase through a drip, or allopurinol as tablets.

Drinking at least 2 litres (3½ pints) of fluid a day will also help.

Hand-foot (palmar-plantar) syndrome

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

  • be sore
  • be painful, tingle, or swell
  • peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

  • keeping your hands and feet cool by washing in cool water
  • gently moisturising your hands and feet regularly
  • wearing gloves to protect your hands and nails when working in the house or garden
  • wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

Hearing changes

This treatment may cause ear pain or hearing changes, including hearing loss. You may have ringing in the ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds. Hearing changes usually get better after this treatment ends. But some can be permanent. Tell your doctor if you notice any changes in your hearing.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor, nurse or pharmacist if you develop: 

  • a cough that does not go away
  • wheezing
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Effects on the heart

This treatment can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.

If the treatment is causing heart problems, your doctor may change the type of treatment you are having.

Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • breathlessness
  • dizziness
  • changes to your heartbeat
  • swollen feet and ankles.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. 

Always call 999 if you have:

  • chest pain, pressure, heaviness, tightness or squeezing across the chest
  • difficulty breathing.

Effects on the brain

Rarely, this treatment can affect the brain. This can cause symptoms including: 

  • drowsiness or confusion
  • memory problems
  • trouble speaking
  • problems with balance, moving, or walking
  • changes in eyesight or flickering eye movements
  • rarely, headaches and fits (seizures)

Contact the hospital straight away if you have any of these symptoms. If someone with you notices you have any of these symptoms, they should contact the hospital straight away.

It is important not to drive or operate machinery if you have any of these symptoms.

Second cancer

Chemotherapy can increase the risk of developing a second cancer, years later. But this is rare. The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • throbbing pain or swelling in a leg or arm
  • reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
  • suddenly feeling breathless or coughing.

Always call 999 if you have:

  • chest pain
  • difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Other medicines

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

Grapefruit and grapefruit juice

Grapefruit and grapefruit juice may affect how well some of your treatment works or make side effects worse.  Speak to your doctor, nurse or pharmacist before eating or drinking grapefruit to make sure it is safe with your treatment.

Lactose

Dexamethasone and mesna tablets contain lactose. If this affects you and you are lactose intolerant, tell your doctor or nurse.

Alcohol

You should avoid drinking alcohol when on methotrexate and cyclophosphamide. It can affect how the drugs work and make some side effects, such as sickness, worse.

Vaccinations

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Contraception

Your doctor will advise you not to:

  • get pregnant while having this treatment and for at least 1 year afterwards.
  • make someone pregnant while having this treatment and for at least 6 months afterwards. 

This is because the drugs may harm the developing baby. It is important to use effective contraception to prevent pregnancy. Your doctor, nurse or pharmacist can tell you more about this.

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Changes to periods

If you have a period, these may become irregular or stop while you are having this treatment. This may be temporary, but it can sometimes be permanent. Your menopause may start sooner than it would have done. Your doctor or nurse can give you more information.

Sex

It is possible that small amounts of chemotherapy may be passed on through vaginal fluids or semen. If you have sex in the first few days after treatment, your cancer team will usually advise using condoms or a dental dam to protect your partner.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

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Date reviewed

Reviewed: 01 December 2023
|
Next review: 01 December 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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