MPT

MPT is given as tablets and capsules that you take at home.

During your course of treatment, you will meet someone from your cancer team, such as a:

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

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

You will have regular blood tests during treatment. This is to check that it is safe for you to have treatment.

You will meet with a doctor, nurse or pharmacist regularly during treatment. They will talk to you about your blood results and ask how you have been feeling.

You usually have a course of several cycles of treatment over a few months. Your cancer team will discuss your treatment plan with you. They may give you a copy of the treatment plan to take home. 

Your cancer team will give you the capsules and tablets to take home. They may give you tablets of different strengths. Always take the capsules and tablets exactly as explained. This is important to make sure they work as well as possible for you.

Your cancer team will also give you other medicines to take home to help relieve or prevent some side effects. Take all your capsules or tablets exactly as they tell you to.

A cycle of MPT is usually 28 days (4 weeks). 

You take:

• melphalan tablets on the first 4 days of each 28-day cycle
• prednisolone tablets on the first 4 or 7 days of each 28-day cycle 
• thalidomide capsules every day of the 28-day cycle.

It is important to take:

• thalidomide at bedtime, as it can make you feel sleepy
• prednisolone with, or just after breakfast.

When taking your tablets and capsules, make sure you:

• swallow them whole with a glass of water
• do not chew, open, break or crush them
• take them at the same times every day.

If you forget to take the melphalan or prednisolone, take the missed dose as soon as possible within the same day. If a full day has passed, do not take a double dose. 

If you forget to take the thalidomide and less than 12 hours have passed, take your capsules straight away. If more than 12 hours have passed, do not take your missed dose. Just take your usual dose at the usual time. 

Contact the hospital on the 24-hour number you have been given for advice.

Other things to remember about your capsules and tablets:

• Keep the melphalan in the fridge.
• Keep the prednisolone and thalidomide in the original packages and at room temperature, away from moisture, heat and direct sunlight.
• Wash your hands after taking melphalan and thalidomide.
• Other people should avoid direct contact with the thalidomide capsules and melphalan tablets. 
• Thalidomide packaging and capsules need to be handled safely. It is important that you, or anyone who helps you with your medicines, follows the advice from your doctor, nurse and pharmacist. 
• Keep them safe, where children cannot see or reach them.
• If you are sick (vomit) just after taking them, do not take an extra dose. Contact the hospital for advice.
• Do not throw away unused capsules or tablets. Return them to your cancer team at the hospital.
• If your treatment is stopped, return any unused capsules or tablets to the pharmacist. 

Some prednisolone tablets may contain lactose. If you have a lactose allergy or intolerance, ask your doctor, nurse or pharmacist for more information.

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. 

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.

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.

You may feel sick during this treatment, but this is usually mild. Your doctor, nurse or pharmacist may prescribe you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to. 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.

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.

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.

Steroids may raise your blood sugar levels and increase the risk of diabetes.

You will have regular blood tests to check this.

Signs of raised blood sugar include:

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

Contact the hospital on the 24-hour number if you have these symptoms during treatment or after it ends.

If you already have diabetes, your blood sugar levels may be higher than usual. You may need advice and support from your GP or diabetes team about managing this.

Steroids can affect your mood. You may:

• feel anxious or restless
• have mood swings
• have 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.

This treatment can affect your skin. It might feel dry. You may develop a rash, which may be itchy. Always tell your doctor, nurse or pharmacist about any skin changes. They can give you advice or prescribe creams or medicines to help.

If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.

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.

Steroids can make you feel hungrier than usual, and you may gain weight. Your appetite should go back to normal when you stop taking steroids. If you are worried about gaining weight, talk to your doctor or nurse. 

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 (palpitations)
• 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.

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.

This treatment can affect how your kidneys or liver work. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your kidneys and liver 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 also 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.

Thalidomide may cause hearing changes, including some hearing loss. Tell your doctor if you notice any changes in your hearing.

This treatment 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 risk of developing a blood clot will be assessed before starting thalidomide. You may be given medication to help prevent blood clots while on treatment. 

Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

This treatment might cause an allergic reaction. But this is not common. Signs of a reaction can include:

• a skin rash or itching
• feeling breathless or wheezy
• swelling of your face, mouth or throat.

If you feel unwell or have any of these signs, contact the hospital straight away on the 24-hour number. Do not take any more of this treatment until you have checked with them.

Always call 999 if swelling happens suddenly or you are struggling to breathe.

Some people are at risk of developing a condition called tumour lysis syndrome (TLS). The risk is highest at the beginning of treatment. TLS happens when treatment makes large numbers of cancer cells die and break down quickly. This releases lots of waste products into the blood and can affect the kidneys and heart.

TLS can be prevented or treated. You will have regular blood tests to check for TLS. You may have:

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

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

Rarely, this treatment can cause a serious skin reaction that needs to be treated immediately in hospital. 

Do not take any more of this treatment and contact the hospital straight away on the 24-hour number if you have any of these symptoms:

• a skin rash that is spreading
• blistering or peeling skin
• flu-like symptoms, such as a high temperature and joint pain
• sores on your lips or in your mouth.

Very rarely, thalidomide can cause a serious brain condition known as progressive multifocal leukoencephalopathy (PML). This condition can cause:

• blurred or double vision, or a loss of or double vision
• difficulty speaking • weakness in an arm or a leg
• changes in the way you walk, or problems with your balance
• persistent numbness
• decreased sensation or loss of sensation,
• memory loss or confusion.

If you have any of these symptoms during or after treatment, it is important to either:

• contact the hospital straight away on the 24-hour number
• go to the hospital straight away.

You should not drive yourself to hospital.

If you had these symptoms prior to treatment with thalidomide, tell your doctor or nurse immediately about any change in these symptoms.

Rarely, this treatment can increase the risk of developing a second cancer years later. The benefits of treatment usually far outweigh this risk. Your doctor, nurse or pharmacist can talk to you about this.