Thiotepa (TEPADINA ®)

Thiotepa (TEPADINA®) is a chemotherapy drug used to treat leukaemia, lymphoma and myeloma. It may also be used to treat other cancers.

It is best to read this information with our general information about chemotherapy and the type of cancer you have.

Thiotepa is given into a vein. You usually have it during a hospital stay. Your cancer doctor or nurse will tell you how often you will have it.

Like all chemotherapy drugs, thiotepa can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is thiotepa?


How thiotepa is given

You will be given thiotepa during a stay in hospital. A chemotherapy nurse will give it to you. Thiotepa can be given in combination with other cancer drugs.

During treatment, you usually see a cancer doctor or haematologist (a doctor who treats blood cancers), and a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.

Your nurse usually gives you anti-sickness (anti-emetic) drugs before the chemotherapy.

The chemotherapy drugs can be given through:

  • 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).

Your nurse will give you thiotepa as a drip (infusion) into your line. The drip is usually given through a pump, which gives the treatment over two to four hours.

Your course of chemotherapy

Thiotepa is usually given in combination with other chemotherapy drugs. It is given over several days before you have a stem cell or bone marrow transplant. The length of your treatment will depend on the type of cancer you have.

Your nurse or doctor will discuss your treatment plan with you.


About side effects

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 haven’t 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.

More information

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.


Side effects during treatment

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 
  • a skin rash
  • itching
  • shivering
  • 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.

Pain along the vein

Thiotepa can cause pain at the place where the injection is given or along the vein. If you feel pain, tell your nurse or doctor straight away so that they can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.


Common side effects

Risk of infection

Thiotepa will 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 are having a stem cell or bone marrow transplant, you will probably be looked after in a single room for a few weeks. This is 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 blood tests to check this.

Bruising and bleeding

Chemotherapy 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:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash
  • blood in the urine
  • bleeding from the vagina.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

Chemotherapy 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.

Feeling sick

You may feel sick in the first few days of your chemotherapy. The nurses will give you anti-sickness drugs regularly. 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

This treatment can affect your appetite. Do not worry if you don’t eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Sore mouth

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.

Diarrhoea

If you have diarrhoea, ask your doctor or nurse for advice. Try to drink at least two litres (three and a half pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

Thiotepa may make you constipated and cause tummy pain. Tell your nurse if this happens. They can give you medicine to help your bowels move (laxatives).

Tummy pain

Thiotepa can cause pain in your tummy (abdomen) or indigestion. Rarely, thiotepa may cause a stomach ulcer. Tell your doctor if you have:

  • tummy pain
  • blood from the back passage when your bowels move
  • dark or tar-like stools.

Skin changes

Thiotepa 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. Thiotepa can cause a rash, which may be itchy. 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.

Hair loss

Your hair will get thinner or you may lose all the hair from your head. You may also lose your eyelashes, eyebrows or other body hair.

Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. It is important to cover your head to protect your scalp when you are out in the sun.

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

Eye problems

This treatment may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe eye drops to help prevent this.

It is important to use these as instructed. Thiotepa may also cause blurry vision. Always tell your doctor or nurse if you have pain or notice any change in your vision.

Hearing changes

This treatment may cause hearing changes. Some people may have pain or ringing in their ears (tinnitus). Tell your doctor if you notice any changes to your hearing.

Effects on the kidneys and liver

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

It is important to drink at least two litres (three and a half pints) of fluids each day to help protect your kidneys.

Muscle or joint pain

You may get pain in your muscles or joints for a few days after chemotherapy. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Effects on the nervous system

Thiotepa can affect the nervous system. You may feel anxious or restless, drowsy, dizzy or confused. Tell your doctor or nurse straight away if you notice any of these symptoms.


Less common side effects of thiotepa

Effects on the heart

Chemotherapy can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during, and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the type of chemotherapy you are having.

Contact a doctor straight away if you:

  • have pain or tightness in your chest
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

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

Effects on the lungs

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

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

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

Second cancer

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


Other information about thiotepa

Blood clot risk

Cancer and treatment with chemotherapy can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • 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.

Other medicines

Some medicines can affect chemotherapy or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment. The drugs may harm the developing baby. It is important to use effective contraception during your treatment.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Fertility

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

Sex

If you have sex in the first few days after 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.