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CTD

Find out what CTD is, how you have it and other important information about having CTD.

CTD is the name of a combination of drugs. It includes the drugs:

  • C – cyclophosphamide (a type of chemotherapy)
  • T – thalidomide (a cancer treatment drug)
  • D – dexamethasone (a steroid)

It is a treatment for myeloma.

How CTD works

The chemotherapy drug cyclophosphamide works by stopping cells dividing into 2. Dexamethasone is a steroid and can help chemotherapy to work better.

Thalidomide is a type of cancer growth blocker. It affects all sorts of cells processes. Researchers are still looking at how it works. We know that it:

  • interferes with chemicals that cells use to tell each other to grow
  • stimulates some of the immune system cells to attack the myeloma cells
  • stops tumours making their own blood vessels that they need in order to grow

So, the drug combination of CTD affects how cells divide and grow.

How you have CTD

You take all of these drugs as tablets or capsules.

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Never stop taking a cancer drug without talking to your specialist first.

When you have it

You usually have CTD chemotherapy as cycles of treatment. Each cycle of treatment lasts either 3 or 4 weeks. Depending on your needs you may have up to 6 cycles. So the course lasts about 6 months in total.

Day 1 is the first day of a cycle of treatment.

3 weekly cycle
  • Cyclophosphamide – you take this once a day on days 1, 8 and 15 and swallow the tablets whole, ideally on an empty stomach
  • Thalidomide – you take this once a day for the whole 3 week cycle. Take the capsules with a glass of water, at night. Your doctor may tell you to increase the dose after a while if the side effects are mild
  • Dexamethasone – you take the tablets once a day from days 1 to 4 and days 12 to 15. Take them after a meal, or with milk, because they can irritate your stomach lining. They can make it difficult to sleep but taking them early in the day can help

On day 21, you have completed one cycle of your treatment. You start the next cycle on the following day.

4 weekly cycle
  • Cyclophosphamide – you take this on days 1,8,15 and 22 and swallow the tablets whole, ideally on an empty stomach
  • Thalidomide – you take this once a day for the 4 week cycle. Take the capsules with a glass of water, at night. Your doctor may tell you to increase the dose after a while if the side effects are mild
  • Dexamethasone – you take the tablets once a day on days 1 to 4 and days 15 to 18. Take them after a meal, or with milk, because they can irritate your stomach lining. They can make it difficult to sleep but taking them early in the day can help

On day 28 you have completed one cycle of treatment. You then start the next cycle on the following day.

Tests during treatment

You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Important information

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

Thalidomide can cause birth defects in children. So you must not become pregnant or father a child while you are taking this drug, and for a time afterwards. Your doctor or nurse will talk to you about contraception before you have the treatment.

Some people worry about taking thalidomide but it does not cause physical defects in adults.

Because thalidomide causes birth defects, you have to sign a consent form before you start treatment. This is to make sure you understand the risks of taking thalidomide and agree to use contraception for a specified period of time. 

If you are a woman of child bearing age you will need to have regular pregnancy tests during the treatment. Your doctor or nurse will tell you about this. 

Pregnant women should not touch or handle thalidomide. You must store it in a place where pregnant women or children cannot reach it.

Men with a female partner who could become pregnant should use condoms during sex for the time they are having treatment and for a week after finishing treatment. You must not donate semen during treatment or for 1 week afterwards.

Fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and Zostavax (shingles vaccine).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine
  • be in contact with other people who've had live vaccines as injections

Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, you mustn't change their nappies for 2 weeks after their vaccination.

You also need to avoid anyone who has had oral polio or typhoid vaccination recently.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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