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What FMD is

FMD is the name of a combination of chemotherapy drugs used to treat non Hodgkin lymphoma. It is made up of the drugs

  • F – Fludarabine (Fludara)
  • M – Mitoxantrone (Onkotrone)
  • D – Dexamethasone, which is a steroid

How FMD works

The chemotherapy drugs in the FMD combination destroy quickly dividing cells such as cancer cells.


How you have FMD

Mitoxantrone is a blue liquid and fludarabine is a clear liquid. Fludarabine also comes as a 10mg pink tablet. You have liquid fludarabine and also tablets as part of FMD treatment. You take the dexamethasone as white tablets. Your doctor will tell you the dose you need to take.

Drips into a vein

You have mitoxantrone and some of the doses of fludarabine into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having chemotherapy into a vein.


You have fludarabine tablets and also dexamethasone tablets. It is very important that you take them according to the instructions your doctor or pharmacist gives you. For example, 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. And never stop taking a cancer drug without talking to your specialist first.

Treatment cycles

You usually have FMD chemotherapy as cycles of treatment. Each cycle of treatment lasts 4 weeks. Depending on your needs, you may have up to 6 cycles. 

You have each cycle in the following way

  • On the 1st day you have fludarabine and mitoxantrone either as an injection into your cannula or central line, or as a drip (infusion). You also start taking the dexamethasone tablets
  • On the 2nd and 3rd day you have fludarabine as an injection or tablets and continue taking the dexamethasone
  • You take dexamethasone tablets on the 4th and 5th day

Then you have no treatment for just over 3 weeks. This completes one cycle. You then start your next cycle.


Tests during treatment

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


About side effects

We've listed the side effects associated with FMD. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.

You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)

The side effects may be different if you are having FMD with other medicines.

Tell your doctor or nurse straight away if any of the side effects get severe.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets happens in 4 out of 10 people (40%) – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
  • Tiredness (fatigue) that may continue after treatment has finished. Most people find their energy levels are back to normal within 6 months to a year
  • A high temperature in up to 6 out of 10 people (60%)
  • Feeling or being sick is usually well controlled with anti sickness medicines
  • Changes in your immune system that permanently affect the production of blood cells – these include autoimmune haemolytic anaemia, thrombocytopenia and thrombocytopenic purpura
  • Urine may become a blue green colour for 1 or 2 days after treatment – this won't harm you
  • Changes to your blood sugar levels due to steroids – you will have regular blood tests and may also need to check your urine for sugar

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if it becomes severe or continues for more than 3 days
  • Mouth sores and ulcers
  • Hair thinning
  • Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished
  • Women may stop having periods (amenorrhoea) but this may only be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. 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

Rare side effects

Fewer than 1 in 100 people have these effects.

  • In a very small number of people who have mitoxantrone, the whites of their eyes have a slight blue tint, but this is temporary
  • Numbness or tingling in your hands or feet – it usually improves a few months after the treatment ends
  • Effects on the brain and spinal cord causing eyesight problems, drowsiness, agitation, fits (seizures) or confusion – tell your doctor or nurse if you have any of these effects
  • A cough or difficulty breathing
  • A skin rash
  • High uric acid levels in your blood due to cancer cells being broken down by the body. You will be asked to drink plenty of fluids to flush out the uric acid. Your doctors may also give you a drug called allopurinol
  • There is a small risk that you may get a second cancer some years after FMD treatment

Important points to remember

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


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


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


Related information


More information about FMD

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information about these drugs look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 14 September 2015