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About chemotherapy

When, where and how you have chemotherapy for myeloma, and the possible side effects.

What chemotherapy is

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate around the body in the bloodstream.

Most chemotherapy is given in cycles of treatment. You have some drugs daily and others weekly. A cycle normally last 3 or 4 weeks. Usually 4 to 6 cycles make up one course of treatment. So a course can last 4 to 6 months.

Types of chemotherapy

The type of chemotherapy you have depends on several things including whether or not your doctor is planning for you to have a stem cell transplant, and your general health.

The chemotherapy drugs doctor use for myeloma include:

  • cyclophosphamide
  • melphalan
  • doxorubicin (Adriamycin)
  • idarubicin

Most people have chemotherapy by mouth, as tablets or capsules (oral chemotherapy). Some people have chemotherapy through a drip into a vein (infusion).

You often have chemotherapy with steroids, such as dexamethasone or prednisolone. And you may also have a biological therapy, such as thalidomide or bortezomib (Velcade).

Combinations of treatment include:

  • cyclophosphamide, thalidomide and dexamethasone (CTD)
  • melphalan and prednisolone (MP)
  • melphalan, prednisolone and thalidomide (MPT)
  • melphalan, prednisolone and bortezomib (VMP)
  • cyclophosphamide, bortezomib and dexamethasone (CVD)
  • doxorubicin, bortezomib and dexamethasone (PAD)

Sometimes doctors use other drugs, such as in the combination DT-PACE or DR-PACE. These include:

  • dexamethasone
  • thalidomide or lenalidomide (Revlimid)
  • cisplatin
  • doxorubicin
  • cyclophosphamide
  • etoposide 

You are more likely to have one of these combinations for myeloma that has come back.

Some people have high dose chemotherapy, usually with melphalan, and a stem cell transplant. This is an intensive treatment, so your doctor will only offer it if you are fit enough to get through it.

Taking your 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.

Having chemotherapy into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You may need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Where you have chemotherapy

Most people with myeloma have chemotherapy as tablets, which you take at home. If you're having chemotherapy into your bloodstream (intravenous chemotherapy), you usually have this in the cancer day unit. Or you might need to stay in a hospital ward for a few days.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have any signs of infection such as a temperature higher than 38C or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for the few days that you’re having the chemotherapy drugs. Your treatment team can help to reduce your side effects.

When you go home

Chemotherapy for myeloma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you take any supplements or if you’re prescribed them by alternative or complementary therapy practitioners.

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

Information and help

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