ChlVPP

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

• Chl = Chlorambucil
• V = Vinblastine
• P = Procarbazine
• P = Prednisolone, which is a steroid

The links above take you to more information about the individual side effects of each drug.

Vinblastine is a clear fluid. You have it into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drug directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

All the other drugs are taken as tablets or capsules.

Procarbazine comes in ivory coloured capsules. Swallow them whole with plenty of water.

Chlorambucil is a brown tablet. You should also swallow these tablets whole with plenty of water. Take them 30 to 60 minutes before you eat any food. Keep them in the fridge.

Prednisolone comes as white or red tablets. Your doctor will tell you the dose you need to take. Take them after breakfast. 

It is very important that you take tablets 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.

Keep all of the tablets and capsules in tightly closed containers and out of the reach of children. Return any unused tablets to the pharmacy.

You usually have ChlVPP chemotherapy as cycles of treatment. Each cycle takes 4 weeks. You may have between 4 and 6 cycles of treatment, which takes between 4 and 6 months.

• On the first day you have vinblastine as an injection into your cannula, central line or PICC line. Your nurse will give you the other drugs (chlorambucil, procarbazine and prednisolone) to take at home. You will need to take them as prescribed each day for 2 weeks 
• A week after the vinblastine injection you have another injection of vinblastine
• When you finish the 2 week course of tablets you have 2 weeks with no treatment
• You then start the next treatment cycle

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with ChlVPP are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drugs side effects section.

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

A temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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 – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment team if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Procarbazine interacts with alcohol and some foods, causing sickness, headaches, difficulty breathing, sweating, faintness or drowsiness. You should not drink alcohol while you are taking procarbazine. Reactions to food are rare, so if you want to try a food on this list, you could have a little at a time until you are sure it won't upset you.

• Mature cheeses (including processed cheeses)
• Yeast or meat extracts (Marmite, Oxo, Bovril)
• Salami and pepperoni
• Overripe fruit, broad beans
• Foods which have been fermented, pickled, smoked, hung or matured

Other common side effects include

• Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Numbness or tingling in fingers and toes affects between 1 and 2 out of every 10 people (10 to 20%) and can cause difficulty with fiddly things such as doing up buttons – this starts within a few days or weeks and usually goes within a few months of finishing treatment
• Feeling or being sick is usually mild to moderate and happens within 24 hours of having treatment – tell your doctor or nurse if your anti sickness injections and tablets do not control your sickness
• Procarbazine has a temporary effect on the brain and nervous system in up to 3 out of every 10 people (30%) – this can cause depression, difficulty sleeping, or nightmares
• Hair loss or hair thinning is common with vinblastine and usually starts about 3 to 4 weeks after treatment begins – your hair will grow back once the treatment ends
• A sore mouth
• Loss of appetite
• Metallic taste in your mouth or a loss of taste
• Flu like symptoms (a fever, chills, blocked nose, sweating, aches and pains), particularly when you first start taking procarbazine
• Women may stop having periods (amenorrhoea) – this may be temporary
• Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk with your doctor before starting treatment if having a baby is important to you
• ChlVPP may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant

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

• Constipation can occur with vinblastine – your doctor may give you laxatives to help prevent this but tell them if you are constipated for more than 3 days
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if it becomes severe or continues for more than 3 days
• Skin changes – you may have dark skin markings along the line of the vein where the chemotherapy was injected
• Increased appetite and weight gain
• Indigestion due to prednisolone
• Sleep and mood disturbances can occur with prednisolone but taking it early in the day can help with this – let your doctor or nurse know if it is causing problems
• Raised blood sugar levels can occur with prednisolone and you will have regular blood and urine tests to check this – let your doctor or nurse know if you feel thirsty or need to pass urine a lot
• There is a risk that you may get a second cancer some years after ChlVPP treatment

Fewer than 1 in 100 people have these.

• An allergic reaction, with an itchy rash, flushed face and difficulty breathing – tell your doctor or nurse straight away if you have any of these effects
• Fits (seizures)
• Inflammation of the lungs with chlorambucil – tell your doctor if you have any difficulty breathing
• Depression
• Headaches
• Jaw pain
• A faster heart rate
• Dizziness and changes in eyesight
• Difficulty emptying your bladder
• High blood pressure

You may have one or two side effects or several. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• Other drugs you are having

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

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies (such as hay fever treatment) – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.