FAD

FAD is the name of a combination of chemotherapy drugs used to treat some types of low grade lymphoma. It is made up of the drugs

• F = Fludarabine
• A = Doxorubicin (also called Adriamycin)
• D = Dexamethasone – a steroid

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

Fludarabine is a clear colourless fluid and doxorubicin is a red fluid. You have these drugs 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 just before your course of treatment starts and it stays in place as long as you need it.

You have FAD chemotherapy as cycles of treatment. You may have up to 6 or 8 cycles. Each treatment cycle lasts 4 weeks.

On the first day you have injections of doxorubicin and fludarabine into a cannula or central line. On the second and third day you have fludarabine injections. You take dexamethasone tablets for the first 5 days.

For the next 23 days you have no treatment. This completes one treatment cycle. You then repeat the 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 FAD are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug 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 effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

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
• A raised temperature in up to 6 people out of 10 (60%)
• Fludarabine may permanently affect your production of blood cells – it may cause autoimmune haemolytic anaemia, thrombocytopenia and thrombocytopenic purpura
• Hair loss affects most people and may include all body hair but this is temporary – your hair will grow back once treatment ends
• Feeling or being sick is generally well controlled with anti sickness injections and tablets – if your sickness is not controlled, tell your doctor or nurse, as you can try other anti sickness medicines
• You may have dark marks in the creases of your skin when having doxorubicin – this is particularly common in children
• Sensitivity to the sun – cover up and stay in the shade while you are having treatment with doxorubicin and use a high factor sun cream on any exposed skin
• Watery eyes occur in about 1 out of 4 people (25%) who have doxorubicin and may last for several days after the beginning of each treatment
• Your urine may become a pink or red colour for about a day after treatment with doxorubicin – this won't harm you
• Steroids can change the level of sugar in your blood and you will have regular blood tests to keep an eye on this – you may also need to have tests to check for sugar in your urine
• Women may stop having periods (amenorrhoea) but this may only be temporary
• Loss of fertility may happen with this combination of drugs so it is important to talk to your doctor before starting treatment if having a baby is important to you
• FAD drugs 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.

• If doxorubicin leaks into the tissue around the drip site it may damage the tissue in that area – tell your nurse or doctor if you have any leakage of fluid around the drip site or any redness, swelling stinging or burning in the area
• An allergic reaction to doxorubicin affects about 3 in 100 people (3%) – you may have a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins, which should clear up within a few days
• Reddening of the skin in areas treated with radiotherapy in the past, and the skin may get dry and flaky and feel sore and hot – this goes away on its own but keep affected areas out of the sun
• Damage to heart muscle from doxorubicin, which is usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment
• Diarrhoea – drink plenty of fluids, and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
• Loss of appetite
• Nails may become darker and white lines may appear on them

Fewer than 1 in 100 people have these.

• Numbness or tingling in fingers and toes which can cause difficulty doing small things such as doing up buttons – this starts within a few days or weeks and usually goes within a few months of finishing treatment
• Temporary changes in 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 sore mouth
• High uric acid levels in your blood due to cancer cells being broken down by the body – you will have regular blood tests and will be asked to drink plenty of fluids to flush out the uric acid. Your doctors may also give you a drug called allopurinol
• Sore eyes

There is a small risk that you may get a second cancer some years later after FAD treatment.

You will not get all of these effects. 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 to ring if you have any questions or problems. Your treatment team can give you advice or reassure you so 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 – 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.