FC

FC is the name of a combination of chemotherapy drugs used to treat chronic lymphocytic leukaemia (CLL). It is made up of the drugs

• Fludarabine
• Cyclophosphamide

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

You usually have FC chemotherapy as cycles of treatment. Each cycle of treatment lasts 4 weeks. Depending on your needs, you may have up to 8 cycles, taking 6 to 8 months in total.

You can either have your treatment

• As tablets - you take one tablet of fludarabine and one of cyclophosphamide once a day
• As a drip (infusion) into a vein or as slow injections through a small tube (cannula) put into a vein

You have treatment for 3 to 5 days. Then for the rest of that week and for the following 3 weeks you have no treatment. Your next cycle of treatment then starts 4 weeks after the beginning of the first treatment.

If you are taking tablets it is important that you store them in a safe place away from children. Take any unused tablets back to the pharmacy. You should only get your prescription for these tablets from your cancer specialist, not from your GP.

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 FC are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.

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

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

• 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 doctor 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

• Feeling or being sick in about 3 out of every 10 people (30%), but this is usually well controlled with anti sickness drugs
• Hair loss - most people have complete hair loss but the hair grows back once the treatment ends
• Tiredness during and after treatment affects just under half (50%) the people who have FC – most people find their energy levels are back to normal within 6 months to a year
• Diarrhoea in 3 out of 10 people (30%) – drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days
• Constipation in 3 out of 10 people (30%) – your doctor may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• A raised temperature in up to 4 out of 10 people (40%)
• Loss of taste or taste changes
• Fludarabine may cause changes in your immune system that permanently affect the production of blood cells - these include autoimmune haemolytic anaemia, thrombocytopenia and thrombocytopenic purpura
• These drugs may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Women may stop having periods (amenorrhoea) but this may be temporary
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with these drugs. It is important to talk to your doctor about fertility before starting treatment.

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

• Cystitis (inflammation of the bladder) can cause pain and occasionally blood when passing urine. Contact your doctor straight away if you see blood in your urine. You should drink 8 to 12 cups of fluid a day while you are having treatment and for 3 days afterwards
• Your nails may darken or become ridged
• Your skin may darken
• Mouth sores and ulcers

Fewer than 1 in 100 people have these.

• Nerve changes causing numbness and tingling in fingers and toes
• There is a small risk that you may get a second cancer some years after cyclophosphamide treatment
• Damage to heart muscle 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
• Changes in lung tissue may lead to a cough or breathlessness
• Fluid retention

Not everyone will get these side effects. You may have one or two 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)
• The way you take the drug (tablets or drip)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them.

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

If you are having, or have had, fludarabine treatment you must always receive specially treated (irradiated) blood if you need a transfusion. This is to prevent a side effect called graft versus host disease. If you need to have a blood transfusion, check with your doctor or nurse that the blood has been irradiated.

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 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 from your chemotherapy.

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. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio, typhoid or cholera vaccination recently.