Decorative image

ChlVPP

ChIVPP is the name of a combination of chemotherapy drugs that includes:

  • Chl – chlorambucil
  • V – vinblastine
  • P – procarbazine
  • P – prednisolone, which is a steroid

It is a treatment for Hodgkin lymphoma. You might have this if you are unable to have another chemotherapy combination called ABVD.

How ChlVPP works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells. Prednisolone can also kill cancer cells and helps the chemotherapy work better. 

How you have ChlVPP

You have ChlVPP into your bloodstream (intravenously) and as tablets and capsules that you swallow. You have:

  • chlorambucil as tablets that you swallow whole with a glass of water 1 hour before you eat any food. Or 3 hours after a meal. You keep chlorambucil tablets in the fridge
  • vinblastine as an injection into your bloodstream 
  • procarbazine as capsules that you swallow whole with plenty of water
  • prednisolone as tablets that you swallow whole with plenty of water after breakfast

Taking your capsules and tablets

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.

Talk to your specialist or advice line before you stop taking a cancer drug.

Drugs into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

When you have ChlVPP

You usually have ChlVPP as a course of several cycles of treatment. A cycle means that you have the drugs and then a rest to allow your body to recover. 

One cycle is 28 days (4 weeks). You might have up to 6 cycles of treatment. 

You usually have ChlVPP in the following way:

Day 1
  • You have vinblastine as an injection into your bloodstream over 10 minutes.
  • You take chlorambucil tablets once a day.
  • You take procarbazine capsules once a day.
  • You take prednisolone tablets once a day.
Day 2 to day 7
  • You take chlorambucil tablets once a day.
  • You take procarbazine capsules once a day.
  • You take prednisolone tablets once a day.
Day 8
  • You have vinblastine as an injection into your bloodstream over 10 minutes.
  • You take chlorambucil tablets once a day.
  • You take procarbazine capsules once a day.
  • You take prednisolone tablets once a day.
Day 9 to day 14
  • You take chlorambucil tablets once a day.
  • You take procarbazine capsules once a day.
  • You take prednisolone tablets once a day.
Day 15 to day 28
  • You have no treatment.

You then start a new cycle of treatment. 

Tests

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

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising, bleeding gums and nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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).

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • loose or watery poo (diarrhoea)
  • mouth ulcers
  • a virus you’ve had in the past becoming active and causing symptoms again
  • changes to your face and appearance (Cushing’s syndrome) – you might develop a swollen or puffy face, stretch marks, increased facial hair or gain weight around your tummy (abdomen)
  • low levels of hormones in the body – symptoms might include weight loss, loss of appetite, feeling or being sick, low blood pressure and general weakness
  • a build up of sodium (salt) in the body- symptoms include bloating, swelling of your legs, ankles and feet and other body tissues
  • increased levels of sugar in your blood and wee
  • weakened bones (osteoporosis) that can increase your risk of breaking them (fracturing)
  • a second cancer – particularly after long term use
  • high blood pressure
  • thinner areas of skin
  • your wounds not healing properly
  • muscle wasting

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening. Alert your nurse or doctor if notice any of these symptoms
  • skin problems such as a rash, that can be raised and itchy
  • seizures (fits)
  • numbness and tingling in your fingers and toes
  • nerve changes – symptoms include a feeling of pins and needles
  • shaky, twitchy or jerky movements of the body
  • lung problems such as scarring of the lung tissue or infection –symptoms include shortness of breath, cough, tiredness and loss of appetite
  • liver problems leading to yellowing of the skin and white of the eyes (jaundice). You have regular blood tests to keep an eye on this
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
  • inflammation of the bladder – symptoms can include pain in the bladder area, the urgency to wee, going very often and only in small amounts
  • high temperature (fever)
  • existing mental health problems can get worse such as depression and psychosis – contact your medical team for help in coping if you notice things worsening for you
  • eye problems causing symptoms such as poor eyesight, blurred vision, pain or tenderness

Other side effects

There isn’t enough information to work out how often these side effects might happen. You might have one or more of them. They include:

  • imbalance of substances in your blood (metabolic acidosis) – it can cause confusion, tiredness, shortness of breath and headaches
  • mood and behavioural changes such as mood swings, feeling very happy, confused, changes in personality, anxious, agitated or hallucinating
  • difficulty sleeping
  • problems with memory and thinking
  • a hole in the bowel wall (perforation)
  • loss of tendon reflexes that can affect your fingers or other parts of your body, and may affect things such as walking or swallowing
  • hearing problems such as partial or total hearing loss that can be temporary or permanent
  • difficulty with balance and feel like the room around you is moving or spinning (vertigo)
  • heart attack
  • bowel and stomach problems. Symptoms might include blood in your poo (it may loo very dark or black), cramps, a feeling of fullness, bloated and unable to pass wind (fart)
  • thinning of the hair or hair loss is usually temporary and starts to grow back when treatment finishes
  • pain in your muscles, bones, jaw or area where the lymphoma is – tell your medical team so they can give you painkillers to help

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Procarbazine food and alcohol

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 such as Marmite, Oxo, and Bovril
  • salami and pepperoni
  • overripe fruit, broad beans
  • foods which have been fermented, pickled, smoked, hung or matured

Lactose intolerance

Chlorambucil contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.

Diabetes

Prednisolone can cause changes to blood sugar levels. So there is a risk of developing diabetes or making your diabetes worse while on this medication.

You might have regular blood and urine tests to check this. You might need to have blood sugar lowering treatment. But your sugar levels usually go back to normal shortly after you stop taking steroids.

If you have diabetes already, you might need to check your blood sugar levels more often than usual.

Chicken pox or shingles

Keep away from people who have chicken pox or shingles while you’re taking prednisolone, if you have never had these illnesses. They could make you very ill.

Tell your doctor or nurse straight away if you have been with someone who has chicken pox or shingles.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

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

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help