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Side effects of ChlVPP

Find out about the side effects of the cancer drug combination: chlorambucil, vinblastine, procarbazine and prednisolone (ChlVPP). 

Tell your doctor or nurse if you have any 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. If in doubt, call them.

Contact your doctor or nurse immediately if any of your side effects get severe or if you have signs of infection including a temperature above 38C.

The side effects may be different if you are having ChlVPP with other cancer treatments.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them.

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 37.5C. Severe infections can be life threatening.

Cancer treatments can reduce the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

This treatment makes the level of red blood cells fall (anaemia). You may feel breathless and look pale.

Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

Tell your doctor or nurse if you feel breathless.

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.

You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.

Talk to your doctor or nurse if you are finding the tiredness difficult to manage.

Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.

Tips

  • Keep your hands and feet warm.
  • Wear well fitting, protective shoes.
  • Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
  • Use oven gloves when cooking and protective gloves when gardening.
  • Moisturise your skin at least a couple of times a day.
  • Take care when cutting your nails.

You might feel sick or be sick. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Tips 

  • Avoid eating or preparing food when you feel sick.
  • Avoid hot fried foods, fatty foods or foods with a strong smell.
  • Eat several small meals and snacks each day.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Try fizzy drinks.
  • Sip high calorie drinks if you can’t eat.

Procarbazine has a temporary effect on the brain and nervous system. This can cause depression, difficulty sleeping, or nightmares. Speak to your doctor if you have this. 

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.

Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.

Tips

  • Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
  • You could choose a wig for a whole new look.
  • Think about having your hair cut short before your treatment starts.
  • Some people shave their hair off completely so they don't have to cope with their hair falling out.
  • Wear a hairnet at night so you won't wake up with hair all over your pillow.

Your mouth might become sore about 5 to 10 days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.

Your doctor or nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.

Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.

Tips

  • Clean your mouth and teeth gently every morning and evening and after each meal.
  • Use mouthwashes as advised by your doctor or nurse. Let them know if the mouthwash stings. They can tell you to stop using it or dilute it with water.
  • Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
  • Moisten meals with gravies and sauces to make swallowing easier.
  • Avoid acidic fruits such as oranges, grapefruit or lemons.

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

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

Changes in taste may make you go off certain foods. Many people go off tea and coffee, for example. You may also find that some foods taste different from usual. Some people find that they prefer to eat spicier foods.

Your taste usually gradually goes back to normal when your treatment is over. It may take a few weeks.

Tips

  • Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
  • Season your food with spices or herbs, such as rosemary, basil and mint.
  • Garnish cold meat or cheese with pickle or chutney.
  • Try lemon or green tea if tea or coffee taste strange.
  • Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
  • Some people find that cold foods taste better than hot foods.

You may have a fever, chills, blocked nose, sweating, aches and pains when you first start taking procarbazine.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.

Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

You may notice changes with your skin, such as dryness, itching, rashes and reddening.

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, smoothing in unperfumed moisturising cream may help. Check with your doctor, pharmacist or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

Steroids can increase your appetite. Feeling hungrier can make it difficult to keep your weight down. Your appetite will go back to normal when you stop steroids - but some people need to diet to lose the extra weight.

Talk to your nurse or your dietitian about how to safely control your weight.

Take your prednisolone tablets after a meal or with milk as they can irritate your stomach.

Sleep and mood disturbances can occur with prednisolone. Taking it early in the day can help with this. Let your doctor or nurse know if it is causing problems.

You have regular blood and urine tests to check this. If you have diabetes you may need to check your blood sugar levels more often than usual. 

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.

Symptoms may include an itchy rash, flushed face and difficulty breathing.

Tell your doctor or nurse straight away if you have any of these effects.

Tell your doctor or nurse if you have any changes to your eyesight.

Tell your doctor or nurse straight away if this happens.

Tell your doctor or nurse if you’re breathless or have a cough. This could be caused by changes to the lung tissue, making it less flexible.

Tell your doctor or nurse if you’re feeling depressed. They can arrange for you to talk to someone and give treatment if necessary.

Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.

Let your doctor or nurse know if you have jaw pain.  

A fast heart rate might feel as though your heart is pounding in your chest (palpitations). Talk to your doctor or nurse if you have this.

Don’t drive or operate machinery if you have this.

You may find it difficult to empty your bladder. Let your doctor or nurse know if that happens.

Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse checks your blood pressure regularly. 

There is a small risk that you may get a second cancer some years after this treatment. Your doctor will discuss this with you.

About ChlVPP

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
26 Feb 2018
  • Electronic Medicines Compendium 
    Accessed February 2018

  • ChlVPP/ABVVP, a first line ‘hybrid’ combination chemotherapy for advanced Hodgkin's lymphoma: a retrospective analysis
    G Martinelli and others
    British Journal of Haematology, 2004. Vol 125, issue 5, pages 584-589

  • Comparison of ABVD and Alternating or Hybrid Multidrug Regimens for the Treatment of Advanced Hodgkin's Lymphoma: Results of the United Kingdom Lymphoma Group LY09 Trial (ISRCTN97144519)
    P Johnson and others
    Journal of Clinical Oncology, 2005. Vol 23, number 36, pages 9208-9218

  • ChlVPP

    South East London NHS Cancer Network, 2008

  • ChLVPP

    St Lukes Cancer Alliance, 2016

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