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Cytarabine into spinal fluid

Cytarabine is a chemotherapy drug. Doctors may use a type of cytarabine called DepoCyte. Or they may use generic cytarabine.

It is a treatment for some types of lymphoma (cancer of the lymph glands).

How it works

This drug is a type of chemotherapy drug called an anti metabolite.

Anti metabolites are similar to normal body molecules but they are slightly different in structure. They kill cancer cells by stopping them making and repairing DNA that they need to grow and multiply.

How you have it

Cytarabine is a clear liquid. An experienced cancer doctor injects it into the fluid around the spinal cord during a lumbar puncture. This treatment is also called intrathecal cytarabine.

If you have DepoCyte your doctor prescribes steroid tablets called dexamethasone for you to take. The steroid reduces the side effects. You need to take them after a meal, or with milk, as they can irritate your stomach.

Taking tablets

You must take tablets 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.

Never stop taking a cancer drug without talking to your specialist first.

Intrathecal injection

You have an intrathecal injection of cytarabine the same way you have a lumbar puncture. You lie on your side. Your doctor gives you a small injection to numb an area in your back. They then inject the cytarabine between 2 of your spinal bones into the spinal fluid. It takes from 1 to 5 minutes. Afterwards you need to lie flat for an hour.

Diagram showing how you have a lumbar puncture

When you have it

If you have DepoCyte treatment you usually have it every 2 weeks for 5 doses. After that you have treatment once a month for 4 months.

If you have generic cytarabine you may have the treatment from twice a week to once a month. The number of treatments may vary. Your doctor will tell you how often you need 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

Common side effects happen in more than 10 in 100 people (more than 10%). At the time of this review, there have been no reports of common side effects for this treatment.

Occasional side effects

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

Breathlessness and looking pale

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

Increased risk of bruising and bleeding

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).

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.

Increased levels of uric acid in the blood

High levels of uric acid in your blood can lead to a build up of crystals in body tissues and cause inflamed joints. You’ll have regular blood tests to check your levels. Drinking plenty of fluids helps to flush out the excess uric acid. You might also have medicines to control the uric acid levels.

Changes to being aware of your surroundings

You might feel sleepy, unable to stay awake or be unaware of surroundings (a low level of consciousness).

Difficulty speaking

You might find that you are not able to speak or have some difficulty speaking. 

Eye problems

You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your doctor or nurse if you have this. They can give you eye drops or other medication to help. 

You might also have abnormal eye movemants and your eyes might be more sensitive to light. 

Changes to how your liver works

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Skin changes

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

You might also have blisters or hives.

Sore inflammed blood vessels

Your blood vessels might get inflamed and sore. Symptoms include red spots on the skin, lumps or sores. Your legs and arms might aso feel weak and numb. Contact your advice line or tell your doctor or nurse if you have any of these symptoms. 

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Changes to how well your kidneys work

To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

You might also find it difficult to pass urine. Contact the advice line or tell your docotor or nurse if this happens. 

High temperature (fever)

If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Inflammation at the site of injection

You might have small blood clots where you had the injection. This can cause swelling, redness and discomfort. Tell your healthcare team if this happens. 

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.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Tummy (abdomen) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Sore mouth

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Sore back passage (anus)

You might also get sores (ulcers) around your back passage. Contact the advice line or tell your doctor or nurse if this happens. 

Rare side effects

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

  • whole body infection (sepsis) causing fever, being sick, confusion, dizziness and chills
  • brown or black spots on the skin (lentigo)
  • headache
  • numbness, weakness or pain in lower arms or legs
  • loss of ability to move (paralysis of) legs and lower body
  • inflammation of the sac surrounding the heart
  • lung infection (pneumonia)
  • shortness of breath
  • sore throat, inflammation and or ulcers of the food pipe (oesophagus)
  • cysts in the bowel, severe inflammation of the bowel causing damage symptoms include bloating, blood in the poo, diarrhoea, being sick and loss of appetite
  • infection of the tissue lining the abdomen (peritonitis)
  • ulcers on the skin
  • itching
  • pain, burning, reddening and blistering of the palms of the hands and soles of the feet
  • muscle and joint pain
  • inflammation at the site of injection

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.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

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 and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

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.

Immunisation

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.