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FMD

FMD is the name of a combination of cancer drugs that includes:

  • fludarabine
  • mitoxantrone
  • dexamethasone (a steroid)

It is a treatment for non-Hodgkin lymphoma (NHL) or chronic lymphocytic leukaemia (CLL). 

How it works

These cancer drugs destroy quickly dividing cells, such as cancer cells.

How you have FMD

You have:

  • fludarabine as a drip into your bloodstream (intravenously), or as a tablet that you swallow whole
  • mitoxantrone as a drip into your bloodstream
  • dexamethasone as tablets that you swallow whole, or as a drip into your bloodstream

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

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

When you have FMD

You usually have FMD as cycles of treatment. Each cycle of treatment lasts 4 weeks. You may have each cycle of treatment in the following way:

Day 1
  • You have fludarabine as a drip into your bloodstream or as tablets that you swallow whole
  • You have mitoxantrone as a drip into your bloodstream
  • You start taking dexamethasone tablets
Day 2 and day 3
  • You have fludarabine as a drip into your bloodstream or as tablets that you swallow whole
  • You take dexamethasone tablets
Day 4 and day 5
  • You take dexamethasone tablets
Day 6 to day 28
  • You have no treatment

You then start your next treatment cycle.

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:

Risk of 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. 

Breathlessness 

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

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 petechia).

Fatigue 

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

High temperature 

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

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.

Cough 

It is important to tell your doctor or nurse if you have a cough. This could be due to an infection, such as pneumonia. Or it could be caused by changes to the lung tissue, making it less flexible.

Loose or watery poo (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.

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. 

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: 

  • loss of appetite
  • numbness or tingling in fingers and toes (peripheral neuropathy)
  • eye problems such as loss of vision
  • mouth sores and ulcers
  • skin rash
  • swelling (oedema) in different parts of your body
  • heart problems such as a build up of fluid around the heart and a heart attack
  • difficulty breathing
  • constipation
  • a second cancer called acute myeloid leukaemia (AML) or a blood disorder called myelodysplastic syndrome (MDS) some years after this treatment

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: 

  • taste changes
  • blood disorders such as an abnormal break down of red blood cells (haemolytic anaemia)
  • high levels of uric acid in your body due to the breakdown of tumour cells (tumour lysis syndrome). You have regular blood tests to check for this
  • fits (seizures)
  • confusion, agitation or anxiety
  • inflammation of the lung tissue (pneumonitis) which can cause difficulty breathing and cough
  • changes in the level of liver and pancreatic enzymes
  • bleeding in your gut
  • a severe allergic reaction that can be life threatening
  • headaches
  • blue discolouration of the white part of your eyes. This is usually temporary and will return to normal after treatment
  • 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

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

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 

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 may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Contraception and pregnancy 

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months 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)
  • 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 oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray. You should do so for 2 weeks following their vaccination if you have a severely weakened immune system.

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