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Melphalan, prednisolone and thalidomide (MPT)

MPT is a treatment for myeloma. Knowing more about it, how you have it, possible side effects and other important information about taking MPT can help you cope with treatment. 

MPT is a cancer drug combination made up of the drugs:

  • M - melphalan, which is a chemotherapy drug
  • P - prednisolone, a steroid
  • T - thalidomide, a targeted cancer drug

It is a first treatment for people with myeloma who are not suitable for high dose treatment with a stem cell transplant. 

How it works

The 3 drugs work in different ways. The chemotherapy drug melphalan destroys quickly dividing cells, such as cancer cells. Thalidomide affects all sorts of cell processes, including how cells divide and grow. When you have them together they work better than when you have each drug on their own.

How you have MPT

You take all of the drugs as tablets or capsules.

Taking your tablets or capsules

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.

When you have it

You usually have MPT chemotherapy as cycles of treatment. Each cycle of treatment lasts either 4 weeks or 6 weeks. Depending on your needs you have between 6 and 12 cycles of treatment. This takes between 6 and 18 months in total.

Melphalan

You have melphalan tablets once a day for the first 4 or 7 days of each cycle of treatment. You should swallow the tablets whole with a glass of water at least an hour before eating. You need to keep the tablets in the fridge.   

Prednisolone

You take prednisolone tablets once a day for the first 4 or 7 days of the cycle of treatment. You swallow them whole with a glass of water and take them with food or immediately after eating. It is better to take prednisolone early in the day.

Thalidomide

You take thalidomide capsules at night with a glass of water. Swallow them whole. You take them every day throughout the time you are having treatment. You can take thalidomide with or without food. You usually start on a low dose and your doctor then increases the dose unless you get bad side effects.

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

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

Increased 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 and looking pale

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

Bruising, bleeding gums or nosebleeds

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).

Feeling and 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.

Drowsiness (somnolence)

You may feel drowsy with this treatment. Do not operate machinery or drive if you are feeling drowsy.

Numbness or tingling in fingers or toes (peripheral neuropathy)

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Shaky hands (tremor)

You may develop shaky hands (tremor) with this treatment.

Blood clots

Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.

Symptoms of a blood clot include:

•    pain, redness and swelling around the area where the clot is and may feel warm to touch
•    breathlessness
•    pain in your chest or upper back – dial 999 if you have chest pain
•    coughing up blood

Tell your doctor immediately or go to A&E if you have any symptoms of a blood clot.

Dizziness and more rarely headaches

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

Constipation

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.

Indigestion

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Tummy (abdominal pain)

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

Changes in blood sugar levels

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. 

Fluid build up in your hands, face or legs

You may have swelling of your hands and legs due to a build up of fluid (oedema). 

Increased appetite and weight gain

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.

Difficulty sleeping (insomnia)

It can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help. 

Mood changes 

This treatment might cause mood changes. Speak to your doctor or nurse if you have this. They can give you advice. 

Periods stopping

Women might stop having periods (amenorrhoea) but this may be temporary.

Occasional side effects

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

  • confusion - contact your advice line if this happens
  • sore mouth - use mouth washes to keep your mouth healthy and tell your team if your mouth is sore
  • tiredness and weakness (fatigue)
  • kidney changes that are usually temporary and go back to normal when treatment finishes - you'll have regular blood test to check for this
  • runny nose
  • low blood pressure
  • loss of appetite
  • changes in the levels of salts or minerals in your blood - you'll have regular blood test to check this
  • slow heart beat
  • increase risk of certain blood disorders - your doctor can tell you more about this
  • pain in your bones

Rare side effects

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

  • severe skin reaction - your skin may become very painful and red, this is called Stevens-Johnson syndrome, contact the advice line if you have this
  • blockage in your bowel - contact your advice line immediately if you think you have this
  • low sex drive
  • erection problems
  • changes in how your liver works - these are usually mild, your regular blood tests will check for this
  • raised levels of uric acid in the blood due to the breakdown of tumour cells (tumour lysis syndrome). You may have a tablet called allopurinol to take
  • allergic reaction

Coping with side effects

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

Important information

Pregnancy and contraception 

Thalidomide harms a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Women of child bearing age will have regular pregnancy tests during treatment. They should use reliable contraception for 4 weeks after stopping treatment. 

Men should use condoms during sex for the time they are having treatment and for a week afterwards. They must not donate semen during treatment or for 1 week afterwards.

Some people worry about taking thalidomide but it does not cause physical defects in adults. Pregnant women and children should not touch or handle thalidomide. You must store it in a place where pregnant women or children cannot reach it.

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.    

Breast feeding

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.