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About chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate around the body in the bloodstream.

Most chemotherapy is given in cycles of treatment. You have some drugs daily and others weekly. A cycle normally lasts 3 or 4 weeks. Usually 4 to 6 cycles make up one course of treatment. So a course can last 4 to 6 months.

Most people have a combination of chemotherapy drugs and a targeted cancer drug. 

Types of chemotherapy

The type of chemotherapy you have depends on whether or not you are having a stem cell transplant, and your general health.

Chemotherapy with a stem cell transplant (intensive treatment) 

Before you have intensive treatment you have a combination of drugs which includes a chemotherapy drug, a targeted cancer drug and steroids. This is called your induction treatment.

There are a few different types of chemotherapy you might have, they include:

  • cyclophosphamide
  • melphalan
  • doxorubicin (Adriamycin)
  • idarubicin
  • etoposide
  • cytarabine
  • cisplatin

The steroids might be dexamethasone or prednisolone.

There are a few different  combinations of treatment. These will include a type of targeted cancer drug treatment. There are different types including thalidomide and bortezomib. The regimens include:

  • cyclophosphamide, thalidomide and dexamethasone (CTD).
  • bortezomib, doxorubicin and dexamethasone (PAD)

Or you might have a combination that doesn't include a chemotherapy drug but instead includes two targeted cancer drugs: bortezomib (Velcade), thalidomide and dexamethsone (VTD).  

You have treatment in cycles and each cycle lasts for between 21 and 28 days. After each cycle of treatment your doctor will check how well treatment is working and how you are. Most people have between 4 and 6 cycles of treatment.

Depending on how well this treatment works you will either go on to have a stem cell transplant or have more chemotherapy.

Chemotherapy without a stem cell transplant

Some people are not able to have a stem cell transplant. They have chemotherapy, targeted cancer drug and steroids. Combinations of treatment include:

  • melphalan, prednisolone and bortezomib (VMP)
  • cyclophosphamide, bortezomib and dexamethasone (CVD)

Myeloma that comes back 

Treatment depends on:

  • how long your myeloma has been in remission
  • the treatments you had before 
  • how your myeloma responded to previous treatments
  • your general health 

Treatment will be a combination of chemotherapy and a targeted cancer drug. There are a number of different combinations of treatment including DT-PACE and VDT-PACE. These regimens include these drugs: 

  • bortezomib (Velcade)
  • dexamethasone
  • thalidomide or lenalidomide (Revlimid)
  • cisplatin
  • doxorubicin
  • cyclophosphamide
  • etoposide

How you have chemotherapy

You might have chemotherapy as:

  • tablets or capsules (oral chemotherapy)
  • an injection under the skin (subcutaneous chemotherapy) 
  • a drip into a vein (intravenous chemotherapy)

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.

Chemotherapy as an injection under the skin (subcutaneous)

The skin of the abdomen, thigh and upper arm are the most common areas for giving subcutaneous chemotherapy. You may be able to give these injections yourself.

The video below shows you how to give an injection just under your skin (subcutaneously).

Having chemotherapy into your bloodstream

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

You may 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.

Where you have chemotherapy

Most people with myeloma have chemotherapy as tablets, which you take at home. If you're having chemotherapy into your bloodstream (intravenous chemotherapy), you usually have this in the cancer day unit. Or you might need to stay in a hospital ward for a few days. This ideo about having chemotherapy lasts for 2 minutes and 55 seconds. 

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have any signs of infection such as a temperature higher than 37.5C or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

When you go home

Chemotherapy for myeloma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you take any supplements or if you have been prescribed anything by alternative or complementary therapy practitioners.

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.

Information and help