Haematology. Fludarabine and Cyclophosphamide Chemotherapy

Transcription

1 Haematology Fludarabine and Cyclophosphamide Chemotherapy This information is about Fludarabine and Cyclophosphamide chemotherapy, which is a treatment for used for Chronic Lymphatic Leukaemia and some types of non-hodgkin lymphoma. Further information on these diseases is available in separate information sheets. Fludarabine and cycylophosphamide are commonly combined with the anti-body treatment Rituximab to produce the FC-R combination. More detailed information on Rituximab is available separately. We try to answer most frequently asked questions, but please ask your doctor or nurse when you are attending for treatment if you have any further questions. Drugs that are used The two drugs used are:- Fludarabine (pronounced flu da ra been) Cyclophosphamide (pronounced sigh clo fos fam ide) These drugs destroy cancer cells by interfering with the internal workings of the cells. They are known as cytotoxic chemotherapy drugs. Unfortunately these drugs not only target cancer cells we want to get rid of, but also result in a certain amount of damage to normal cells. This causes some of the possible side effects discussed below. Fortunately not all patients get all of the possible side effects, and some may have very few. How is it given? For this treatment both drugs are given in tablet form and should be swallowed whole with plenty of water. The Cyclophosphamide should be taken in the morning and the Fludarabine at lunchtime. How Often? The treatment is repeated every 4 weeks. Each 4 week block is known as a cycle. Each cycle has 5 days of treatment when you take your treatment tablets and then 23 days with no treatment tablets. The number of cycles that you will have varies with several things such as the overall plan for management of your disease, your response to the treatment, and whether or not you have any significant side effects. This should be discussed with your Doctor. 1

2 Possible side effects Each person's reaction to chemotherapy is unique. Some people have very few side effects while others may experience more. The side effects described here will not affect everyone who is having Fludarabine and Cyclophosphamide chemotherapy. We have outlined the most common side effects that may occur, but have not included those that are rare and therefore unlikely to affect you. If you do notice any effects that you think may be due to your treatment but are not listed here, please let your Doctor or Nurse know. Lowered resistance to infection Cyclophosphamide and Fludarabine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect may begin about 4 days into each treatment cycle, reaches its maximum at days and then slowly recovers to normal as your next treatment cycle is due to begin. You must contact us immediately if: Your temperature is above 38 C on 2 occasions one hour apart Your temperature is above 38.5 C at any time You suddenly feel unwell, even with a normal temperature. While your immunity is low, you cannot fight infection very well yourself and what would usually be minor infections can become serious and in some cases life threatening if they are not treated promptly. Because you will be at increased risk of developing some chest infections, you will be prescribed an antibiotic called Cotrimoxazole (also known as Septrin) to be taken 3 days a week. This antibiotic will continue for 6 months after you have finished treatment with Fludarabine, and reduces the risk of developing these chest infections. You will have a blood test before each cycle of chemotherapy to make sure that your bone marrow cells have recovered. Occasionally it may be necessary to delay your treatment if your blood count is too low. Bruising or bleeding Cyclophosphamide and Fludarabine can reduce the production of blood cells known as platelets that help the blood to clot normally. Let us know if you have any unexplained bruising or bleeding. If the platelet count has become low you may need to have a transfusion of platelets. Anaemia Cyclophosphamide and Fludarabine can reduce the number of red cells in the blood. This is known as anaemia and may make you feel tired and breathless. A blood transfusion may occasionally be needed to correct this. If you need to have a blood transfusion you will be given specially treated irradiated blood. This is because Fludarabine treatment makes you more likely to have a reaction with transfused blood products and this treatment reduces the risk. 2

3 Feeling sick (nausea) and vomiting With these tablets at these doses nausea and vomiting is fortunately not common. It may however be a problem for some people, so you will be given a supply of anti sickness drugs to take if you need to. Fever, chills and joint pain May occur shortly after taking these medicines, but do not usually last long. You may be prescribed medicines to reduce these if it is a problem. Raised levels of Uric acid in the blood A drug called Allopurinol may be given to stop this happening, as high urate levels in the blood can result in gout and rarely kidney damage. It may also help to drink plenty of fluids. Changes in eyesight, headaches and confusion, weakness or agitation These occasionally may happen with Fludarabine. Report to your Doctor straight away if this happens. Changes to the lungs Both of these drugs may rarely cause some changes to the lung tissues. This is more likely to happen if you smoke. Let us know if you notice a cough or increased breathlessness. Your liver may be temporarily affected Both of these drugs may cause changes in the way that your liver works, but it will return to normal when treatment is finished. Your liver tests will be monitored closely during your treatment. Changes in the way your heart works This is very uncommon with the doses of Cyclophosphamide that are usually used, but can occasionally happen when high doses are used. If you have any other risk factors, tests to see how well your heart is working may be carried out before you start treatment. Tiredness Many people feel tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try and get as much rest as you need. Hair loss There may be some hair loss or thinning with this treatment, but often it is not severe. This usually starts about 3-4 weeks after your first treatment. As well as scalp hair loss, you may have thinning or loss of eyebrows, eyelashes and other body hair. This is temporary and your hair will start to grow again once your treatment is finished. If hair loss is significant then speak to your nurse who will give you information about a wig. 3

4 Sore mouth Your mouth may become sore or dry, or you may develop small ulcers during this treatment. Drink plenty of fluids and clean teeth regularly and gently with a soft toothbrush to help reduce the risk of this happening. Tell your nurse if you have a problem with a sore mouth. You may be given mouthwashes or medicines to prevent or treat mouth soreness and ulcers. Taste You may notice that your food tastes different, but normal taste will return once your treatment is finished. Irritation of the bladder It is important to drink plenty of fluids to minimise this. If you notice any blood in your urine or pain on passing urine, tell your Doctor or Nurse. Diarrhoea This may occasionally be a problem, but can usually be easily controlled with medicines. Let us know if it is severe or persistent. It is important to drink plenty of fluids (at least 2 or 3 litres a day) to replace those that you are losing. Skin changes During treatment and for several months afterwards you will be more sensitive to the sun and your skin will burn more easily than usual. You can still go out in the sun but wear a high protection factor sun cream and cover up with clothes. Rarely your skin may darken during treatment. If it does it will usually return to normal over a few months once treatment is completed. Many people find that their skin becomes drier than usual during treatment. Simple moisturising creams can help this. Fludarabine may cause a rash that may be itchy. Let us know if this happens as prescription of antihistamines may help. Nail changes Your nails may become darker and white lines may appear on them. They may also become dry. These changes grow out with the nails over a few months once treatment is finished. Additional information Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medicines you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs. Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss this with your doctor before starting treatment if this is of concern to you. 4

5 Contraception It is not advisable to become pregnant or father a child while having this treatment as the developing baby may be harmed. It is important to use effective contraception while taking these drugs, and for at least 6 months afterwards, and it may be advisable to delay starting a family for about 12 months after your treatment to make sure that you are fully recovered. Discuss this with your nurse or doctor if you have any concerns. Loss of periods in women Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular or stop. In younger women this is often temporary but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes and sweats and vaginal dryness. Second cancers For people treated with chemotherapy there is a small increase in the risk of developing other cancers at a later date. With this treatment this risk is very low and after about 10 years falls back towards the background risk shared by the whole population. Reviewer: Dr John Davies Review Date: April