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This information is about a chemotherapy treatment called CVP which is used to treat low grade non-Hodgkin lymphoma (a cancer of the lymphatic system). If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
CVP is named after the chemotherapy drugs used, which are cyclophosphamide, vincristine and prednisolone, which is a steroid.
CVP is usually given to you as a day patient. Before you start treatment you will need to have a blood test, either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood tests are normal the pharmacy will prepare your treatment. All of this may take several hours.
The nurse will put a thin flexible tube (cannula) into a vein in your hand or arm, through which your chemotherapy will be given. You may find this uncomfortable or a little painful but it should not take long.
Some people have their chemotherapy given through a thin flexible tube, which is inserted under the skin into a vein near the collarbone (a central line) or passed through a vein in their arm (a PICC line). Your doctor or nurse will explain more about this to you.
Once your chemotherapy is ready you will be given anti-sickness (anti-emetic) drugs. These are usually given by injection through your cannula or line, but can also be given as tablets.
Vincristine (a colourless fluid) and cyclophosphamide are usually given as an injection into your cannula or line. Cyclophosphamide (a colourless fluid) can also be given as a drip (infusion).
When you have been given the drugs, the nurse will remove your cannula or put a cap on your line to close it off. You will be given a supply of anti–sickness tablets to take home with you. It’s important to take these regularly (as directed) even if you are not feeling sick. Some medicines are much better at preventing sickness than at stopping it once it has been started.
You will also be given a course of prednisolone tablets (a steroid).The first dose of the prednisolone is usually given with your chemotherapy. It is important to take all the tablets as prescribed by your doctor.
Your doctor may use the word regimen (eg the CVP regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment you are having.
You will be given cyclophosphamide and vincristine on the first day of your treatment. On the same day you will begin a five day course of prednisolone tablets. When you have finished the tablets you will have a rest period with no treatment for the next 16 days. This completes what is called a cycle of treatment. Each cycle takes 21 days.
After the rest period the same treatment will be repeated again, which begins the next cycle of chemotherapy. Usually 6–8 cycles are given over a period of 4–6 months. This makes up a course of treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is having this treatment.
We have outlined the most common side effects so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects which you think may be due to the drugs, but which are not listed in here, please let your nurse or doctor know.
Lowered resistance to infection The chemotherapy drugs can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally, it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.
Bruising or bleeding Chemotherapy can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.
Anaemia (low number of red blood cells) While having the treatment you may become anaemic. This can make you feel tired and breathless. Let your nurse or doctor know if these effects are a problem.
Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti–sickness drugs which may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem for you.
Abdominal cramps and constipation Vincristine may cause constipation. Let your doctor or nurse know if this is a problem. It usually helps to drink plenty of fluids, eat a high fibre diet and take gentle exercise.
Loss of appetite A dietician or specialist nurse at your hospital can give advice and tips on boosting your appetite, coping with eating problems and maintaining your weight.
Tiredness Many people feel extremely tired during chemotherapy, particularly towards the end of treatment. This is a common side effect and it’s important to try to get as much rest as you need.
Hair loss This usually starts 2–4 weeks after the first cycle of treatment. Hair usually thins rather than falling out completely. Hair loss is temporary and your hair usually starts to grow again when your treatment is over.
Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your doctor if you have any of these problems, as they can prescribe special mouthwashes and medicine to prevent or clear any mouth infection and to help relieve pain.
Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Irritation of the bladder Cyclophosphamide may irritate your bladder. It’s useful to drink plenty of fluid (up to about 2 litres/4 pints) on the day following chemotherapy to help prevent this. If you notice any blood in your urine, tell your doctor.
Numbness or tingling in hands or feet This is due to the effect of vincristine on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms. The dose of vincristine may need to be reduced. This problem usually improves slowly a few months after treatment is over.
Irritation of the stomach lining Prednisolone may irritate the lining of your stomach and should be taken with meals or a glass of milk. Tell your doctor if you have indigestion or any other stomach problems. They can prescribe medicine to relieve these symptoms.
Increased appetite You may notice that you feel hungrier than usual while taking prednisolone. This will stop when you are no longer taking the drug.
Changes in the level of sugar in your blood Occasionally prednisolone may cause your blood-sugar level to rise. During treatment you may have regular blood or urine tests to check this.
Fluid retention Prednisolone may affect the salt and water balance in your body. You may notice that your ankles and/or your fingers swell. Let your doctor know if this happens. This is usually only a problem with long-term treatment.
Skin changes Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished.
Lungs Cyclophosphamide may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness.
Changes in nails Your nails may become darker and white lines may appear on them. These changes usually grow out over a few months once the treatment has finished.
Changes in behaviour You may experience mood swings, difficulty sleeping and perhaps anxiety or irritability because of your steroids. Let your doctor know if there are any changes in your behaviour which are worrying you.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs to thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Leakage into the tissue around the vein If this happens while vincristine is being given the tissue in that area can be damaged. If you notice any stinging or burning around the vein while the drug is being given tell your doctor or nurse immediately.
Fertility Your ability to become pregnant or father a child is likely to be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.
Contraception It’s not advisable to become pregnant or father a child while taking this treatment, as the developing foetus may be harmed. It‘s important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor or nurse.
Loss of periods in women Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular and may eventually stop. In younger women this may be temporary, but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
This section is based upon our CVP chemotherapy factsheet which has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography.
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