This information is about a chemotherapy treatment for Hodgkin's lymphoma called ChlVPP. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer information nurse specialists.

ChlVPP is named after the chemotherapy drugs used, which are chlorambucil, vinblastine, procarbazine and prednisolone, which is a steroid.

ChlVPP chemotherapy is usually given to you as a day patient. Before you start treatment you will need a blood test, either on the same day or a few days earlier. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.

The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.

You will be given an anti-sickness drug as a tablet or by injection through the cannula, central line or PICC line, which is connected to a drip (infusion).

The anti-sickness drug is followed by a small infusion of vincristine (a colourless fluid). The infusion takes about 5–10 minutes. Your cannula will be removed after this. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You will be shown how to look after the line.

The rest of your drugs are taken as tablets or capsules. You will be given chlorambucil, procarbazine and prednisolone to take at home. It is important to take all the tablets as prescribed by your doctor.

You will also be given a supply of anti-sickness (anti-emetic) tablets to take home with you. It is important to take these as directed, even if you are not feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than at stopping it once it starts.

Your doctor may use the word 'regimen' (eg the ChlVPP regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment that you are receiving.

On the first day of your treatment, you will be given vinblastine (as described above) for one day only. You will also begin a two-week course of chlorambucil, procarbazine and prednisolone, which are all taken as tablets. A week after your treatment starts (day 8) you will be given vinblastine again. After you have finished all your tablets, you will have a rest period with no chemotherapy for the next two weeks. This completes what is called a cycle of your treatment. Each cycle takes four weeks.

After the rest period the treatment will be repeated again, beginning the next cycle of your chemotherapy. Usually 6–8 cycles are given over a period of 6–8 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 ChlVPP chemotherapy.

We have outlined the most common side effects, so 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 that you think may be due to the drugs, but which are not listed in this information, please let your nurse or doctor know.

Lowered resistance to infection ChlVPP 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 straight away if:

• your temperature goes above 38ºC (100.4ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

Bruising or bleeding ChlVPP 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, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with ChlVPP you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.

Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it's important to try to get as much rest as you need.

Hair loss This usually starts 3–4 weeks after the first course of treatment. Hair is usually lost completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once the treatment has finished. Your nurse can give you advice about coping with hair loss.

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 nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Irritation of the stomach lining Prednisolone can reduce the stomach's protective layer, making it more prone to irritation by stomach acid. Tell your doctor if you have indigestion or any other stomach problems. They can prescribe medicine to relieve these symptoms. Some prednisolone tablets are coated to protect the stomach, however others should be taken with meals or a glass of milk.

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.

Diarrhoea If you have diarrhoea it can usually be easily controlled with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of liquid a day to replace the fluid you are losing.

Numbness or tingling in hands or feet This is due to the effect of vinblastine on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these effects. This problem usually improves slowly a few months after treatment is over.

Changes in the level of sugar in your blood Occasionally prednisolone may cause your blood-sugar level to rise. During treatment you will have regular blood and urine tests to check this. Tell your doctor if you get very thirsty or if you are passing more urine than usual.

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. Procarbazine can cause a rash which may be itchy and your doctor can prescribe medicine to help with this.

Flu-like effect This can occur after you have had procarbazine. If you experience headaches or aching joints or muscles, then drink lots of fluids and get some rest. If these symptoms continue for more than a day contact your doctor.

Behavioural changes Occasionally prednisolone may make you have some strong feelings and can cause mood swings. Let your doctor know if there are any changes in your behaviour that are worrying you. You may also find it difficult to sleep when you are taking prednisolone. Taking the prednisolone earlier in the day can help to prevent sleeping problems.

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 straight away if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which 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 (including those you can buy in a shop or chemist). Tell your doctor 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 when vinblastine 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 the doctor or nurse immediately.

Drinking Alcohol should be avoided while taking procarbazine, as the combination can make you feel very unwell. You should also avoid alcohol-free beers, as they can have the same effect.

Fertility Your ability to conceive or father a child is likely to be affected by this treatment. It's 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 is 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 ChlVPP chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
• The Chemotherapy Source Book (4th edition). Ed. Perry. Lippincott, Williams and Wilkins, 2007.

For further references, please see the general bibliography.