This information is about a chemotherapy treatment called C-VAMP, which is used to treat multiple myeloma (a cancer of the white blood cells, which also affects the bones). 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 support service nurses.

C-VAMP is named after the initials of the chemotherapy drugs used in the treatment, which are cyclophosphamide, vincristine, doxorubicin, (originally called Adriamycin®) and methyl-prednisolone, which is a steroid.

C-VAMP chemotherapy 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 day or two beforehand. 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.

C-VAMP chemotherapy is usually 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 the arm (PICC line). Your doctor or nurse will explain more about this to you.

Once your chemotherapy drugs are ready, you will be given an anti-sickness (anti-emetic) drug - either by injection through your central line or as tablets. The chemotherapy drugs are then given separately:

• Cyclophosphamide (a colourless fluid) is given as either a drip (infusion), or as an injection into your central or PICC line.
• Methyl-prednisolone can be given as a drip or taken as tablets. If it is given as a drip, you will be asked to come back as a day patient (the drip only takes half an hour). If you are taking it as tablets, it is important to take all the tablets exactly as prescribed.
• Once your cyclophosphamide is finished, you will be given vincristine (a colourless fluid) and doxorubicin (a red fluid) together through a small portable pump.

The pump is used to give a controlled amount of the drugs into your bloodstream over a set period of time. It is small enough to be carried in a belt so that you can carry on doing the things you normally do. Once the pump is connected to your central line you can go home with it attached. All of this may take up to two hours.

Before you go home, you should be given instructions on how to look after the pump. The nurse will explain how to care for it and what to do if something goes wrong. After four days of treatment you will usually come back to the hospital to have your pump disconnected.

When the infusion is finished there may be some fluid left in the pump. This may be normal, as some types of pump need to be overfilled to get the correct dose. You can check with your nurse or pharmacist whether you have this type of pump. Occasionally, if no pump is available, you will have to stay in hospital for the vincristine and doxorubicin to be given.

You will be given a supply of anti-sickness tablets to take with you. It is important to take these regularly 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 C-VAMP regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment that you are following.

On the first day of your treatment, you will be given cyclophosphamide (as described above) for one day only. On the same day you will begin your treatment with vincristine and doxorubicin through the pump, which will be continuous for four days. The methyl-prednisolone may be given as an infusion on the fifth day when you come back to have your pump disconnected, or as a five-day course of tablets at the start of treatment. The methyl-prednisolone may also be given each time you have cyclophosphamide.

A week after your treatment begins (day 8) you will come back to hospital to have more cyclophosphamide treatment. After this, you will have no treatment for a week until you are given cyclophosphamide again (on day 15). You will then have a rest period of one week. This completes what is called a cycle of your chemotherapy treatment. Each cycle lasts three weeks.

You will then start the next cycle of your treatment, which will be exactly the same. Usually 4–6 cycles are given over a period of 3–5 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 below will not affect everyone who is having C-VAMP chemotherapy. 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 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 C-VAMP 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:

• your temperature goes above 38ºC (100.5ºF)
• 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 C-VAMP 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 C-VAMP you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse 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.

Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is 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 usually falls out 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.

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 do 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 Methyl‑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. Always take methyl‑prednisolone tablets with meals or a glass of milk.

Increased appetite You may notice that you feel hungrier than usual while taking methyl-prednisolone. This will stop when you are no longer taking the drug.

Irritation of the bladder Cyclophosphamide may irritate your bladder. It is important to drink plenty of fluid (two litres a day, if you can) to help prevent this. If you notice any blood in your urine tell your doctor. Doxorubicin is red and so your urine may become a pink-red colour. This may last up to 24 hours after your treatment and is quite normal.

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 up to 2–3 litres of fluid a day to replace the fluid you are losing.

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 side effects. This problem usually improves slowly a few months after treatment is over.

Changes in the level of sugar in your blood Occasionally methyl-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 Methyl-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. During treatment and for several months afterwards, you will be more sensitive to the sun, and your skin may burn more easily. You can still go out in the sun, but always wear a high protection factor suncream and cover up with clothes and a hat.

Sometimes areas which have been treated with radiotherapy may become red and sore. Let your doctor know if this happens.

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 treatment is finished.

Behavioural changes Occasionally methyl-prednisolone may cause you to be irritable and have very intense feelings and mood swings. You may also have difficulty sleeping. Taking the methyl-prednisolone earlier in the day can help to prevent sleeping problems. Let your doctor know if there are any changes in your behaviour which are worrying you.

Changes in the way your heart works This is very rare with usual doses of doxorubicin but may occasionally happen when high doses are used. Tests to see how well your heart is working may be carried out before you start treatment.

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 when doxorubicin or vincristine are 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 conceive 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 is 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 during treatment and for a few months afterwards. Again, discuss this with your doctor.

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 C-VAMP 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 (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see the general bibliography.