This information is about a chemotherapy treatment called VAD, which is given for myeloma (a cancer of the white blood cells, which also affects the bones). It describes the drugs, 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.

VAD is named after the initials of the chemotherapy drugs used, which are vincristine, doxorubicin, originally known as Adriamycin®, and dexamethasone, which is a steroid.

VAD chemotherapy can be given to you as a day patient or during a short stay in hospital. 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. All of this may take a couple of hours.

VAD chemotherapy is usually given through a thin plastic tube (central line) that is inserted under the skin into a vein near the collarbone, or passed through a vein in your arm (PICC line). In some situations it may be given to you through a thin plastic tube inserted into a vein in your hand or arm (cannula). Your doctor or nurse will explain more about this to you.

You will be given an anti-sickness (anti-emetic) drug, either by injection through your central or PICC line, or as tablets. Vincristine (a colourless fluid) and doxorubicin (a red fluid) are then given 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 line you can go home with it. Before you go home you should be given instructions on how to look after the pump. Your nurses should explain how to care for it and what to do if something goes wrong.

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.

If you are having the chemotherapy through a cannula you will need to stay in hospital until the treatment has finished.

You will be given a supply of anti-sickness tablets to take home 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 stopping it once it has started.

You will also be given dexamethasone tablets to take. It is important to take all the tablets exactly as prescribed by your doctor.

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

When your treatment begins you will be given vincristine and doxorubicin continuously for four days, either through a pump or as an infusion. You will also be given dexamethasone tablets for four days. On the fifth day you will come back to the hospital to have your pump disconnected. If you have a cannula the infusion will finish and the cannula can be removed. You will be given another four-day course of dexamethasone to take from the ninth day of your treatment (days 9–12) and again from the 17th day of treatment (days 17–20). You will then have a rest period with no treatment for the next eight days. This completes what is called a cycle of your chemotherapy treatment (each cycle lasts four weeks). After the rest period you will start the next cycle of your treatment, which will be exactly the same.

Usually 4–6 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 will not affect everyone who is receiving VAD 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 here, please let your nurse or doctor know.

Lowered resistance to infection VAD 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 VAD 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 VAD 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 that 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 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 Dexamethasone may irritate the lining of your stomach. Tell your doctor if you have indigestion or any other stomach problems. Your doctor can prescribe medicine to relieve these symptoms. Always take dexamethasone tablets with meals or a glass of milk.

Constipation and abdominal cramps If constipation is a problem for you drink plenty of fluids and increase the amount of fibre in your diet. Sometimes you may need to take medicines to stimulate your bowel (laxatives). Your doctor can prescribe these.

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

Diarrhoea If you have diarrhoea it can usually be controlled easily with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of fluid a day to replace the fluid that 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 symptoms. The dose of vincristine may need to be reduced. This problem usually improves slowly a few months after the treatment is over.

Changes in the level of sugar in your blood Occasionally dexamethasone 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 Dexamethasone may affect the salt and water balance in your body. You may notice that your ankles and/or 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. 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 the treatment has finished.

Behavioural changes Occasionally dexamethasone may cause you to have intense feelings, mood swings and irritability. You may also have difficulty in sleeping. Taking the dexamethasone earlier in the day can help to reduce problems with sleeping. Let your doctor know if there are any changes in your behaviour that 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 have been 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 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. 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 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 the doctor or nurse immediately. This is unlikely to happen if the chemotherapy is given through a central or PICC line.

Discoloured urine Doxorubicin is red and, due to this, your urine may become a pink-red colour. This may last up to 24 hours after your treatment and is quite normal.

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 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 VAD 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 et al, 2001.

For further references, please see the general bibliography.