Fludarabine is a chemotherapy drug used to treat chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), and some types of non-Hodgkin lymphoma.

HOW IS FLUDARABINE ADMINISTERED?

Fludarabine is given in the chemotherapy day unit or during a hospital stay. A chemotherapy nurse will give it to you.

Before the day of treatment, a nurse will take a blood sample from you to see if you are fit for chemotherapy.

You will also be able to see a doctor or nurse before having chemotherapy. They will ask you how you have been feeling. If the results of your blood test are good on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will give you medication for nausea and, sometimes, steroids administered intravenously. Chemotherapy drugs may be given in the following ways:

• Through a thin tube (line) inserted into a vein in the arm or hand by a nurse
• Through a tube that goes below the skin of your chest to a nearby vein (central line)
• Through a thin tube that is placed in a vein of the arm and goes up through a vein toward the chest (PICC)

Your nurse will give you fludarabine as a drip (perfusion) through a cannula or a line for about half an hour.

When the chemotherapy is administered

Some people may have side effects while they are receiving chemotherapy.

PAIN ALONG THE VEIN

If you have pain, let your nurse know immediately. They will check your puncture site and will lower the drip rate to try to relieve your pain.

TAKING YOUR CHEMOTHERAPY PILLS

If you are taking fludarabine pills, you can take them at home, but always take them as you are instructed. Swallow them whole with a glass of water. They can be taken with food or on an empty stomach.

If you vomit right after taking the pills, get in touch with your hospital. You may have to take another dose. If you forget to take a pill, do not take a double dose. Keep your normal schedule and tell your doctor or nurse.

Other things to keep in mind about pills:

• Keep them in their original packaging at room temperature. They should be stored away from heat and direct sunlight.
• Keep them safe and out of the reach of children.
• Return the remaining pills to the hospital if the treatment is discontinued.

YOUR COURSE OF FLUDARABINE

You will have chemotherapy as part of a course or cycle, consisting of several treatment sessions and lasting several months. Your doctor or nurse will tell you how many cycles you are likely to have.

POSSIBLE SIDE EFFECTS OF FLUDARABINE

You may experience some of the side effects mentioned here, though it is rare for a patient to have all of them. If you receive other chemotherapy drugs, you may have other side effects that are not mentioned here. Always inform your doctor of the effects you experience.

Your doctor can prescribe medication to help control some of the side effects. It is very important to take the medication exactly as your doctor says for it to have the highest chance of working well. Your nurse will advise you on managing the side effects. After treatment, the side effects start to get better.

RISK OF INFECTION

Fludarabine may lower the number of white blood cells in your blood. This will make you more susceptible to infection. Your nurse can tell you when you might have the lowest levels of these cells. When the number of white blood cells is low, this is called neutropenia.

Contact your hospital immediately if any of the following happens:

your temperature goes above 38 ° C

you suddenly feel unwell, even if your temperature is normal.

You have symptoms of infection, which may include sore throat, coughing, or the need to urinate frequently.

You will have a blood test done before your next chemotherapy. If your white blood cells are still low, your doctor may postpone the treatment for a short period of time.

While taking fludarabine, you are at risk of developing a chest infection called pneumocystis. To help prevent this, your doctor will give you an antibiotic called co-trimoxazole. You take it during the treatment and for a number of months after the treatment has concluded. You may also receive other medicines to try to prevent infection.

BRUISING AND BLEEDING

Fludarabine may lower the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any unexplained bleeding or bruising. This includes nosebleeds, bleeding gums, blood spots, or skin eruptions (rashes). Some people may require additional platelets.

ANEMIA

Fludarabine may lower the number of red blood cells in your blood. Red blood cells transport oxygen throughout the body. If you have a low number of red blood cells, you may be tired and short of breath. Tell your doctor or nurse if you feel like this. If you are very anemic, it's possible you will require a blood transfusion.

NAUSEA

This can happen on the first few days after chemotherapy. Your doctor will prescribe you antiemetic drugs to help prevent or control your nausea. It is easier to prevent nausea than it is to treat it once it has begun.

If you still have nausea or are vomiting, get in touch with the hospital as soon as possible. They can give you advice and change your medication to one that works better.

LOSS OF APPETITE

You may lose your appetite during the treatment. Try to eat in small quantities and have frequent meals. Don't worry if you don't eat much for a day or two. If your appetite doesn't get any better after a few days, tell your nurse or dietitian. They can give you nutritional supplements or good-tasting meal-replacement drinks.

SORENESS OF THE MOUTH

You may have a sore mouth or mouth ulcers, which could make you more prone to getting a mouth infection. Lightly brush your teeth and/or dentures in the morning and night and after meals. Use a soft-bristle toothbrush. Your nurse might ask you to rinse your mouth out regularly or use mouthwash. It is important that you follow all the instructions you are given and that you drink a lot of fluids.

Tell your nurse or doctor if you have any mouth problems. They can prescribe you drugs to prevent or treat infections of the mouth and to treat any kind of pain.

TIREDNESS

Feeling very tired is a common side effect. Fatigue is often worst toward the end of treatment and for a few months after the treatment has finished. Try to pace yourself and rest as much as you need to. Help balance this with a bit of light exercise, such as short walks. If you feel drowsy, don't drive or operate heavy machinery.

DIARRHEA

Your doctor can prescribe medicines to control diarrhea. Let them know if your diarrhea is severe or if it doesn't get better. Make sure you drink at least two liters of fluids each day if you have diarrhea.

SKIN CHANGES

Chemotherapy can affect your skin. Fludarabine can produce a rash, which may cause itchiness. If your skin is dry, try to use a fragrance-free moisturizing cream every day. Always tell your doctor about any change to your skin. These changes can be temporary, improving once the treatment is over.

HEADACHES

Tell your doctor or nurse if you have headaches. They can give you painkillers to help.

CHANGES IN THE KIDNEYS AND LIVER

Fludarabine can affect the kidneys and liver. These changes are normally mild and return to normal after the treatment. You will have blood tests done before the chemotherapy to see how your kidneys and liver are functioning.

FLUID BUILD-UP

Your ankles and legs may swell because of the build up of fluid in this area. Doctors can prescribe steroids to help prevent this, so let your physician known if your legs or ankles become swollen. Try to put your feet up on a stool or a cushion. The inflammation gets better when the treatment ends.

TINGLING IN THE HANDS OR FEET

These symptoms are caused by the effect of fludarabine on the nerves. It is called peripheral neuropathy. It may also be hard for you to press buttons and it can make other tasks more uncomfortable. You may also feel a certain degree of pain at your nerve endings.

Tell your doctor if you have these symptoms. It is sometimes necessary to lower the drug dose. The symptoms normally get better slowly once the treatment is over, though in some people they never go away. Talk to your doctor if you are worried about this.

JOINT AND/OR MUSCLE PAIN

You may have pain in your joints or muscles for a few days after chemotherapy. Tell your doctor if this happens so they can prescribe you some painkillers. Let them know if your pain doesn't go away. Try to get lots of rest. Taking warm baths on a regular basis can help.

EYE PROBLEMS

Fludarabine can cause blurry vision or soreness of the eyes. Always tell your doctor or nurse if you have soreness in the eyes or notice any changes in your vision. Your eyes may also become more sensitive to light.

LESS COMMON SIDE EFFECTS OF FLUDARABINE

CHANGES IN THE HEART

In rare cases, fludarabine can affect the way the heart works. If you notice a change in your heartbeat, feel out of breath, or feel pain or pressure in your chest at any time during or after treatment, let your doctor know immediately. These symptoms could be caused by other conditions, but it important to have them looked at by a doctor.

EFFECTS ON THE LUNGS

The treatment can cause changes in the lungs. Always let your doctor know if you have wheezing, coughing, fever, or if you are out of breath. If necessary, tests can be done to check your lungs.

EFFECTS ON THE NERVOUS SYSTEM

Fludarabine can affect the nervous system. You may feel anxious or restless, have trouble sleeping or experience mood swings. Some people may feel drowsy or confused. Tell your doctor or nurse immediately if you have any of these symptoms. It is important not to drive or operate machinery if you notice these effects. In rare cases, this drug can cause seizures.

HIGH LEVELS OF URIC ACID IN THE BLOOD

Fludarabine can make leukemia and other cancer cells decompose rapidly. This releases uric acid (a waste product) into the blood. Excess uric acid may cause joint swelling and pain, known as gout.

Your doctor can give you a drug called allopurinol to help keep this from happening. Drinking at least two liters of fluids each day will also help. You will have periodic blood tests done to check your levels of uric acid.

SECOND CANCER

Fludarabine can increase the risk of developing a second cancer years down the road. Overall, however, the benefits of the treatment far outweigh this risk. Your doctor can talk to you about the possibility of this happening.

MORE INFORMATION ON FLUDARABINE

BLOOD IRRADIATION

After treatment with fludarabine, any blood transfusion or platelets you are given should be treated with radiation. This lowers the risk of the donated blood cells reacting against your own blood. This process won't damage the blood or make it radioactive.

Your doctor will mark down in your medical notes that you are only to be given radiated blood products.

BLOOD CLOT RISK

Cancer and chemotherapy increase the chances of a blood (thrombosis). The symptoms include pain, reddening or swelling in a leg, difficulty breathing, and pain in the chest. Get in touch with your doctor immediately if you have any of these symptoms.

OTHER DRUGS

Some medicines can interact with chemotherapy or be harmful if they are taken alongside chemotherapy. This includes medications that can be purchased in a store or pharmacy. Tell your doctor the medicines you are taking, including over-the-counter medications, complementary therapies, and herbal medicines.

FERTILITY

Etoposide may affect your fertility. If this worries you, you can talk to your doctor before beginning treatment.

CONTRACEPTION

Your doctor will advise you not to become pregnant during the treatment. This is because the drugs can harm developing babies. It is important to use contraception during chemotherapy and for a few months after the treatment ends.

SEX

If you have sex within the first few days after chemotherapy, it is necessary to use a condom. This is to protect your partner in case there is chemotherapy in semen or vaginal fluid.

BREASTFEEDING

Women are recommended not to breastfeed during treatment and for a few months after chemotherapy has concluded. This is in case the chemotherapy enters their breast milk.

MEDICAL AND DENTAL TREATMENT

If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are having chemotherapy.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always let your dentist know that you are having chemotherapy.