CVP

CVP is the name of a combination of chemotherapy drugs used to treat low grade non Hodgkin’s lymphoma cancer. It is made up of the drugs

• C = Cyclophosphamide
• V = Vincristine (also known as Oncovin)
• P = Prednisolone, which is a steroid

The links above take you to more information about the individual side effects of each drug.

Cyclophosphamide and vincristine are clear fluids. You have them into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You have prednisolone as tablets. You need to swallow them after a meal, or with milk, as they can irritate your stomach. Your doctor will advise you which dose you need to take. It is best to take prednisolone early in the day, preferably after breakfast.

You usually have chemotherapy as cycles of treatment. You may have between 6 and 8 cycles of CVP. Each cycle lasts 3 weeks, so it takes from 4 to 6 months.

You have each cycle of treatment in the following way. On the first day you have an injection of cyclophosphamide and vincristine into your cannula or central line, which takes about 30 minutes. You also start taking your prednisolone tablets and continue for 5 days. You then have no treatment for just over 2 weeks. The cycle then starts again.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with CVP are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drugs side effects section.

With these drugs, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion
• Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue during and after treatment - most people find their energy levels are back to normal within 6 months to a year
• Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons - this starts after a few days or weeks and usually goes within a few months of finishing treatment
• Vincristine can temporarily stop the normal muscle contractions of the bowel, causing sickness, a swollen abdomen and cramps for a few days
• Severe constipation with abdominal pain occurs in 1 in 3 people who have vincristine but this can generally be prevented with regular laxatives - if you are constipated for more than 3 days, tell your doctor or nurse
• Feeling or being sick is usually mild and well controlled with anti-sickness drugs
• Loss of appetite
• Hair loss or thinning - this usually starts about 3 to 4 weeks after your first dose but your hair will grow back once the treatment ends
• Prednisolone can cause a change in blood sugar levels - tell your doctor if you get very thirsty or if you are passing urine more than usual. If you are diabetic you need to monitor your blood sugar levels very carefully.
• CVP may have a harmful effect on a developing baby - do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Women may stop having periods (amenorrhoea) but this may be temporary
• Loss of fertility - we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you

Some people may have one or more of the following side effects

• Inflammation around the drip site - if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Vincristine can have an effect on the bladder nerves, making urine leak from the bladder (incontinence)
• Temporary taste changes
• Mouth ulcers
• Jaw pain, caused by vincristine affecting your nerves
• Diarrhoea - you should drink plenty of fluids. If your diarrhoea is severe or continues you could become dehydrated so let your doctor or nurse know
• Your nails may darken or become ridged, brittle or chipped
• Your skin may darken
• Cyclophosphamide can cause cystitis (inflammation of the bladder), pain and occasionally blood in the urine. If you see blood in your urine, contact your doctor straight away. You need to drink 1 to 2 pints of fluid a day. You may have extra fluids through your cannula or central line too.

A very small number of people have one or more of the following side effects

• There is a small risk that you may get a second cancer some years after CVP treatment
• Damage to heart muscle which is usually temporary but for a small number of people may be permanent - your doctor will check your heart before and after your treatment
• Lung changes may lead to a cough or breathlessness
• A build up of fluid may cause swelling in the legs and feet
• Cramps
• Staggering
• Bone pain
• Blurred or double vision
• Hearing loss or dizziness
• Confusion
• Depression
• Hallucinations
• Trouble sleeping

These side effects are temporary and usually go back to normal within two months of finishing CVP treatment. If you have any of these effects tell your doctor or nurse.

Not everyone will get these side effects. You may have none or several. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. Your nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but very few people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.