DA

DA is the name of a combination of chemotherapy drugs. It includes the drugs we list below. How to pronounce the drug names are in brackets.

• D – daunorubicin (daw-noh-roo-bih-sin)
• A – cytarabine (sye-ta-ra-bin) - it is also known as Ara C or cytosine arabinoside

 It is a treatment for acute myeloid leukaemia (AML).  

How does DA work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have DA?

You have both drugs into your bloodstream (intravenously).

Daunorubicin is a red liquid.  

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Risk of tissue damage

When you are having this treatment through a cannula it could damage the tissue if it leaks out of the vein. This is called extravasation. This can happen anywhere along the vein that the drug is going into. It doesn’t happen very often. Tell your nurse straight away if you notice any changes such as swelling, redness, pain, burning, or a stinging feeling.

Your nurse will stop the drug treatment. And they will treat the area to relieve symptoms and reduce tissue damage. Contact your healthcare team if you develop any of these symptoms when you are at home.

How often do you have DA?

You have daunorubicin and cytarabine as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover.

Each cycle lasts 4 weeks (28 days). You might have 2 cycles.

Exactly how often you have your treatment may depend on your circumstances. The following is an example.

Induction treatment cycle 1 

Cycle 2

Your doctor, pharmacist or nurse will tell you more about how you will have your treatment. Speak to them if you are not sure. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You usually have heart tests such as an echocardiogram (ECHO) or a multigated acquisition (MUGA) scan to build up a picture of how well your heart is working.

If there is a chance you could be pregnant or become pregnant, you will need to take a pregnancy test before starting this treatment. 

What are the side effects of DA?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or burning feeling when weeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Sore mouth 

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tummy (abdominal pain) 

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Inflammation and ulcers of the opening at the end of the bowel (anus)

Talk to the team looking after you about this. They might be able to give you medicines or creams to help with this.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Skin changes

You might notice skin changes, such as a rash.

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

Less commonly, you might have skin ulcers, redness, a rash with blisters, or hives that are itchy.

Rarely, you might have a patch of skin that is darker than the rest of your skin, itching, burning of your palms or soles, or you might have red raised spots or red flat areas.

High temperature 

Talk to the team looking after you or telephone your advice line.

Cytarabine syndrome

Cytarabine syndrome sometimes happens about 6 to 12 hours after having this drug. 

It causes a combination of symptoms. These include a high temperature, aching muscles, bone pain, occasionally chest pain, a rash, sore eyes, and extreme weakness. Steroids can help to prevent or treat this syndrome.

Biopsy and blood test results

These drugs can cause abnormal results. Your doctor or nurse might need to take more biopsies or blood tests. Talk to your team about this. 

Red or pink urine 

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Occasional side effects

Each of these effects happens in between 1 and 10 in 100 people (between 1% and 10%). You might have one or more of them. They include:

• swallowing problems (dysphagia)

• inflammation of blood vessels

• inflammation of a vein caused by a blood clot at the drip site

• kidney problems – you have regular blood tests to check this

• difficulty with fully emptying your bladder (urinary retention)

• burst blood vessels in the eye with an eye infection (conjunctivitis). You may have a dislike of bright lights, a burning sensation in the eye, vision changes or a watery eye

• loss of appetite

• high levels of uric acid in the blood

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• sore throat

• pockets of gas in the bowel wall or inflammation of the bowel wall causing it to die. Symptoms include bleeding from your bottom or a swollen tummy. Contact your advice line straight away if you have this or visit A&E (accident and emergency)

• infection around the drip site where the drugs enter your body

• pain in the muscles or joints

• inflammation of the lining of the heart (pericarditis). Symptoms include a sharp or stabbing chest pain

• inflammation or ulceration of the food pipe (oesophagus)

• a change in your heart rhythm

• headaches

• numbness or tingling in fingers and toes (peripheral neuropathy)

• breathlessness and cough - this could be due to an infection, such as pneumonia. Or it could be caused by changes to the lung tissue, making it less flexible

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• allergic reaction which might lead to swelling underneath the skin in areas such as the hands, feet, lips, tongue, around the eyes or genitals (angioedema)
• inflammation of nerves causing pain
• dizziness
• inflammation of the pancreas (pancreatitis). Symptoms include severe pain in your upper tummy (abdomen), being sick, a fever and a fast pulse
• yellowing of the skin or whites of the eyes (jaundice)
• redness, soreness and peeling of hands and soles of feet (palmar plantar syndrome)
• loss of body fluid (dehydration)
• inflammation and pain at the drip site
• hot flushes
• skin and nail changes - the colour might change
• second cancers
• periods stopping (amenorrhoea)
• no sperm in semen. You may be able to store some of your sperm before you start treatment
• an enlarged liver causing abdominal pain, tiredness, feeling and being sick
• a collection of fluid in the abdomen
• a collection of fluid between the layers covering the lung (pleural effusion). Symptoms include breathlessness and a cough
• stiffening of the heart muscle making it less able to pump blood. Symptoms include difficulty breathing and tiredness
• shock - symptoms include pale, cold and clammy skin, sweating, shallow breathing, weakness, feeling and being sick
• bleeding from the skin or from somewhere in the body
• inflammation of both the small and large bowel. Symptoms may include fever, abdominal pain and diarrhoea that can have blood in it. Contact your advice line straight away or visit A&E if you have these symptoms
• if you have had radiotherapy to your skin in the past, the skin in this area may become more sensitive
• freckles
• chest pain
• a collection of pus in the liver (abscess)
• changes to the levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome). You have regular blood tests to check for this
• a heart attack. You may have chest pain causing a feeling of pressure, heaviness, tightness or squeezing across your chest. Other symptoms include pain spreading down the left arm or both arms, feeling dizzy, sweating, shortness of breath, feeling or being sick, feeling panicky and coughing
• changes in the brain that are usually reversible, causing a sudden onset of symptoms including headaches, dizziness, confusion, fits (seizures) and changes to vision (reversible posterior leukoencephalopathy syndrome). Contact your healthcare team straight away if you have any of these symptoms

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception 

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. 

Fertility 

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding 

It is not known whether these drugs come through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.