Liposomal daunorubicin and cytarabine (Vyxeos, CPX351, L-DA)

Liposomal daunorubicin and cytarabine is a type of chemotherapy combination. It is also known as CPX351 and L-DA.

You pronounce daunorubicin as daw-noh-roo-bih-sin and cytarabine as sye-ta-ra-bin.

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

How does liposomal daunorubicin and cytarabine work?

Daunorubicin and cytarabine are both types of chemotherapy.

Daunorubicin works by destroying quickly dividing cells, such as cancer cells. This helps to stop the cancer growing.

Cytarabine is a type of chemotherapy drug called an antimetabolite . It kills cancer cells by stopping them from making and repairing DNA that they need to grow and multiply.

Liposomal means that these chemotherapy drugs are ‘wrapped up’ in a fatty covering called liposome. This helps to keep the drugs in the bloodstream longer, so that more of the drug reaches the cancer cells. It also causes less severe side effects.

How do you have liposomal daunorubicin and cytarabine?

You have liposomal daunorubicin and cytarabine as a drip into your bloodstream (intravenously).

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

How often do you have liposomal daunorubicin and cytarabine?

You have liposomal 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 of treatment lasts 28 days (4 weeks). You may start your next cycle the following day. Or you may need to wait until your blood counts have recovered. This can vary from person to person.

You have up to 2 cycles to get rid of the leukaemia cells (induction treatment). After the first cycle you have a bone marrow test to check how well the treatment has worked.

You have your first cycle of treatment in the following way:

Some people may have a second induction cycle, you have this in the following way:

About 5 to 8 weeks after induction treatment you may have up to 2 cycles of consolidation treatment with the same drugs. This is to lower the risk of leukaemia coming back. You have consolidation treatment in the following way:

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 also have heart tests such as an ECHO, ECG or both before treatment. You may continue to have heart tests during and after treatment with these drugs.

What are the side effects of liposomal daunorubicin and cytarabine?

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. 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, headaches, feeling cold and shivery and generally 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. 

Allergic reaction

A reaction may happen during the infusion. Symptoms can include a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction. 

Difficulty sleeping

If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help. 

Feeling anxious or confused

You may have mood changes that mean you feel anxious or confused. Tell your doctor of nurse if you are finding it difficult to cope. 

Headaches

Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.

Dizziness

This drug might make you feel dizzy. Don’t drive or operate machinery if you have this.

Eyesight changes

You might have blurred vision or other changes. It usually temporary, speak to your doctor, nurse of pharmacist if you are worried about this.

Heart changes

You may have changes to how your heart works such as your heart rhythm may be fast, slow or irregular. Some people might also develop chest pain. Let your healthcare team know if you have this or any other symptoms such as shortness of breath, feeling lightheaded or dizzy.

You usually have heart tests before you start this treatment.

Blood pressure changes

During treatment, your blood pressure may be lower or higher than normal. Tell your nurse if you feel dizzy, faint, or if you have headaches, nosebleeds, blurred or double vision, or shortness of breath. Your blood pressure usually goes back to normal while you are on treatment or when treatment ends.

Shortness of breath or cough

Tell your doctor or nurse if you are short of breath or you have a cough. This could be due to a collection of fluid around the lung (pleural effusion) or it may be for another reason.

Feeling or being sick (nausea)

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.

Sore mouth and throat

It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy. 

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Skin changes

You might notice skin changes, such as reddening of the skin, itching, or rashes.

Rarely, the skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Tell your healthcare team if you have any skin changes. They might be able to give you a medicine or something to help like a cream or lotion.

Sweating

This drug might cause you to sweat more than usual. But there are ways to reduce sweating. Less commonly you might have night sweats. Let your healthcare team know if you are sweating much more than normal.

Pain in different parts of the body

It is common with this drug to have pain in areas such as your tummy (abdomen), muscles, bones, or joints. Speak to your doctor or nurse about what painkillers you can take to help with this.

Kidney changes

Liposomal daunorubicin and cytarabine can affect how well your kidneys work. You have regular blood tests to check how well they are working.

Let your healthcare team know if you have breathlessness, tiredness, itchy skin, confused, fluid build up especially around the hands or ankles. 

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Fluid build up

A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your healthcare team if this happens to you.

High temperature or chills

You might get a high temperature. Or you might feel cold or start shivering (chills). 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• low levels of red blood cells in your blood (anaemia), this can make you feel weak and tired
• low levels of platelets – this can increase the risk of bleeding
• 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
• hair loss
• Indigestion, symptoms include heartburn, bloating and burping

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, foods and drinks

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.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

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. 

Breastfeeding

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

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 about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet 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.