Melphalan, prednisolone and thalidomide (MPT)

Melphalan, prednisolone and thalidomide (MPT) is a cancer drug combination for the treatment of myeloma.

MPT is a cancer drug combination made up of the drugs:

• M - melphalan
• P - prednisolone
• T - thalidomide

You might have MPT if you have myeloma. You might have it as your first treatment or if your cancer has come back and you are not suitable for high dose treatment with a stem cell or bone marrow transplant.

How does MPT work?

Melphalan is one of a group of drugs called alkylating agents. It sticks to one of the cancer cell's DNA strands. DNA is the genetic code that is in the nucleus of all animal and plant cells. It controls everything the cell does. The cell cannot then grow and divide into 2 new cells.

Thalidomide works in different ways. It: 

• stops cancer cells developing
• stops cancers making their own blood vessels, that they need to be able to grow
• stimulates some of the immune system cells to attack myeloma cells

Prednisolone is a steroid and helps the drugs work better and kills myeloma cells.

How do you have MPT?

You take melphalan and prednisolone as tablets. You take thalidomide as capsules.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

How often do you have MPT?

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

Each cycle of treatment lasts 28 days (4 weeks). The number of cycles you have depends on your individual situation.

Melphalan

You take melphalan tablets once a day for the first 4 or 7 days of each cycle of treatment. You should swallow the tablets whole with a glass of water. You need to keep the tablets in the fridge.   

Prednisolone

You take prednisolone tablets once a day for the first 4 or 7 days of the cycle of treatment. You swallow them whole with a glass of water and take them with food or immediately after eating. It is better to take prednisolone early in the day.

Thalidomide

You take thalidomide capsules at night to prevent feeling sleepy at other times of the day. You swallow them whole with a glass of water. You take them every day throughout the time you are having treatment. You can take thalidomide with or without food. You usually start on a low amount (dose) and your doctor then increases the dose unless you get bad side effects.

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.

Women of childbearing age will have a pregnancy test before each cycle.

Before treatment starts you might have a blood test to check for Hepatitis B infection. Treatment could cause a virus you’ve had in the past to become active and cause symptoms again.

You will have your blood sugar levels checked regularly. This is because prednisolone (a steroid) can increase your blood sugar level.

What are the side effects of MPT?

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. 

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).

Feeling and 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.

Drowsiness (somnolence)

You may feel drowsy with this treatment. Do not operate machinery or drive if you are feeling drowsy.

Numbness or tingling in fingers or toes (peripheral neuropathy)

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

You might also have a prickling or crawling feeling in your skin.

Shaky hands (tremor)

You may develop shaky hands (tremor) with this treatment.

Dizziness 

Let your doctor or nurse know if you feel dizzy. Don’t drive or operate machinery if you feel dizzy.

Difficulty opening your bowels (constipation)

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can prescribe a laxative.

Loose or watery poo (diarrhoea)

Contact your advice line if you have diarrhoea. For example, 2 or more extra loose bowel movements than usual each day. 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.

Fluid build up in your hands or legs

You may have swelling of your hands and legs due to a build up of fluid (oedema). 

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:

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• tiredness and weakness (fatigue)
• skin changes that can make the skin dry, red, itchy, thinner in areas or you may get a rash. You might also find wounds take longer to heal
• hair tinning or loss
• kidney problems such as high levels of urea in your blood or your kidneys not working very well. Symptoms might include passing less urine than normal, swelling of the legs, ankles and feet, feeling very tired, confusion and shortness of breath
• changes in the levels of minerals in your blood such as low levels of potassium and high levels of sodium- you'll have regular blood test to check this
• slow heartbeat, or changes in how well your heart is working. Rarely this treatment can cause a heart attack
• weakening of the bones making them more likely to break (fracture)
• a second cancer such as acute myeloid leukaemia
• feeling very low (depressed)
• feeling confused
• indigestion, symptoms include feeling bloated, heartburn and burping
• dry mouth
• seizures (fits)
• high temperature
• generally feeling unwell
• lung problems causing symptoms such as shortness of breath, cough, changes to how fast you breath, chest pain and feeling very tired
• weight loss
• muscle wasting
• high blood sugar levels – you have regular blood and urine tests to check this
• high blood pressure
• developing symptoms such as a swollen or puffy face, acne, thicker more visible facial hair due to too much of a hormone called cortisol in your body
• spinning feeling in your head, making it difficult to stand up and move normally
• hearing changes such as not being able to hear as well or not at all

Rare side effects

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

• sore mouth - use mouth washes to keep your mouth healthy and tell your team if your mouth is sore
• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
• blockage in your bowel symptoms include severe pain and cramping in your tummy (abdomen), being sick, bloating, feeling full, unable to have a poo and you may or may not be able to pass wind - contact your advice line immediately if you have this
• changes in how your liver works, very rarely you might get yellowing of the skin and whites of your eyes
• allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life-threatening, alert your nurse or doctor if notice any of these symptoms
• a blood disorder where your red blood cells get destroyed faster than they can be made • headaches
• eye problems such as clouding of the lens of the eye (cataracts) or damage to the main eye nerve (optic nerve) that allows you to see (glaucoma)

Other side effects

Posterior reversible encephalopathy syndrome (PRES) is a rare disorder of the nerves causing headache, fits, confusion and changes in vision. There isn't enough information to work out how often you might get this side effect, however this condition is reversible. Contact your health team straight away.

More about side effects

If you have side effects that aren’t listed on this page, you can look at the individual drug pages:

Coping with side effects

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

What else do I need to know?

Other medicines, foods and drink 

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Isomalt

Thalidomide capsules contain an ingredient called isomalt. If you have problems digesting some sugars (such as fructose) speak to your team before starting this treatment.

Pregnancy and contraception 

Thalidomide harms a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for 3 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Women of child bearing age will have a pregnancy test before and every 4 weeks during treatment. You will also have one 4 weeks after finishing your treatment. You’ll have to start using reliable contraception 4 weeks before starting this treatment. 

Men need to use a condom if their partner is pregnant or is able to become pregnant, if their partner is not using effective contraception. Men need to use contraception during treatment and for 7 days afterwards

Men should not donate sperm during treatment and for 7 days afterwards.

Some people worry about taking thalidomide but it does not cause physical defects in adults. Pregnant women and children should not touch or handle thalidomide. You must store it in a place where pregnant women or children cannot reach it.

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.    

Breast feeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

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 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.