Ifosfamide is a clear fluid which can be given:

● as a drip (infusion) or injection into a vein in your arm, through a fine tube (cannula)
● through a central, PICC or hickman line

what about side effects?

Some people only get a few side effects while others have more. It’s hard to know how it will be for you. Most side effects are short term and will gradually disappear once the treatment has finished.

The doctors and nurses on the ward will keep a close eye on you while you have your treatment. But it’s important to let them know if you feel unwell or have any problems.

Here are some of the more common side effects you might experience.

effect on bone marrow

Bone marrow is a bit like the ‘factory’ of the blood. It’s the spongy stuff inside some of our bones and it’s where new blood cells start life. Blood cells start off as stem cells and then go on to become:

• white cells - which fight infection
• red cells - which carry oxygen around the body
• platelets - which help the blood to clot and prevent bleeding

Ifosfamide can affect the production of all these cells which can lead to problems such as:

infection – Ifosfamide can reduce the number of white cells made by the bone marrow, making it easier for you to pick up infections and harder to fight them off. Your immune system is usually at it’s lowest from 10-14 days after the chemo has been given. So around this time it’s important to avoid being in crowded places and near people who have an infection (such as colds, flu and chicken pox).

Keep an eye on your temperature and if it goes above 38ºC (or you feel unwell) it’s important to let your doctor know. After 14 days your bone marrow will gradually start to make more white cells and your immune system should begin to pick up. Doctors will keep an eye on all this by taking regular blood tests throughout your treatment. If necessary, you’ll be given antibiotics to keep any infection under control.

anaemia – if the level of your red cells (haemoglobin) is low you can become tired and lethargic, even a bit breathless. These are symptoms of anaemia which means there’s not enough oxygen getting to your cells. To help with this, you can have a blood transfusion. This will increase the amount of haemoglobin in your body and sort out these symptoms.

bruising and bleeding – if the number of platelets in your blood is low you might bruise very easily and may have nosebleeds. You can bleed more heavily from a small cut or graze. If you do have any unexplained bleeding then you must contact your doctor straight away. If your platelets drop below a certain level, you might need a platelet transfusion (fluid containing platelets is given to you in a drip).

nausea and vomiting

Ifosfamide can make you feel sick (nausea) or actually be sick (vomit). You will be given anti-sickness drugs to try to stop any sickness. You can feel sick from a few minutes to a few hours after you have the chemo. It might last for a couple of hours or (very rarely) for several days. Your doctor will prescribe anti-sickness drugs that will be given intravenously with your chemo. You’ll also have tablets to take home just in case.

hair loss

Hair loss usually happens 3-4 weeks after the first dose of Ifosfamide. Very rarely it can start to fall out within a few days. You may also lose your eyelashes, eyebrows, underarm, pubic and other body hair. This can be really upsetting and tough to cope with. It’s important to remember that your hair will grow back once you’ve finished the treatment.

You might want to look at our section on wigs and scarves and read some tips from other teenagers.

irritation of the bladder

Ifosfamide can irritate your bladder so it’s important to drink plenty of fluids to prevent this. You will usually be given lots of fluid into your vein before and after the chemo. While you are having the chemo your urine may be measured and tested to make sure that your bladder and kidneys are ok.

nail changes

Your nails might get ridges on them. These ridges will grow out over a few months once the treatment has finished.

tiredness

The chemo can make you feel tired and weak, so it’s important to rest and take things easy whenever you can.

less common side effects

● skin changes – Ifosfamide can cause a rash that can be itchy. Let your doctor know if this happens. It can also make your skin darken, which should return to normal once the treatment has finished
● confusion, sleepiness and loss of balance – this is a very rare side effect and only happens with high dose treatment. If you feel any of these symptoms you must let your doctor know

what else should I know?

Chemo can affect your ability to become pregnant or father a child. It’s important to talk this through with your doctor before you start the treatment. Have a look in our fertility section for more information.

It can feel really scary reading about all these side effects. It’s important to remember that most of them can be controlled and once the treatment stops, the side effects will get better.

If you’re feeling nervous or worried, chat to your doctor and parents about things. They are there to help you. Also have a look at our forum, where you can talk to other young people who have been through a similar experience.