R-CHOP chemo is used to treat Non Hodgkin Lymphoma. You will usually be given 6-8 cycles over 3-4 months. This is called a course of treatment.
Which drugs?
R-CHOP is named after the initials of the drugs that are used, which are Rituximab, Cyclophosphamide, Doxorubicin, Vincristine (also called Oncovin) and Prednisolone.
How is it given?
Into a vein (intravenously). This may be through a cannula, central line or a PICC line.
You’ll be given an anti-sickness medicine as tablets or by injection through the cannula, central line or PICC line, which is connected to a drip (infusion). The chemo drugs are then given separately:
- Rituximab (a clear fluid) is given as an infusion
- Doxorubicin (a red fluid) is given as an injection into your cannula through a fast running salt water (saline) drip.
- Vincristine (a clear fluid) is given as an injection in the same way
- Cyclophosphamide ( a clear fluid) is given as an injection in the same way
- Prednisolone are tablets
Rituximab is a type of drug called a monoclonal antibody and works in a different way from chemo. Our bodies make proteins called antibodies to help our immune system fight infection. Monoclonal antibodies are made in the lab and are used to fight cancer. They can trigger the body’s immune system to attack cancer cells and make them destroy themselves. You may need to stay in hospital overnight for your first treatment. After that it’s usually given as an outpatient which means you don’t have to stay in hospital.
How often will I have it?
Treatment will be given every 3 weeks
- Day 1 you will have rituximab, doxorubicin, vincristine and cyclophosphamide
- Days1–5 You will be given a 5 day course of prednisolone tablets to start on day 1
- Days 6–21 There’s no treatment during this time. This gives you a chance to recover before you start your next cycle of treatment.
Day 1 of the next cycle starts the following day (day 22). You will have a blood test and be seen by your doctor before each cycle of chemo.
Are there any side effects?
Some people only get a few side effects while others will have more. It’s hard to know how it will be for you. Most side effects will disappear after treatment has finished. You can read about ways to help cope with them in our deal with it section
Common side effects
- Lowered resistance to infection: Your immune system doesn’t work so well when you’re having chemo, so you might pick up more colds and infections. This begins around 7 days after treatment is started and reaches its lowest point around 10–14 days after chemo. Your blood cells then gradually go back to normal.
Keep an eye on your temperature and if it goes above 38°C (or you feel unwell) it’s important to let your doctor know. If necessary, you’ll be given antibiotics to keep any infection under control.
- Bruising and bleeding: The number of platelets in your blood can fall because of the chemo. This can cause bleeding or bruising (for example, of the gums, nose bleeds, heavy periods or pin prick dots on the skin). Let your doctor know if you have any problems with this. If your platelets are really low, they might suggest a platelet transfusion.
- Anaemia: The number of red cells (haemoglobin) in your blood can be low because of the chemo. This can make you feel tired and sometimes breathless. If necessary, (to help with the symptoms) your doctor might suggest a blood transfusion to increase the amount of red cells in your blood.
- Hair loss: This usually starts 3–4 weeks after the first course of treatment. Usually all the hair on your head will fall out. You may also notice that some or all of your eyelashes, eyebrows and body hair fall out. This can feel really tough to cope with but remember it’s temporary and your hair will start to grow again once the treatment is finished. You might want to read our info on wigs and scarves in our deal with it section.
- Feeling sick: Anti sickness medicines are given to help prevent or control this. Let your doctor know if you feel sick and they’ll prescribe extra medicines.
- Sore mouth: You might get a sore, dry mouth or notice some small ulcers. Drinking plenty of fluids and brushing your teeth regularly with a soft toothbrush can help. Doctors can prescribe mouthwashes and medicine to prevent or clear any infection.
- Tiredness: You may feel more tired than normal and may not have as much energy. It’s important to try to get as much rest as possible and take it easy.
- Difficulty sleeping: When taking the prednisolone tablets you may find that you have some problems sleeping at night. It's best to take it first thing in the morning to try to prevent this.
- Numbness or tingling in your hands or feet: This is caused by the effect of vincristine on the nerves and is known as peripheral neuropathy. Let your doctor know if you experience this. It usually improves slowly a few months after treatment is finished.
- Changes to your urine: Doxorubicin can make your urine look pink or red. This will only last for about a day. Cyclophosphamide can irritate your bladder. It’s really important to drink plenty of fluids to try to prevent this. You should also report any blood in your urine, pain on passing urine or needing to pass urine frequently to your doctor.
- Taste changes: You may find that your food tastes different. Normal taste usually comes back when the treatment has finished.
- Fertility: Treatment can also affect your fertility. That’s your ability to become pregnant or father a child. It’s important to talk this over with your doctor before you start your treatment. See our information on fertility to find out more. Guys may wish to consider sperm banking.
- Periods: For girls, your periods may stop. This is usually a temporary effect of treatment and they will come back after treatment has finished.
Less common side effects
- Constipation: This is also a side effect of the vincristine. If you find that you are not going to the toilet as often as you used to, let your doctors know and they may give you some medicine to treat the constipation.
- Changes to your heart: High doses of doxorubicin can affect the way your heart works. This sounds scary but the doctors will keep a close check on things. For example, you’ll have tests to see how well your heart is working before the drug is given.
- Changes in your nails: Your nails may become darker or ridged. They usually return to normal within a few months of finishing treatment.
These are the most common side effects. It can feel really scary reading about all of these. It’s important to remember that most of them can be controlled and they will get better after the treatment is finished.
It might help to talk to your doctor or nurse about things if you’re worried or nervous. They are there to help. Also have a look at our share it section where you can talk to others who have been through a similar experience.
Anything else I should know?
Some people have a slight reaction to Rituximab. This reaction can include a skin rash, irritation of the throat and nostrils, wheezing, coughing or breathlessness. Some people also feel flushed and feverish. The nurses will keep a close eye on you while the rituximab is running. They'll check your blood pressure and heart rate while it’s running. You might be given medicines before it to try to prevent a reaction.
Prednisolone can increase your appetite. You’ll probably find that you eat more and maybe put on a bit of weight. Some people notice their fingers and ankles become puffy. This is because steroids can cause your body to store fluid. They can also cause changes in your mood. If you’re worried about any changes in your mood, talk it over with your doctor or nurse.
How will I feel?
Chemo affects everyone differently, but it’s likely that you may feel a bit rough sometimes when you’re having your treatment. You might also feel emotional, depressed or irritable at times. All of these feelings are normal for people having chemo. Some people find it really helps to talk things over with someone close or a counsellor. If you want to find out more, there’s lots of information in our deal with it section.
