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ESHAP

Find out what ESHAP is, how you have it and other important information about having ESHAP.

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

  • E - etoposide
  • SH - methylprednisolone, which is a steroid
  • A - cytarabine, also known as Ara C
  • P - cisplatin

It is a treatment for Hodgkin lymphoma and non Hodgkin lymphoma (NHL). It is usually used before having a stem cell transplant.

How it works

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

How you have it

You have these drugs into your bloodstream (intravenously). 

Drugs into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have it

You usually have ESHAP as cycles of treatment each lasting 3 weeks (21 days). Depending on your needs, you might have between 1 and 6 cycles. 

You have each treatment cycle in the following way:

Day 1
  • Etoposide as a drip into your bloodstream for 1 hour
  • Methylprednisolone as a drip into your bloodstream for 15 to 30 minutes
  • Cytarabine as a drip into your bloodstream for 2 hours
  • Cisplatin as a drip into your bloodstream continuing for 4 days
Day 2
  • Cisplatin as a continuous drip into your bloodstream
  • Etoposide as a drip into your bloodstream for 1 hour
  • Methylprednisolone as a drip into your bloodstream for 15 to 30 minutes
Day 3 and Day 4
  • Cisplatin as a continuous drip into your bloodstream
  • Etoposide as a drip into your bloodstream for 1 hour
  • Methylprednisolone as a drip into your bloodstream for 15 to 30 minutes
Day 5
  • Methylprednisolone as a drip into your bloodstream for 15 to 30 minutes
  • Cytarabine as a drip into your bloodstream for 2 hours
  • Cisplatin drip finishes

During the 5 days of treatment you stay in hospital but you will be able to move around the ward even when the drip is going through. You also have fluids (hydration) during your treatment. This is because ESHAP can cause kidney damage and the extra fluids help to keep your kidneys working properly.

Your doctor or nurse will give you steroid eye drops to use for 7 days to help stop your eyes getting sore.

When the treatment finishes you have just over 2 weeks with no treatment. Then you start the next cycle. 

Tests during treatment

You have blood tests before starting treatment 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.

Side effects

Important information

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.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with these drugs and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

You may not be able to become pregnant or father a child 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 may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

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

Treatment for other conditions

Always tell other doctors, nurses or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and Zostavax (shingles vaccine).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine
  • be in contact with other people who've had live vaccines as injections

Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, you mustn't change their nappies for 2 weeks after their vaccination.

You also need to avoid anyone who has had oral polio or typhoid vaccination recently.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

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

Last reviewed: 
27 Apr 2015
  • Electronic Medicines Compendium 
    Accessed April 2015

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study.

    A Martín and others

    Haematologica, 2008. Vol 93, Issue 12

  • Handbook of Cancer Chemotherapy (8th edition)
    Roland K Keel
    Lippincott, Williams and Wilkins, 2012

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