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R-DHAP

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

What is R-DHAP

R-DHAP is a cancer drug combination made up of the drugs:

  • R – rituximab (also called Mabthera), a type of biological therapy called a monoclonal antibody
  • DH – dexamethasone, which is a steroid
  • A – cytarabine (also known as Ara C), a chemotherapy drug
  • P – cisplatin, a chemotherapy drug

It is a treatment for high grade non Hodgkin lymphoma that has come back.

How it works

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

How you have it

Cytarabine, cisplatin and rituximab are colourless fluids that you have into your bloodstream (intravenously).

You usually have the steroid drug (dexamethasone) as tablets (orally) but you may also have it into your bloodstream. If you take dexamethasone as tablets, you should swallow them whole after a meal, or with milk, as they can irritate your stomach. It is best to take them early in the day, immediately after breakfast. 

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.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

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

Never stop taking a cancer drug without talking to your specialist first.

When you have R-DHAP

You have R-DHAP as cycles of treatment. Each cycle lasts 3 weeks. You may have 1 or 2 cycles.

You have each cycle in the following way:

Day 1
  • You have dexamethasone tablets or as a drip into your bloodstream.
  • You have rituximab as a slow drip into your bloodstream.
  • You have cisplatin as a drip into your bloodstream for 24 hours.
  • You have hydration fluids as a drip into your bloodstream.
Day 2
  • You have cytarabine as a drip into your bloodstream twice (each drip lasts for 3 hours and you have them 12 hours apart).
  • You have hydration fluids as a drip into your bloodstream.
  • You have dexamethasone tablets or as a drip into your bloodstream.
Day 3 and 4
  • You have dexamethasone tablets or as a drip into your bloodstream.
Day 5 to day 21
  • You have no treatment.

You then start a new treatment cycle.

Your nurse or doctor will give you steroid eye drops to use for 5 to 7 days to help prevent your eyes getting sore.

Allergic reaction

Some people can have an allergic reaction to rituximab so you have the first dose slowly over about 4 hours. To help prevent a reaction you will have paracetamol and a drug called chlorphenamine (Piriton). If you have a reaction your nurse will stop the drip. They will start it again once your symptoms have reduced. You should be able to have further doses of rituximab at a faster rate (about 2 hours).

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 might harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few 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.

Information and help

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