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R-ESHAP

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

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

  • R – rituximab (Mabthera), a type of biological therapy called a monoclonal antibody
  • E – etoposide, a chemotherapy drug
  • SH – methylprednisolone, a steroid
  • A – cytarabine (Ara C), a chemotherapy drug
  • P – cisplatin, a chemotherapy drug

It is a treatment for non Hodgkin lymphoma (NHL). Most people who have this type of treatment also have a stem cell transplant.

How it works

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

How you have it

All the R-ESHAP drugs are clear colourless fluids. You have them 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 R-ESHAP as cycles of treatment. Each cycle lasts 4 weeks. You usually have between 2 and 8 cycles.

Each cycle of treatment is given in the following way:

Day 1
  • You have rituximab as a slow drip (infusion) into your bloodstream.
  • You have etoposide as a drip into your bloodstream for 1 hour.
  • You have methylprednisolone (steroid) as a drip into your bloodstream for 15 to 30 minutes.
  • You have cytarabine as a drip into your bloodstream for 2 hours – this may be on the 5th day instead.
  • You start cisplatin as a drip into your bloodstream that lasts 96 hours (4 days).
Days 2, 3 and 4
  • You continue with the cisplatin drip.
  • You have etoposide as a drip into your bloodstream for 1 hour.
  • You have methylprednisolone as a drip into your bloodstream for 15 to 30 minutes.
Day 5
  • You have methylprednisolone as a drip into your bloodstream for 15 to 30 minutes.
  • You have cytarabine as a drip into your bloodstream for 2 hours.
  • You finish the cisplatin drip.

You have no treatment for just over 3 weeks. Then you start the next cycle.

You will need to stay in hospital for the 5 days of treatment. But you will be able to move around the ward even while the drips are going through. You will also have drips of fluids (hydration). Cisplatin can cause kidney damage and the extra fluids keep your kidneys working properly. You may also have a drug called mannitol as a drip alongside your cisplatin. Mannitol helps your kidneys produce more urine.

You can go home once the treatment is finished. Your doctor or nurse will give you anti sickness medicines to take home and some steroid eye drops. You will need to use these as prescribed by your doctor for the next 5 to 7 days. You may also need to take them before going into hospital to have your treatment and your doctor or nurse will discuss this with you.

Allergic reaction

Some people can have an allergic reaction to rituximab so your first dose is given slowly over about 4 hours. To help prevent a reaction your doctor or nurse will give you paracetamol and another drug called chlorphenamine (Piriton). If you do have a reaction they will stop the infusion and start it again once your symptoms have reduced. If you don't have a reaction you should be able to have further doses of rituximab at a faster rate (over 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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