This page tells you about the chemotherapy drug combination CHOP and its possible side effects. There is information about
CHOP is the name of a chemotherapy treatment used to treat non Hodgkin lymphoma. It is made up of the drugs
- C = Cyclophosphamide
- H = Doxorubicin Hydrochloride (also called Adriamycin)
- O = Vincristine (also called Oncovin)
- P = Prednisolone (a steroid)
The side effects of a combination of drugs are usually a mixture of the side effects of each drug. The combination of drugs may increase or decrease your chance of getting each side effect. Or it may change the severity.
You have cyclophosphamide, vincristine and doxorubicin into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. The tube stays in throughout the course of treatment. You have prednisolone (steroid) tablets to take at home.
You have CHOP chemotherapy in cycles of treatment. Each cycle lasts 3 weeks and you may have 6 to 8 cycles in total.
You have each treatment cycle in the following way. On the first day you have cyclophosphamide, vincristine and doxorubicin as injections or drips into your cannula or central line. You have prednisolone tablets to take at home for 5 days. Then you have no treatment for 16 days. This completes your treatment cycle and you then start the next cycle.
Sometimes CHOP is given over 2 weeks with a drug called G-CSF that makes the bone marrow produce white blood cells faster.
The side effects associated with CHOP are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link please see our cancer drugs side effects section or use the search box at the top of the page.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Hair loss – your hair will grow back when the treatment ends
- Feeling or being sick can usually be controlled with anti sickness medicines – if you still have sickness after taking these, tell your doctor or nurse
- Nerve problems causing abdominal cramps, constipation, numbness or tingling of fingers and toes, jaw pain or double vision – tell your doctor or nurse if you have any of these
- Women may stop having periods (amenorrhoea), which may only be temporary but can be permanent
- Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. 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
- Your urine may become pink or red for one or two days after treatment with doxorubicin – this won't harm you
- Mouth sores and ulcers
- Loss of appetite
- Skin changes – your skin may darken, or you may have an itchy rash or become sensitive to sunlight. Use a high factor suncream and cover up when you go out
- Indigestion and stomach pains or discomfort
- A change in blood sugar levels – tell your doctor or nurse if you get very thirsty or if you are passing urine more than usual
- A puffy face and ankles due to fluid build up
- Increased appetite with possible weight gain
- Difficulty in sleeping
- Mood swings
Between 1 and 10 in every 100 people have one or more of these.
- Burning, stinging or pain on passing urine (cystitis) – if you see blood in your urine contact your doctor or nurse straight away
- Taste changes
- Nails may darken or become ridged or white lines may appear on them
- Damage to heart muscle, which is usually temporary but for a small number of people it may be permanent – you will have heart tests before and after your treatment
- Diarrhoea – drink plenty of fluids. If the diarrhoea continues for more than 3 days or gets severe, let your doctor or nurse know
- Reddening of the skin in areas where you have had radiotherapy in the past – the skin may also get dry and flaky and feel sore and hot. These effects go away on their own but keep affected areas out of the sun
- The skin over your drug injection site may become discoloured
- Fever and chills
- Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
- Other drugs you are having
Coping with side effects
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
These drugs may 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.
Do not breastfeed during this treatment because the drugs may come through in the breast milk.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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