This page tells you about the chemotherapy drug combination ESHAP and its possible side effects. There is information about
ESHAP is the name of a combination of chemotherapy drugs used to treat Hodgkin lymphoma and non Hodgkin lymphoma (NHL). It is usually used before having a stem cell transplant.
ESHAP is made up of the drugs
- E – Etoposide
- SH – Methylprednisolone, which is a steroid
- A – Cytarabine, also known as Ara C
- P – Cisplatin
All the ESHAP drugs are clear colourless fluids. You have them 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, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
You usually have chemotherapy as cycles of treatment. For ESHAP, this is usually 3 weekly cycles (every 21 days). Depending on your needs, you may have between 1 and 6 cycles.
You have each treatment cycle in the following way.
On the 1st day you have
- Etoposide as a drip (infusion) for one hour
- Methylprednisolone (steroid) as a drip for 15 to 30 minutes
- Cytarabine as a drip for 2 hours
- Cisplatin as a drip continuing for 4 days
On the 2nd day you
- Continue with your cisplatin
- Repeat the etoposide and methylprednisolone drips
On the 3rd and 4th day you have the same drugs as on day 2.
On day 5 the cisplatin drip finishes and you have
- Another dose of methylprednisolone
- A drip of cytarabine for 2 hours
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 a break for just over 2 weeks. Then you start the next cycle.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.
We've listed the side effects associated with ESHAP treatment below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.
You may have a few side effects. They 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)
The side effects may be different if you are having ESHAP with other drugs.
Tell your doctor or nurse straight away if any of the side effects get severe.
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 happens in 1 out of 4 people (25%) – 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
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – 3 out of 10 people (30%) need a blood transfusion
- Bruising more easily due to a drop in platelets happens in 1 out of 4 people (25%) – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Feeling or being sick is usually well controlled with anti sickness medicines
- Hair loss – most people have complete hair loss but the hair grows back once the treatment ends
- Kidney changes – you will have fluids to flush the drugs through
- Hearing changes – you may have ringing in the ears (tinnitus) or have problems hearing. These usually get better on their own
- Loss of taste or a metallic taste in your mouth
- Low blood pressure can occur if you have your treatment too quickly – if you feel dizzy or faint, call your nurse straight away to slow your drip down
- Sore, red eyes can happen because cytarabine is removed from your body (excreted) in your tears – you will have steroid eye drops to help prevent sore eyes
- Changes to your blood sugar levels due to steroids – you will have regular blood tests and may also need to check your urine for sugar
- Women may stop having periods (amenorrhoea) – this may be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. 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
Between 1 and 10 in every 100 people have one or more of these effects.
- Numbness or tingling in hands or feet – this usually improves a few months after the treatment finishes. Some people have permanent numbness
- Allergic reactions can happen while any of the drugs are going into your bloodstream – while you are having the treatment your nurse will monitor you for signs of an allergic reaction. Tell your nurse if you feel hot or have any skin rashes, itching, dizziness, headaches, or shivering. Also let them know if you have breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
- A skin rash
- A sore mouth
- Mood changes
- Diarrhoea or constipation – drink plenty of fluids. Let your nurse know if these effects last for more than 3 days or get severe
- Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished
A very small number of people have a second cancer some years after ESHAP treatment.
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
This drug 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 at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Do not breastfeed during this treatment because the drug 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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