This page tells you about the cancer drug combination R-CVP. You can read about
R-CVP is the name of a combination of cancer drugs used to treat low grade non Hodgkin lymphoma. It is made up of the drugs
- R – Rituximab (Mabthera), a type of biological therapy called a monoclonal antibody
- C – Cyclophosphamide (a chemotherapy drug)
- V – Vincristine (a chemotherapy drug)
- P – Prednisolone, which is a steroid
You have prednisolone as tablets. It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
You have the drugs 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 R-CVP as cycles of treatment. You have between 6 and 8 cycles. Each cycle lasts 3 weeks and you have it in the following way.
On the first day you have
- Rituximab in a drip – the first time it lasts about 4 hours, but after that it usually lasts 2 hours
- Vincristine as a short drip (infusion)
- Cyclophosphamide as an injection into your cannula or central line or as a drip over 30 minutes
- You start taking prednisolone as tablets. You take it for 5 days. After the first dose you take the rest at home. You need to swallow the tablets whole after a meal, or with milk, as they can irritate your stomach. It is best to take them after breakfast.
Once you have finished your prednisolone tablets you have no treatment for just over 2 weeks. Then you start the next cycle.
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 you will have paracetamol and a drug called chlorphenamine (Piriton).
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 R-CVP 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 R-CVP 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 – 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) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – 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)
- A reaction to rituximab while the drug is being given, causing flu like symptoms such as a fever, chills and shivering (rigors), a headache and feeling sick. About 1 in 20 people (5%) have a more severe reaction, with wheezing, an itchy rash and a drop in blood pressure. Your nurse will give you medicines beforehand to try to prevent a reaction. If you do have a reaction, your nurse will slow your drip down or stop it for a while
- 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
- Numbness or tingling in fingers and toes can cause difficulty with small things such as doing up buttons. This starts a few days or weeks after treatment and usually goes within a few months of treatment ending
- Constipation, sometimes with stomach cramps, happens in 1 out of 3 people (33%). It can generally be prevented with regular laxatives. If you are constipated for more than 3 days, tell your doctor or nurse
- Loss of appetite
- Hair loss or thinning usually happens about 3 to 4 weeks after your first dose and is temporary
- 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
- Feeling weak happens in about 1 in 4 people (25%)
- Night sweats occur in about 3 in 20 people (15%)
- Indigestion, 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 more urine than usual
- A runny nose (rhinitis) during the rituximab drip, which is usually mild
Between 1 and 10 in every 100 people have one or more of these.
- Flushing occurs in about 1 in 20 people (5%) – when you are having rituximab you may have a sudden warm feeling and your face may go red
- Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your nurse straight away
- Vincristine can affect the bladder nerves, causing temporary urine leakage (incontinence)
- Temporary taste changes
- Mouth ulcers
- Jaw pain, caused by vincristine affecting the nerves
- Diarrhoea is usually mild, but drink plenty of fluids – if it becomes severe or continues let your doctor or nurse know
- Your nails may darken or become ridged, brittle or chipped
- Your skin may darken or you may have a rash that may itch
- Cyclophosphamide can cause cystitis (inflammation of the bladder), pain and occasionally blood in the urine – if you see blood in your urine, contact your nurse or doctor straight away. You need to drink 1 to 2 pints of fluid a day. You may have extra fluids into a vein too
- A mild effect on the liver that is unlikely to cause any symptoms – it will almost certainly go back to normal when the treatment ends
Fewer than 1 in 100 people have these.
- Lung changes that may lead to a cough or breathlessness
- A build up of fluid may cause swelling in the legs and feet
- Poor balance and staggering
- Bone pain
- Blurred or double vision
- Hearing loss or dizziness
- Trouble sleeping
There is a small risk of developing a second cancer some years after R-CVP 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 a few 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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