R-DHAP | Cancer Research UK
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What R-DHAP is

R-DHAP is the name of a combination of drugs used to treat high grade non hodgkin lymphoma that has come back. It is DHAP chemotherapy with the drug rituximab. 

R-DHAP is 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

How you have R-DHAP

Cytarabine, cisplatin and rituximab are colourless fluids given 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 the steroid (dexamethasone) as tablets (orally) but you may have it into the vein as well. 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. 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 early in the day, immediately after breakfast.

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.

  • On the 1st day you start taking the dexamethasone tablets or you have it as a drip. You also have a slow drip (infusion) of rituximab followed by cisplatin as a drip for 24 hours
  • On the 2nd day you have cytarabine (Ara C) as a drip twice. Each drip lasts for 3 hours and you have them 12 hours apart. You also take the dexamethasone tablets
  • On the 3rd and 4th days you carry on taking the dexamethasone either as tablets or through a drip. If you are having it as tablets you will be able to take them home with you

You also have fluids (hydration) into the drip during your first two days of treatment. This is because R-DHAP can cause kidney damage and the extra fluids help to keep your kidneys working properly.

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

Once you have finished the dexamethasone you have no treatment for 3 weeks. You then start a new treatment cycle.

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 regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.


About side effects

We've listed the side effects associated with R-DHAP 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-DHAP with other drugs.

Tell your doctor or nurse straight away if any of the side effects get severe.


Common side effects

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 happens in 4 out of 10 people having R-DHAP (40%) – 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)
  • Kidney changes – you will have fluids to flush the drugs through
  • 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
  • Diarrhoea may happen up to a week after your treatment – make sure that you drink plenty of fluids. Tell your doctor or nurse if it becomes severe or continues for more than 3 days. 1 in 5 people (20%) have severe diarrhoea
  • A sore mouth or ulcers
  • Loss of appetite – this is more likely if you have sickness, diarrhoea, or a sore mouth
  • Flu like symptoms including fever and chills happen in 1 out of 2 people (50%) – taking paracetamol as your doctor or nurse prescribes can help
  • Changes in your blood sugar levels – steroids can change your blood sugar levels so you will have regular blood tests to check this. You may also need to check your urine for sugar
  • Ringing in the ears (tinnitus) happens to about 3 in 10 people treated (30%) and usually gets better on its own
  • 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
  • Sore, red eyes because some of the cytarabine is removed from your body (excreted) in your tears
  • Skin changes – your skin may be sore and red, particularly on the hands and feet. You may also have an itchy rash
  • A reaction while having rituximab can cause flu like symptoms, such as a fever, chills and shivering (rigors), a headache and feeling sick. Let your doctor or nurse know straight away if you have this
  • Feeling weak occurs in about 1 in 4 people (25%)
  • Night sweats occur in about 3 in 20 people (15%)
  • Stomach pains
  • Low blood pressure happens in about 1 in 10 people (10%) and more rarely, raised blood pressure
  • A runny nose (rhinitis) may occur during the rituximab drip, which is usually mild

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these effects.

  • High uric acid levels in your blood due to cancer cells being broken down by the body – your nurse will ask you to drink plenty of fluids to flush out the uric acid. Your doctors may also give you a drug called allopurinol
  • Numbness or tingling in hands or feet – this usually improves a few months after the treatment ends. Some people have some permanent numbness
  • Loss of taste or a metallic taste in your mouth
  • Hair loss or thinning
  • Aching muscles (myalgia) and bones
  • Drowsiness and confusion happens in up to 1 in 10 people (10%) but is usually mild and gets better on its own. It is more likely if you are over 40 or have liver or kidney problems
  • A cough and breathlessness – tell your doctor or nurse if this continues
  • Liver changes that are very mild and unlikely to cause symptoms – your liver will almost certainly go back to normal when treatment is finished
  • Indigestion
  • Dizziness
  • Flushing occurs in about 1 in 20 people (5%) when having the rituximab drip – you may have a sudden feeling of warmth and your face may go red

Rare side effects

There is a small risk that you may get a second cancer some years after R-DHAP treatment.


Important points to remember

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.

Other medicines

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.


Related information


More information about R-DHAP drugs

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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Updated: 27 April 2015