CHOP

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)

Click on the links above to find out the side effects of each individual drug. 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. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it. 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.

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.

A temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Hair loss
• 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 get pregnant or father a child after having this treatment. It is important to talk to your doctor about your fertility before starting treatment
• CHOP may have a harmful effect on a developing baby – it is not advisable to become pregnant or father a child whilst having this treatment. Discuss contraception with your doctor or nurse
• Your urine may become pink or red for one or two days after treatment with doxorubicin, which is not harmful
• 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, stomach pains or discomfort
• A change in blood sugar levels – tell your doctor 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 from doxorubicin and cyclophosphamide, which is usually temporary but for a small number of people it may be permanent – your doctor will check your heart before and after your treatment
• Diarrhoea
• Reddening of the skin in areas where you have had radiotherapy in the past, and the skin may get dry and flaky and feel sore and hot – this goes away on its 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 immediately

Fewer than 1 in 100 people have these effects.

• There is a small risk of developing another cancer in the future after CHOP treatment
• Changes in lung tissue – tell your doctor or nurse if you have a cough or breathlessness

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

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring for advice or reassurance if you have any questions or problems.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.