DHAP

DHAP is the name of a combination of chemotherapy drugs. It is used to treat the following cancers

• High grade non Hodgkin's lymphoma that has come back
• Hodgkin’s lymphoma that has come back

It is made up of the drugs

• D – Dexamethasone, which is a steroid
• HA – High dose Ara C, also known as cytarabine
• P – Cisplatin

Ara C and cisplatin are clear fluids and 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 just before your course of treatment starts and it stays in place as long as you need it.

You usually have the steroid (dexamethasone) as daily tablets (orally) but you may have it into a vein (intravenously) instead.

You usually have DHAP chemotherapy as cycles of treatment. You may have between 2 and 6 cycles. Each cycle of treatment lasts 3 weeks.

You have each cycle of treatment in the following way.

• On the first day of treatment you have cisplatin as a drip which lasts for 24 hours. You also start taking the dexamethasone tablets for 4 days or else have dexamethasone into your drip
• On the second day you have cytarabine (Ara C) as a drip twice. Each drip lasts for 3 hours and you have them 12 hours apart
• If you have the dexamethasone as tablets you will be able to go home and carry on taking them for two more days. 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, preferably before lunch. If you have the dexamethasone into your drip you will need to go back into the hospital each day for two more days.

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

Your doctor will give you steroid eye drops to take for 5 to 7 days. The drops help to stop your eyes getting sore.

When you stop taking the dexamethasone tablets you have no treatment for just over 2 weeks. You then start the next cycle.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with DHAP are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.

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

• 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 occurs in up to 4 out of 10 people (40%) – 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

• Kidney changes – you will have regular blood tests to check how well your kidneys are working and will have fluids to flush the drugs through
• Tiredness 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 for up to a week – make sure that you drink plenty of fluid and tell your doctor or nurse if it becomes severe, or continues for more than 3 days. 1 out of 5 people (20%) have severe diarrhoea
• A sore mouth or mouth ulcers
• Loss of appetite – this is more likely if you have sickness, diarrhoea or a sore mouth
• Changes to your blood sugar levels due to dexamethasone – 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 get pregnant or father a child after treatment with these drugs. It is important to talk to your doctor about your fertility before starting treatment
• DHAP may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Sore, red eyes (conjunctivitis) can happen 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 your hands and feet
• Ringing in the ears (tinnitus) happens to about 3 in 10 people (30%) and usually gets better on its own

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. You will have regular blood tests and will be asked 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 your hands or feet usually improves a few months after the treatment finishes – occasionally, people have 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%) – this is usually mild and gets better on its own. It is more likely if you are over 40, or have liver or kidney problems
• Some people have an allergic reaction while having DHAP, usually at the first or second treatment – let your treatment team know immediately if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine

Not everyone will get these side effects. You may have 1 or 2 effects or a few. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• The way you take the drug (tablets or drip)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them.

Tell your doctor, nurse or pharmacist 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 chemotherapy or for at least 6 months afterwards. In the UK, these 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 from your chemotherapy.

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.