ESHAP

ESHAP is the name of a combination of chemotherapy drugs used to treat Hodgkin’s lymphoma and non Hodgkin’s lymphoma (NHL). You may have it before going on to have 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 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 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 cycle of treatment in the following way. On the first 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 two hours
• Cisplatin as a drip continuing for 4 days

On the second day you

• Continue with your cisplatin
• Repeat the etoposide and methylprednisolone drips

On days 3 and 4 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 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.

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 ESHAP 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.

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. This drop in white blood cells happens in 1 out of 4 people (25%)
• 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, 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

• Fatigue that may continue after treatment has finished – 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 regular blood tests to check how well your kidneys are working and 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 (conjunctivitis) can happen because cytarabine is removed from your body (excreted) in your tears – you 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
• ESHAP may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Loss of fertility – these drugs may stop you from being able to have a child in the future so do talk with your doctor before starting treatment if having a baby is important to you

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

• Numbness or tingling in hands or feet – this usually improves a few months after the treatment finishes. but occasionally there may be some 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 have skin rashes and itching, feel hot, shivery, go red in the face, feel dizzy, have a headache, feel breathless, anxious, or suddenly need to pass urine.
• A skin rash
• A sore mouth
• Mood changes
• Indigestion
• Diarrhoea or constipation
• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working

A very small number of people have a second cancer some years after ESHAP treatment.

You will not get all these side effects and those that you have may be mild. 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)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. Your nurse will give you a contact number. You can ring them if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other 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, 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.

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.