R-CVP

R-CVP is the name of a combination of chemotherapy drugs used to treat low grade non Hodgkin’s lymphoma. It is made up of the drugs

• R = Rituximab (Mabthera), which is a monoclonal antibody
• C = Cyclophosphamide (a chemotherapy drug)
• V = Vincristine (a chemotherapy drug)
• P = Prednisolone, which is a steroid

You have prednisolone as tablets.

You have the other 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, central vein in your chest. You have them put in just before your course of treatment starts and they stay in place as long as you need them.

You usually have chemotherapy as cycles of treatment. You have between 6 and 8 cycles of R-CVP. Each cycle of treatment lasts 3 weeks and is given 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 a tablet. 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).

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 R-CVP 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
• 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

• 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 doctor 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 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%) but 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
• R–CVP 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
• 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 this drug. Talk to your doctor before starting treatment if having a baby is important to you
• Feeling weak happens in about 1 in 4 people (25%)
• Night sweats occur in about 3 in 20 people (15%)
• A runny nose may occur, but is usually mild and goes away within an hour of the drip ending
• Indigestion, stomach pains or discomfort
• A change in blood sugar levels – tell your doctor if you get very thirsty or if you are passing more urine than usual

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 chemotherapy nurse immediately
• 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 through your cannula or central line too
• Mild effect on the liver that is unlikely to cause any symptoms – it will almost certainly go back to normal when the treatment ends but you will have regular blood tests to check how well your liver is working

Fewer than 1 in 100 people have these.

• There is a small risk that you may get a second cancer some years after R-CVP treatment.
• Lung changes may lead to a cough or breathlessness.
• A build up of fluid may cause swelling in the legs and feet.
• Cramps
• Poor balance and staggering
• Bone pain
• Blurred or double vision
• Hearing loss or dizziness
• Confusion
• Depression
• Hallucinations
• Trouble sleeping

Not everyone will get these side effects. You may have 1 or 2 or several. 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.