R-CHOP

R-CHOP is the name of a chemotherapy treatment used to treat non Hodgkin's lymphoma. R-CHOP is the CHOP chemotherapy regime with the drug rituximab. Rituximab is a type of biological therapy. The CHOP regime is

• C = Cyclophosphamide
• H = Doxorubicin hydrochloride
• O = Vincristine (used to be called Oncovin)
• P = Prednisolone

You can click on the links to find out the side effects of each individual drug.

Rituximab is a type of biological therapy drug called a monoclonal antibody. Monoclonal antibodies target proteins on the surface of cells. Rituximab targets a protein known as CD20. CD20 is found on B cells. It is the B cells that are cancerous in the most common type of non Hodgkin’s lymphoma. Rituximab attaches itself to the B cells and marks them. The cells of the immune system recognise the marked cells and kill them.

You usually have chemotherapy in cycles of treatment. For R-CHOP, this is usually 3 week cycles (every 21 days). A usual course of treatment consists of between 3 and 8 cycles.

Some people may have R-CHOP over 2 weeks. You have the drugs in exactly the same way, but with less of a break between treatments. Doctors call treatment over 2 weeks R-CHOP14. Treatment over 3 weeks is called R-CHOP21.

On the first day of each cycle (day 1) you have the following drugs (as injections into a vein or through a drip)

• Rituximab
• Cyclophosphamide
• Vincristine
• Doxorubicin

And you have prednisolone (steroid) tablets to take at home on days 1 to 5. The side effects of a combination of drugs are usually a mixture of the side effects of each drug. You may get one or two or a few of the side effects.

The side effects associated with R-CHOP are listed below. You can use the links (underlined) to find out more about each side effect. Or you can go to the cancer drug side effects 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

• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal after 6 months to a year
• A reaction to rituximab while the drug is being given – this causes 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, 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
• Feeling or being sick is usually well controlled with anti sickness medicines
• Hair loss or thinning
• 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 effects
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
• Women may stop having periods (amenorrhoea) – this may only be temporary
• R-CHOP 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
• Your urine may become pink or red for one or two days after treatment with doxorubicin (this is not harmful)
• Mouth sores and mouth ulcers
• Appetite changes – you may lose your appetite or the steroids may boost your appetite and make you put on weight
• Skin changes – your skin may darken, you may have an itchy rash or become sensitive to sunlight. Use a high factor sun cream and cover up when you go out
• Indigestion, stomach pains or discomfort
• Change in blood sugar levels – tell your doctor if you get very thirsty or if you are passing more urine than usual
• A puffy face and ankles from fluid buildup
• Difficulty in sleeping and mood swings – taking the steroids early in the day can reduce this
• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your doctor or chemotherapy nurse immediately

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

• Allergic reactions to doxorubicin affects 3 people in 100 (3%) – this causes a sudden rash of pink, itchy bumps on your skin and reddening of the skin along the vein. This should clear up within a few days
• Burning, stinging or pain on passing urine (cystitis) – if you see blood in your urine contact your doctor straight away
• Temporary taste changes
• Your nails may darken or become ridged or white lines may appear on them
• Changes to the muscles of your heart may occur with high doses of cyclophosphamide and doxorubicin
• Diarrhoea
• Areas of skin that have been treated with radiotherapy may get red or sore, or the skin over your drug injection site may become discoloured

Fewer than 1 in 100 people have these.

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

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 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.