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DHAP

Find out what the cancer drug combination DHAP is, how you have it and other important information about having DHAP.

DHAP is the name of a cancer drug combination. It includes the drugs:

  • D – dexamethasone, which is a steroid
  • HA – high dose Ara C, also known as cytarabine
  • P – cisplatin

It is a treatment for:

  • high grade non-Hodgkin lymphoma that has come back
  • Hodgkin lymphoma that has come back

How DHAP works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells. Dexamethasone is a steroid and can help the chemotherapy to work better.

How you have it

Ara C and cisplatin are clear fluids and you have them into your bloodstream (intravenously).

You usually have the steroid drug dexamethasone as daily tablets (orally) but you may have it into your bloodstream instead. 

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have it

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

You have each cycle of treatment in the following way:

Day 1
  • You have cisplatin as a drip into your vein (intravenously) for up to 24 hours
  • You start taking dexamethasone tablets or have dexamethasone into your vein
Day 2
  • You have cytarabine (Ara C) as a drip into your vein, twice. Each drip lasts for 3 hours and you have them 12 hours apart
  • You take dexamethasone tablets or have dexamethasone into your vein

If you have the dexamethasone as tablets you will be able to go home and carry on taking the tablets at home. If you have the dexamethasone into your vein, you will need to go back to the hospital for 2 more days.

Day 3 and 4
  • You take dexamethasone tablets or have dexamethasone into your vein
Day 5 to 21
  • You have no treatment

You then start the next cycle.

Drugs to help with the side effects

You have fluids (hydration) into your vein 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. You may also take a drug called allopurinol on your first cycle of treatment. This is to help keep the levels of uric acid in your blood stable. 

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

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Important information

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
08 Jan 2018
  • Electronic Medicines Compendium 

    Accessed January 2018

  • Handbook of Cancer Chemotherapy (8th edition)

    Roland K Keel

    Lippincott, Williams and Wilkins, 2012

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination

    Public Health England

    First published: March 2013 and regularly updated on the Gov.UK website

  • DHAP +/- R (dexamethasone, cytarabine, cisplatin +/- rituximab) for relapsed / refractory Lymphoma

    South East London Cancer Network, 2012

  • Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin's disease.

    A Josting and others

    Annals of Oncology, 2002. Vol 13, issue 10, pages 1628-1635

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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