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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
  • Hodgkin lymphoma that got worse during or after treatment

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 2 to 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

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Risk of bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Mouth sores and ulcers 

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Sore anus 

Your anus could become inflamed, sore and develop ulcers. This can be painful. Contact your advice line or talk to your doctor or nurse if this happens. 

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Changes to how your liver works

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Cytarabine syndrome

This can happen about 6 to 12 hours after having cytarabine.

It is a combination of symptoms including a high temperature, aching muscles, bone pain, occasionally chest pain, a rash, sore eyes, and extreme weakness. You have steroids to help to prevent this syndrome. Contact your advice line or tell your doctor or nurse if this happens. 

Skin problems 

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Less common you could also get skin ulcers. 

With high dose cytarabine your skin might also peel. 

High temperature

If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Low level of sodium in the blood 

You may have changes in levels of minerals and salts in your blood, such as low sodium. This will most likely go back to normal when you finish treatment. You have regular blood tests during treatment to check this.

Feeling sleepy (drowsy)

High doses of cytarabine can make you drowsy. 

Changes to how you think and feel 

High dose cytarabine can:

  • make you feel confused
  • cause slurred speech
  • affect your level of consciousness making you sleepy or not alert

Contact your advice line or tell your doctor or nurse if you or someone else notice these changes. 

Eye problems

High dose cytarabine can cause eye problems.

You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your doctor or nurse if you have this. They can give you eye drops or other medication to help. 

Lung and breathing problems

High dose cytarabine can cause a life threatening syndrome called acute respiratory distress syndrome (ARDS). Symptoms are:

  •  severe shortness of breath
  • rapid, shallow breathing
  • tiredness, drowsiness or confusion
  • feeling faint

You might also get fluid on the lung which can cause difficulty breathing.

Contact your advice line or tell your doctor or nurse if you have any of these symptoms. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

  • infection or inflammation of the lining of the bowels causing feeling bloated, swelling of the tummy (abdomen), blood in your poo, diarrhoea, loss of appetite and being sick
  • blood clot
  • changes to your heartbeat this can be either slower or faster

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than1%). You might have one or more of them. They include:

  • an allergic reaction causing swelling of the face, difficulty breathing, wheezing, fast heart rate and low blood pressure
  • a low level of magnesium in the blood
  • hearing problems including loss of hearing

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

  • loss of appetite
  • pain, redness and inflamation at the injection site
  • dizziness
  • inflammation of the tissue surrounding the heart
  • inflammation of the veins
  • inflammation of the pancreas
  • ulcers and inflammation of the food pipe (oesophagus)
  • yellowing of the white of the eyes and skin (jaundice)
  • red, sore and peeling of the skin of the soles of the feet and palms of the hands
  • chest pain
  • not enough fluid in the body (dehydration)
  • stroke
  • sore muscles and muscle spasms

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

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.

Loss of 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 might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

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.

Immunisation

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)

Contact with others who have had immunisations - You can 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 the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

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.

Information and help