R-CHOP is a cancer drug combination. It includes:
- R - rituximab
- C – cyclophosphamide
- H – doxorubicin hydrochloride
- O – vincristine (which used to be called Oncovin)
- P – prednisolone (a steroid)
It is a treatment for non-Hodgkin lymphoma. It is also a treatment for a rare type of Hodgkin lymphoma called nodular lymphocyte predominat Hodgkin lymphoma (NLPHL).
How R-CHOP works
These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.
Rituximab is a type of targeted cancer 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 white blood cells called B cells. It is the B cells that are cancerous in the most common type of non-Hodgkin lymphoma.
Rituximab attaches itself to the B cells and marks them. The cells of the immune system recognise the marked cells and kill them.
How you have R-CHOP
You have the drugs into your bloodstream (intravenously).
Prednisolone is a steroid. You take this as a tablet in the morning after food.
Into your bloodstream
You can have the drug through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have it through a long line: a central line, a PICC line or a portacath.
These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.
An injection under your skin
You usually have injections under the skin (subcutaneous injection) into the stomach, thigh or top of your arm.
You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.
Taking your tablets
You should take the right dose, not more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
When you have R-CHOP
You usually have R-CHOP in cycles of treatment over 3 weeks. A usual course of treatment consists of between 3 and 8 cycles so it can last from 9 to 24 weeks.
Some people have an allergic reaction to rituximab. This can cause flu like symptoms such as fever and sickness. To prevent an allergic reaction you usually have the first dose of rituximab slowly over a few hours. You may also have paracetamol, steroids and an antihistamine drug before the treatment.
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 you have the following drugs:
You have prednisolone (steroid) tablets to take at home for 5 days. Then you have a break with no treatment until the next treatment cycle starts.
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.
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.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
Common side effects
Each of these effects happens in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased 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.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
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).
Tiredness and weakness (fatigue)
Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for 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.
You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before.
Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids, avoid acidic foods such as oranges, lemons and grapefruits, and chew gum to keep the mouth moist. Tell your doctor or nurse if you have ulcers.
Loss of appetite and loss of weight
You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss.
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.
A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your doctor if this happens to you.
Red or pink urine
This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.
Occasional side effects
Each of these effects happens in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
- nerve pain - this might cause abdominal pain, tingling or numbness of the fingers or toes, jaw pain or double vision
- allergic reaction causing swelling, itching, a rash or difficulty breathing - contact your advice line straight away if this happens
- difficulty sleeping
- inflammation of the muscles
- changes to the way the liver works
- inflammation of the bladder causing blood in the urine - contact your advice line about this
- anxiety and agitation
- changes to the way your kidneys work
- dry or watery eyes
- red, sore, itchy eyes (conjunctivitis)
- ear pain or ringing in the ears (tinnitus)
- low blood pressure
- runny nose
- diarrhoea or constipation
- sore throat and, or difficulty swallowing
- sweating and, or night sweats
- loss of strength
- pain in the joints, muscles, neck, back or where the cancer is
- cold syndrome - signs of inflammation such as rash, joint pain and itchiness caused by exposure to the cold
- mood changes such as suicidal thoughts, irritability, moodiness
- delusions, hallucinations and schizophrenia becoming worse if you are or have been schizophrenic
- a change to the way your heart works
Rare side effects
Each of these effects happens in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:
- a second cancer - this might happen years after the end of treatment
- loss of hearing
- swollen tummy (abdomen)
Other side effects of prednisolone
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:
- an increase to the amount of sugar in your blood
- an increase in appetite and weight gain
- an increase in hair growth
- thinning of the skin
- a rounded, puffy face (cushiod face)
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 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.
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.
Pregnancy and contraception
This treatment may 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 at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
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.
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 one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your
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 as this is a live vaccine. 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.