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R-CVP

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

  • R – rituximab (Mabthera), a targeted cancer drug
  • C – cyclophosphamide, a chemotherapy drug
  • V – vincristine, a chemotherapy drug
  • P – prednisolone, a steroid

How R-CVP works

These cancer drugs destroy quickly dividing cells, such as cancer cells.

How you have R-CVP

You have the drugs into your bloodstream (intravenously). 

Prednisolone is a steroid, you take this as a tablet.

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.

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 R-CVP

You usually have R-CVP as cycles of treatment. You have between 6 and 8 cycles. Each cycle lasts 3 weeks and you have it in the following way.

Day 1
  • Rituximab as 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 vein or as a drip over 30 minutes.
  • Prednisolone as tablets. You take it for 5 days. After the first dose you take the rest at home.
Days 2 to 5
  • Continue taking prednisolone tablets.

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).

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 (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. 

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 petechia).

Tiredness and weakness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

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.

Hair loss

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. 

Inflammation of the bladder and blood in the urine 

You might have pain when you pass urine. Or you may see blood when you pass urine. This is caused by inflammation of the bladder. Let your doctor know if this happens. 

You should drink 8 to 12 cups of fluid a day to try to prevent this.

Allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction. Tell your nurse or doctor immediately if at any time you feel unwell. They will slow or stop your drip for a while.

General swelling

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.

High temperature (fever)

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

Headache

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Skin changes

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.

Occasional side effects

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

  • sore mouth and ulcers - keep your mouth and teeth clean and drink plenty of fluids
  • a change to the way your liver works that are usually mild and not likely to cause symptoms
  • a high level of sugar in your blood
  • weight loss
  • an increase in a certain type of fat called LDH in your blood
  • a low level of calcium in your blood
  • tingling or prickling (pins and needles) in your hands and feet and a reduced sense of touch
  • feeling agitated and anxious or depressed
  • difficulty getting to sleep
  • widening of the blood vessels causing low blood pressure and flushing of the skin
  • dizziness
  • eye problems such a dry, watery or itchy eyes
  • ringing in the ear (tinnitus) and ear pain
  • changes to the heart such as a high heart beat and a heart attack
  • high blood pressure
  • shortness of breath
  • chest pain
  • runny nose
  • diarrhoea or constipation
  • tummy (abdominal) pain
  • difficulty swallowing or throat irritation
  • indigestion and heart burn
  • loss of appetite
  • hives
  • increase in sweating or night sweats
  • sore muscles, sore joints and a loss of muscle strength
  • back, neck, general pain and pain 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

Rare side effects

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

  • deafness
  • nerve damage causing pain
  • problems with the way your blood clots
  • enlarged lymph nodes
  • taste changes
  • slow heart rate
  • lung changes causing asthma and a low level of oxygen in the blood

Other side effects

For more information about the side effects of individual drugs:

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 this drug. 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.

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.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into 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)
  • 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. You should do so for 2 weeks following their vaccination if you have a severely weakened immune system.

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