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R-GCVP is the name of a cancer drug combination that includes:

  • rituximab, a type of targeted cancer drug called a monoclonal antibody
  • gemcitabine, a chemotherapy drug
  • cyclophosphamide, a chemotherapy drug
  • vincristine, a chemotherapy drug
  • prednisolone, a type of steroid

It is a treatment for high grade B cell non Hodgkin lymphoma (NHL). It is used for people who have heart problems and can’t have some types of chemotherapy, such as the combination R-CHOP.

How it works

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

How you have R-GCVP

You have prednisolone as 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.   

You usually have all the other drugs into your bloodstream (intravenously).

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Taking your tablets

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

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-GCVP

You have R-GCVP as cycles of treatment. You usually have 6 cycles of treatment.

Each cycle of treatment lasts 3 weeks and is given in the following way:

Day 1
  • You have rituximab as a drip (infusion) into your bloodstream.
  • You have gemcitabine as a drip into your bloodstream for about 30 minutes.
  • You have vincristine as a short drip into your bloodstream over 5 minutes.
  • You have cyclophosphamide as a drip into your bloodstream over 30 minutes.
  • You start taking prednisolone tablets.
Days 2 to 5
  • You take prednisolone tablets.
Day 6 to 7
  • You have no treatment.
Day 8
  • You have gemcitabine as a drip into your bloodstream for about 30 minutes.
Day 9 to day 21
  • You have no treatment.

You then start the next cycle of treatment.

Allergic reaction

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 your nurse will give you paracetamol and another drug called chlorphenamine (Piriton). 

Your nurse will stop the infusion if you have a reaction. They start it again once your symptoms have reduced. If you don't have a reaction, you should be able to have further doses of rituximab at a faster rate (about 90 minutes).


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

Each of these effects happens in more than 1 in 10 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. 


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).

Allergic reaction to rituximab

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.


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.

Diarrhoea or constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

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. 

Blood or protein in your urine

Small amounts of blood and protein in your urine may be found when your nurse tests your urine. This usually goes away on its own. If there are large amounts of protein you may have tests to check how well your kidneys are working.

Skin and nail problems

Skin and nail problems include a skin rash, dry skin, itching and darker skin. Your nails may also become brittle, dry, change colour or develop ridges. This usually goes back to normal when you finish treatment.

A high temperature

You might get a high temperature (fever) for a few hours after having this treatment. Tell your doctor or nurse if you have a fever.

Numbness or tingling in fingers or toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:

  • feeling or being sick
  • indigestion or stomach pain
  • mouth sores and ulcers
  • inflammation around the drip site
  • pain when passing urine or a temporary lack of control over the bladder (incontinence)
  • taste changes
  • swelling of hands and feet due to fluid build up
  • wheeziness or breathlessness soon after treatment
  • numbness or tingling in fingers and toes
  • mood changes
  • difficulty sleeping
  • blood sugar changes

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.

  • a second cancer
  • lung problems such as cough or shortness of breath
  • changes in the way your kidneys work
  • bone and muscle pain
  • blurred or double vision
  • dizziness
  • hearing loss, especially with high pitched sounds
  • confusion, lack of energy and hallucinations

Coping with side effects

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

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

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.    


Don’t breastfeed during this treatment and for a year afterwards 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 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.

Last reviewed: 
03 Sep 2018
  • Electronic Medicines Compendium 

    Accessed February 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

  • First Analysis of a Phase II Study of Rituximab-Gemcitabine, Cyclophosphamide, Vincristine and Prednisolone (R-GCVP) for Diffuse Large B Cell Lymphoma (DLBCL) Patients Considered Unsuitable for Anthracycline Containing Chemo-Immunotherapy. An NCRI Lymphoma Clinical Studies Group Trial
    P Fields and others
    Blood, 2011. Vol 118, issue 21, page 1634

  • R-GCVP (Rituximab, Gemcitabine, Vincristine & Prednisolone) for Non-Hodgkin's Lymphoma (NHL)
    South East London Cancer Network, 2012