ESHAP

What is ESHAP?

ESHAP is the name of a cancer drug combination. You have:

E – etoposide (ee-top-o-side)

S – solu-medrone (sol-you-med-rone), also called methylprednisolone

HA – high dose cytarabine (sye-ta-ra-bin), also known as Ara C

P – cisplatin (sis-pla-tin)

It is a treatment for lymphoma and myeloma. It is usually used before having a stem cell transplant using your own stem cells (​autologous transplant​).

Read about stem cell transplants

For some types of non-Hodgkin lymphoma (NHL), you might also have ESHAP with a drug called rituximab. This is called R-ESHAP.

Find out more about R-ESHAP

How does ESHAP work?

Etoposide, cisplatin and cytarabine are chemotherapy drugs. These drugs destroy quickly dividing cells, such as cancer cells.

Methylprednisolone is a type of steroid. It treats lymphoma by stopping the cancer cells growing and killing them. It may also help you feel less sick during treatment.

How do you have ESHAP?

You usually have all drugs as a drip into your bloodstream (intravenously). In some hospitals you might take methylprednisolone as a tablet.

Drugs 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

Find out more about having drugs into your bloodstream

Taking your tablets

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

How often do you have ESHAP?

You usually have ESHAP as cycles of treatment. This means you have the drugs and then a rest to allow your body to recover. Each cycle lasts 3 weeks (21 days).

If you’re having ESHAP before a stem cell transplant you usually have between 2 and 3 cycles of treatment. 

If you’re not having a stem cell transplant you might have up to 6 cycles of treatment.

When having ESHAP in the hospital (an inpatient), you have it slightly different from how you have it in the day care unit (an outpatient).

Below is an example of one way of having ESHAP:

Day 1

• You start cisplatin as a continuous drip into your bloodstream that lasts for 4 days.

• You have etoposide as a drip into your bloodstream for 1 hour.

• You have methylprednisolone as a drip into your bloodstream for 15 to 30 minutes or you take it as a tablet.

Day 2, 3 and 4

• You continue with the cisplatin drip.

• You have etoposide as a drip into your bloodstream for 1 hour.

• You have methylprednisolone as a drip into your bloodstream for 15 to 30 minutes or you take it as a tablet.

Day 5

• You have methylprednisolone as a drip into your bloodstream for 15 to 30 minutes or you take it as a tablet.

• Your nurse disconnects the cisplatin drip.

• You have cytarabine as a drip into your bloodstream over 2 to 3 hours.

Day 6 to 21

• You have no treatment.

Then you start the next treatment cycle.

G-CSF injections

You might also have a drug called granulocyte colony stimulating factor (G-CSF). This makes your bone marrow produce white blood cells more quickly after treatment. It helps lower your risk of getting an infection.

You usually start G-CSF on day 6 of your cycle of treatment, and you have it for a few days. Your healthcare team will tell you more about this.

Find out more about G-CSF

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.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV. This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation).

What are the side effects of ESHAP?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

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

These side effects happen 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, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling 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 

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. This is known as petechiae.

Rarely you might bleed from other areas of the body. Tell your healthcare team straight away if you notice any bleeding.

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. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs 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. 

Cytarabine syndrome

Cytarabine syndrome sometimes happens about 6 to 12 hours after having this drug. 

It is a combination of symptoms including a high temperature, aching muscles, bone pain, occasionally chest pain, a rash, sore eyes, and extreme weakness. Steroids can help to prevent or treat this syndrome.

Feeling very sleepy

You might feel very tired or find you are falling asleep during the day. Do not drive or operate machinery. Let your doctor know straight away. 

Feeling generally unwell

Speak to your healthcare team if you feel generally unwell after having this treatment.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a ​stoma, you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Hearing changes

You might have some hearing loss, especially with high pitched sounds. You might also have some ringing in your ears (tinnitus). This is due to the drug cisplatin. Tell your doctor or nurse if you notice any changes.

Low levels of sodium and magnesium in your body 

You may have changes in levels of minerals and salts in your blood, such as low sodium. Rarely your levels of magnesium can drop. You may not have any symptoms with this drop and they are usually picked up on blood tests.

You have regular blood tests during treatment to check this.

Tummy (abdominal) pain 

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

Loss of appetite 

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

Constipation 

​Constipation​ is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Liver changes 

You might have liver changes that are usually mild and unlikely to cause symptoms. These changes are usually picked up on blood tests.

Let your healthcare team know if you are having the following symptoms: yellowing of the skin and white parts of the eyes; feeling or being sick; dark or tea coloured urine; pain in your tummy; rash and feeling tired and weak.

You have regular blood tests to check for any changes in the way your liver is working.

Skin changes

Skin problems include a skin rash and your skin colour might become darker. Less commonly your skin may peel, get dry, itch or you may develop a break in the skin (ulcer). This usually goes back to normal when your treatment finishes. You’ll get advice on what products you can use on your skin to help.

ESHAP can also cause a severe skin reaction, but this is rare. Symptoms usually start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish, and your eyes may be more sensitive to light. This is serious and could be life threatening.

Tell your healthcare team if you have any of these symptoms so they can give you medicines to help.

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:

• sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, a very high or very low temperature, shivering, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness

• heart problems including changes to your heart rhythm. Contact your healthcare team straight away if you feel tightness in your chest, pain in your chest, feeling lightheaded, dizzy, pain in different parts of the body, sweating or anxious attack

• acute respiratory distress syndrome (ARDS) -cytarabine can cause ARDS due to inflammation of the lungs from infection or injury. It causes a lack of oxygen to your organs such as the lungs, heart and brain. You might have symptoms that include fast and shallow breathing, tiredness, drowsiness, confusion, feeling like you will faint and shortness of breath. ARDS is life threatening call 999 or get help straight away

• dizziness

• redness, swelling and pain at the site of injection

• a second cancer such as ​leukaemia​  

• low blood pressure that can cause you to feel lightheaded or dizzy

• high blood pressure

• sore mouth inclusing mouth ulcers

• difficulty swallowing

• inflammation and ulcers at the opening of the end of the bowel (anus)

• changes to how your kidneys work which might include problems peeing

• a high temperature (fever)

• problems with your eyes including sore, red, itchy eyes, increased tears, sensitivity to light or burning pain. Tell your team if this happens

• high levels of uric acid in the blood

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

• a serious condition causing inflammation of the bowel. Symptoms might include diarrhoea, loss of appetite, being sick, swollen tummy or you might notice blood in your poo. Let your team know straight away of you have any of these symptoms

• problems with speech, walking or balance and difficulty controlling your muscles

Rare side effects

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

• numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons

• joint and muscle pain

• headaches

• bleeding

• inflammation of the food pipe (oesophagus) or ulcers in the food pipe

• changes to your taste

• seizures (fits)

• changes in the brain that are usually reversible. This can cause a sudden onset of symptoms. These include headaches, dizziness, confusion, fits (seizures) and changes to your vision

• a build up of fluid in the lungs

Coping with side effects

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

Read more about how to cope with side effects

What else do you need to know

Other medicines, foods and drinks 

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility 

You may not be able to become pregnant or get someone pregnant 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 get someone pregnant while you're having this treatment.

Women must not become pregnant for at least 7 months after the end of treatment.

Men should not get someone pregnant for at least 6 months after treatment.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. 

Breastfeeding 

Don’t breastfeed during this treatment and for 4 weeks after your last dose, because the drug may come through into your breast milk.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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, and yellow fever.

You can usually 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 a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your ​immune system​ is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

Read more about immunisations and cancer treatment

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

eMC website

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

Report a side effect to the MHRA