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R-ESHAP

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

  • R – rituximab (ri-tuk-si-mab)

  • E – etoposide (ee-top-o-side)

  • S – solu-medrone (sol-you-med-rone), you commonly hear it 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. You usually have it before having a stem cell transplant, but you might have R-ESHAP if you’re not able to have a stem cell transplant.

How does R-ESHAP work?

Rituximab is a type of targeted cancer drug called a monoclonal antibody Open a glossary item. It targets a protein called CD20 on the surface of the lymphoma cells. Rituximab sticks to all the CD20 proteins it finds. Then the cells of the immune system pick out the marked cells and kill them.

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. And help reduce your body’s immune response, to try and prevent an allergic reaction to rituximab.

How do you have R-ESHAP?

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

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

How often do you have R-ESHAP?

You usually have R-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 to 4 weeks. This depends on how quickly it takes for your blood count Open a glossary item to recover.

If you’re having R-ESHAP before a stem cell cycle 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.

Rituximab can cause an allergic reaction. So before each dose you have paracetamol, a steroid and an antihistamine drug such as chlorphenamine (Piriton).

For the first cycle of rituximab, you have it as a drip into your bloodstream slowly over a few hours. This is to prevent an allergic reaction. Your nurse will increase how fast it goes in (rate) approximately every 30 minutes if you have no allergic reaction.

Your next rituximab drip will usually go in quicker, but this will depend on how you got on with the first cycle.

When having R-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 R-ESHAP:

Day 1
  • You have rituximab as a slow drip into your bloodstream (intravenously).
  • 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.
  • You have cytarabine as a drip into your bloodstream for 2 hours.
  • You start cisplatin as a continuous drip into your bloodstream that lasts 4 days.
Days 2, 3 and 4
  • 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.
  • You continue with the cisplatin drip.
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 or 28
  • You have no treatment.

Then you start the next treatment cycle.

You also have G-CSF. This is an injection under the skin (subcutaneous). It helps your body make white blood cells Open a glossary item to lower your chance of getting an infection. You usually start this on day 6 and continue for up to 10 days.

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 Open a glossary item. 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 Open a glossary item and can cause the virus to become active again (reactivation). 

What are the side effects of R-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: