R-CHOP

What is R-CHOP?

R-CHOP is a cancer treatment regimen that uses a combination of five drugs to treat non-Hodgkin lymphoma. Treatment includes three chemotherapy drugs, a targeted therapy drug and a corticosteroid (steroid).

Each letter in “R-CHOP” stands for a drug used for treatment:

• R: Rituximab is a targeted therapy drug that attaches to a protein on cancer cells. Once rituximab attaches, your immune system can find and destroy the cells.
• C: Cyclophosphamide is a chemotherapy drug. Chemotherapy drugs destroy fast-growing cells, like cancer cells.
• H: Doxorubicin hydrochloride (Hydroxydaunomycin) is a chemotherapy drug.
• O: Vincristine sulfate (Oncovin) is a chemotherapy drug.
• P: Prednisone is a corticosteroid (steroid). It kills cancer cells and can help prevent allergic reactions to the other R-CHOP drugs.

As most of the drugs are chemotherapy medications, some providers call this treatment “R-CHOP chemotherapy” or “R-CHOP chemo.” But R-CHOP also involves a targeted therapy drug (Rituximab) that helps your immune system kill cancer cells. For this reason, your provider may call R-CHOP “immunochemotherapy.”

What conditions are treated with R-CHOP?

Healthcare providers use R-CHOP to treat non-Hodgkin lymphoma, including the most common type, diffuse large B-cell lymphoma (DLBCL). Other types of non-Hodgkin lymphoma treated with R-CHOP include:

• Advanced follicular lymphoma.
• Mantle cell lymphoma.
• Waldenstrom macroglobulinemia.

Your provider may recommend R-CHOP alongside treatments for other cancer types.

What happens during R-CHOP treatment?

You’ll receive R-CHOP in cycles. The typical cycle for R-CHOP treatment is three weeks (21 days). Cycles include:

• Treatment days, where you get the medicine.
• Rest days, so your body can recuperate before the next cycle.

Treatment days

You’ll receive medicine for five days.

Prednisone (the steroid) is a pill you take by mouth. For the other medicines, you’ll need to visit a hospital or clinic to get an intravenous infusion (IV) that sends the drugs to your bloodstream. For the infusion, you’ll sit in a chair while a machine sends the medicine through a plastic line into a vein. The vein may be in your arm, hand or chest. For infusions in your chest, you may need an implantable disc called a port-a-cath, also known as a chemo port.

The first R-CHOP treatment cycle goes like this:

You’ll receive medications to prevent nausea during your infusion. You’ll also receive antihistamines to prevent allergic reactions. It’s common to have a mild reaction to rituximab (feeling a little light-headed or flushed) during an infusion, but the medicine usually prevents serious reactions.

Rest days

For a typical R-CHOP cycle, you’ll need 16 days to give your body time to heal following the drug treatments. R-CHOP kills cancer cells, and this work takes a toll on your body. It’s normal to feel exhausted afterward. You may need to reach out to loved ones for help with everyday tasks during your rest days.

During rest days, if you have the energy, your healthcare provider may recommend that you do light activities, like walking or jogging. They may remind you to drink plenty of fluids and eat healthy foods.

How long will I need this treatment?

Most people treated receive six cycles of R-CHOP. Each cycle lasts three weeks (18 weeks total). But the number of R-CHOP cycles you need depends on your diagnosis. For example, some people need eight cycles of R-CHOP instead of six. Some providers recommend R-CHOP cycles that last two weeks instead of three.

Your healthcare provider will explain the R-CHOP treatment regimen you need.

What are the potential benefits of this treatment?

All the drugs that are part of R-CHOP destroy cancer cells. But they all work in different ways. So, instead of having a single cancer fighter, with R-CHOP, you have an entire cancer-fighting force.

The success rate of R-CHOP is excellent. Up to 70% of people diagnosed with diffuse large B-cell lymphoma (DLBCL) go into complete remission (no signs or symptoms of cancer) and remain that way at the five-year follow-up mark. Most people with no signs of cancer within five years of diagnosis typically remain cancer-free.

It doesn’t always get rid of the cancer or prevent it from coming back for everyone. Still, R-CHOP has a reliable track record of being both a safe and effective treatment for non-Hodgkin lymphoma.

What are the risks or complications of R-CHOP?

Your healthcare provider will give you medications to prevent the most common side effects (like nausea) and counteract major issues (like low white blood cell counts). But as with any treatment, there are risks you should discuss with your provider before starting R-CHOP.

Infusion reactions

Many people have mild reactions to rituximab during the first R-CHOP cycle. This is why providers administer it so slowly at first — to give your body time to adjust to the medicine. Feeling light-headed or warm is common and usually passes. But you may need emergency treatment if the rituximab causes symptoms of a severe reaction, like:

• A rash.
• Itching.
• Swelling in your mouth or lips.
• Your throat closing up.

Your provider will monitor you to ensure your safety during the infusion, but you should seek emergency care if you notice these symptoms afterward.

Side effects

Each drug that’s a part of R-CHOP carries a risk of side effects. Everyone’s experience is different, so there’s no way to predict which ones you may experience. Talk with your provider beforehand about what side effects to expect.

Common side effects of R-CHOP include:

• Reddish or pink urine (pee). The doxorubicin hydrochloride is red, and you’ll probably pee it out over the next 48 hours after your infusion. This is normal and nothing to worry about.
• Nausea and vomiting. Even with anti-nausea medicines, you still may experience nausea. In addition to taking anti-nausea medicines as prescribed, avoid things that may make you queasy, like eating large (especially fatty or spicy) meals.
• Hair loss. Hair loss is one of many common chemotherapy side effects. Most people start to lose hair within three weeks of the first infusion. It usually grows back after R-CHOP treatment.
• Feeling chilled and feverish. The chemotherapy drugs reduce your white blood cells, leaving you more susceptible to an infection. You’ll get G-CSF shots that help your body make more white blood cells to give your immune system a boost. Still, contact your provider immediately if you have a fever.
• Feeling extremely tired. R-CHOP treatment can cause low red blood cells (anemia). If you’re feeling fatigue set in, it’s a good idea to get help with everyday tasks. In the meantime, try to get moderate exercise (about 30 minutes) daily, but don’t overdo it. If you’re feeling tired, rest.
• Bleeding and bruising more easily. R-CHOP treatment can leave you with low platelets. This means you’ll bleed more easily. You should take extra precautions to avoid injuries. In the meantime, let your provider know if you’re bleeding more or showing signs of bruising.
• Tingling or numbness in your hands or feet. You may notice signs of peripheral neuropathy, like tingling, numbness or even a burning sensation in your hands or feet. Contact your provider if you’re experiencing symptoms.

There are several other side effects of R-CHOP, including (but not limited to):

• Rash.
• Mouth sores.
• Headache.
• Constipation.
• Diarrhea.
• Heartburn.
• Muscle weakness.
• Trouble sleeping.
• Mood changes.
• Irregular heartbeat.
• Retained water and unexplained weight gain.
• Having to pee more or a burning feeling when you pee (signs of bladder inflammation).

Long-term effects of R-CHOP

Most side effects go away in time after you finish treatment.

But depending on things like how strong your dose is, R-CHOP may increase your risk of heart problems or developing other types of cancer in the future. It can also impact fertility, when you’re unable to get pregnant or impregnate someone.

Discuss these risks with your healthcare provider beforehand. You can discuss fertility preservation options, like freezing your eggs or sperm, if you’d like to try for a baby at some point after R-CHOP treatment.

What can I do to make this treatment easier on me?

The best thing you can do to make treatment easier is to be informed about what to expect.

Talk to your healthcare provider about what side effects to expect and how to cope if you start to notice signs of them. Ask them to connect you with support groups of other people with lymphoma who are getting R-CHOP. Being able to share your experience with others who can relate to your experience is one of the best ways to get through cancer treatment.

When should I call my healthcare provider?

Contact your provider if you have new or worsening symptoms during R-CHOP treatment. Let them know immediately if you have a fever.

Go to the ER immediately if you’re experiencing signs of an emergency, like difficulty breathing or sudden chest pain.

What’s the difference between R-CHOP and CHOP chemotherapy?

R-CHOP cancer treatment is an improvement on CHOP chemotherapy. CHOP was developed in the early 1990s. It quickly became the standard in treating and even curing non-Hodgkin lymphoma.

In the early 2000s, cancer researchers added the targeted therapy drug rituximab to the CHOP regimen. R-CHOP further improved the cure rate for non-Hodgkin lymphoma and has replaced CHOP chemotherapy as the most effective treatment for non-Hodgkin lymphoma.