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R-CHOP cancer treatment

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was reviewed on June 14, 2022.

The standard treatment for the most common type of non-Hodgkin lymphoma goes by the name R-CHOP. It’s an acronym for a combination of three chemotherapy drugs given along with a monoclonal antibody and a steroid. Some other lymphomas are also treated with R-CHOP.

What it is and how it works

Each of the letters in R-CHOP stands for one of the drugs:

R: Rituximab is a monoclonal antibody, which is a man-made protein that’s been engineered to find cancer cells and help the immune system destroy them. It does that by attaching to a specific protein, or antigen, called CD20. This antigen is found on the surface of B cells, white blood cells or lymphocytes that are part of the body’s immune system. When rituximab binds to CD20, it makes the immune system attack the cancerous B cells.

C: Cyclophosphamide is a chemotherapy drug that stops or slows down the growth of cancer cells. It’s a type of drug known as an alkylating agent that works by damaging the DNA of cancer cells.

H: Hydroxydaunorubicin hydrochloride (doxorubicin hydrochloride or Adriamycin®) is a chemotherapy drug that stops or slows down the growth of cancer cells by blocking an enzyme that the cancer cells need to make more copies of themselves..

O: Oncovin® (vincristine) is a chemotherapy drug that stops or slows down the growth of cancer cells by stopping the cells from dividing and making new cells. It’s a type of drug known as a vinca alkaloid.

P: Prednisone is a corticosteroid (often just called a steroid) used to treat many conditions, including easing cancer symptoms. It affects the immune system and helps reduce inflammation. It may also be used to help reduce potential side effects like nausea, vomiting and low platelet counts.

All the medicines in R-CHOP except prednisone are given by infusion. Your care team will give you the drugs through an IV; a central line, which goes into a vein near your heart; or a PICC line. It often takes several hours to receive the treatment. You can take prednisone as a pill or tablet, at home.

What R-CHOP is used for

Doctors use R-CHOP to treat non-Hodgkin lymphomas that begin in B cells, including diffuse large B-cell lymphoma (DLBCL), Waldenstrom macroglobulinemia and as an initial treatment for advanced follicular lymphoma. It’s also used for other forms of cancer, or in combination with other cancer drugs and treatments.

R-CHOP is the standard treatment for diffuse large B-cell lymphoma, the most common type of lymphoma. This cancer tends to be aggressive, meaning it grows quickly.

Another lymphoma treated with R-CHOP is primary mediastinal B-cell lymphoma, which develops between the lungs. Often, treatment begins with R-CHOP, sometimes followed by radiation therapy.

What to expect

Chemotherapy is typically given in cycles. You may get treatment on one day, followed by days of rest to let your body recover. R-CHOP is often given in cycles spaced three weeks apart, but your doctor will decide how often and for how long you’ll get R-CHOP. It depends on the type of cancer, how far it’s spread and other factors like your overall health. Doctors use stages to indicate how far lymphoma has spread.

  • Stage 1: Lymphoma in a single area of lymph nodes or lymphoid organ, which includes your bone marrow, thymus gland, tonsils and spleen.
  • Stage 2: Lymphoma in two or more groups of lymph nodes on the same side of the diaphragm (a large muscle below your lungs that helps you breathe), or in a group of lymph nodes and one neighboring organ.
  • Stage 3: Lymphoma in lymph nodes both above and below the diaphragm or in lymph nodes above the diaphragm and also in the spleen.
  • Stage 4: Lymphoma has spread to bone marrow or one or more organs outside the lymphatic system.

R-CHOP regimen for stage 1 or 2 cancers

Patients with stage 1 or stage 2 lymphoma may receive three to six cycles of R-CHOP, sometimes followed by radiation therapy.

R-CHOP regimen for stage 1 or 2 cancers

Patients with stage 3 or stage 4 cancers may get six cycles. After a few cycles, your oncologist may order positron emission tomography (PET) or computed tomography (CT) scans to see whether lymphoma is responding to the medications. Young patients with a high risk of relapse may get high-dose chemotherapy and a stem cell transplant after R-CHOP. Those with an increased risk of lymphoma spreading to tissue around the brain and spinal cord may receive chemotherapy through an injection into the spinal fluid or a drug called methotrexate given intravenously.

R-miniCHOP

Doctors may reduce the dose for patients in their mid-70s and 80s. This is known as R-miniCHOP. Studies have shown reduced dosing to be an effective and safe therapy for elderly patients with a diagnosis of DLBCL and high-grade follicular lymphoma (FL). The idea of the reduced dose is to enhance treatment while reducing its toxicity. Studies show that older patients on a reduced dose are less likely to experience a disease relapse. However, further studies are needed to determine exactly what dose intensity of R-CHOP is necessary in different ages of men.

How to prepare for R-CHOP treatment

Make arrangements for someone to drive you to and from your R-CHOP appointments, and check ahead to see whether he or she is allowed to come in with you while you undergo treatment.

You’ll spend some time waiting before and after your treatment, and the infusion itself takes a while. Having something to read or some music to listen to will help pass the time. The day of your appointment, drink plenty of water and wear clothing that allows easy access to your arm for an IV line, or to your port, if you have one surgically implanted on your chest or arm. Unless your doctor tells you otherwise, you may want to eat a light meal a few hours before your appointment.

During each cycle, you’ll receive each of the drugs intravenously (IV) except for prednisone, which you’ll take a few days after your appointment, at home. Cycles are usually 21 days apart, but can be 14 days apart. The first appointment often takes longer than the others.

At these appointments, you may have blood drawn and have a brief exam and discussion with members of your care team. You may be given medicine before the infusion to help reduce side effects, such as nausea. Afterward, you may stay at the infusion center for a short time in case you experience any immediate side effects.

Benefits of R-CHOP treatment

R-CHOP is considered one of the most promising treatments for diffuse large B-cell lymphoma, with about 50 to 70 percent of patients having subsequent scans show no evidence of disease. Patients with early-stage cancer and who have a lower score for several specific risk factors tend to see better results with treatment, according to the American Cancer Society.

R-CHOP treatment side effects

Chemotherapy drugs kill cancer cells, but they also damage healthy cells, which causes side effects. Each patient reacts differently to treatment, but some common side effects of R-CHOP include:

  • Fatigue
  • Poor appetite
  • Nausea and vomiting
  • Weight loss
  • Bruising and bleeding
  • Anemia
  • Raised risk of infection
  • Skin rashes and itching
  • Hair loss
  • Mouth sores
  • Swelling

Side effects that are less common may include:

  • Muscle or nerve pain
  • Night sweats
  • Mood/mental changes
  • Low blood pressure
  • Hives
  • Problems with liver or kidney function

Side effects usually go away after a while. Your medical team can help you manage any concerning or disruptive side effects.

One of the drugs in R-CHOP, doxorubicin, may damage the heart. If you have heart-related conditions, your oncologist may recommend another chemotherapy regimen.

Rituximab may cause allergic reactions in some people. Most reactions are mild and tend to happen with the first dose, then improve with successive doses. Your medical team will monitor you while you’re undergoing the infusion, so they can respond to any reactions that may occur. In rare cases when hypersensitivity develops, the drug would be discontinued.

Sometimes, though rare, R-CHOP kills cancer cells so quickly that the body can’t remove all the substances that are left when these cells break down. When the substances enter the bloodstream, they cause potassium, phosphorus and uric acid levels to spike and calcium levels to drop. This condition, called tumor lysis syndrome (TLS), may harm the kidneys and cause muscle cramps, irregular heartbeat and seizures. Your medical team will check your risk for TLS and take precautions to avoid it.

Results from R-CHOP treatment

Many things affect how well R-CHOP will work, including the stage of the cancer. About 50 to 70 percent of patients with diffuse large B-cell lymphoma may respond well to R-CHOP treatment, according to a December 2016 review in Hematology. Among those who don’t experience positive results, about 20 percent see their cancer progress during or soon after treatment, and 30 percent relapse after having scans that show no evidence of disease.

If your cancer doesn’t respond well to R-CHOP or if it recurs, your doctor may recommend another type of chemotherapy. Other subsequent options may include a stem cell transplant (if you’re healthy enough), immunotherapy, targeted therapy or a clinical trial, if you qualify for an ongoing study.

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