This leaflet provides information on a course of treatment called R-CHOP. The leaflet will explain what this is and when and how it is given. It will also tell you about common side effects that you may experience. Contact telephone numbers and details of how to obtain further information on R-CHOP are given at the end of the leaflet.
This leaflet should be read alongside the ‘General information for patients receiving chemotherapy’ leaflet. If you haven’t received this leaflet please ask your nurse for a copy.
What is R-CHOP treatment?
This is a treatment which consists of a combination of drugs which work in different ways to treat your cancer.
This is an artificially made antibody which attaches itself to lymphoma cancer cells. It is not chemotherapy. Mabthera helps your own immune system kill the cancer cells.
This is the R part of the treatment.
This part of the treatment consists of four drugs. There are three chemotherapy drugs which are given through a drip (infusion):
The last drug is a steroid tablet called prednisolone.
This is the CHOP part of the treatment.
Why am I having R-CHOP treatment?
Your doctor has prescribed this treatment because this combination has been found to be effective in treating your type of cancer.
How often will I receive my treatment?
For this treatment to be most effective, it is given at specific time intervals. These are known as cycles. A cycle of R-CHOP lasts for three weeks. It is usual to have between six and eight cycles. Your doctor will discuss with you the exact number of cycles you will receive.
You will be given the Mabthera and the chemotherapy drugs once every three weeks. The prednisolone tablets are given for five days, starting on the same day as the other drugs.
How long will I be in the hospital?
Your treatment will usually be on a different day to your clinic appointment.
The Mabthera treatment will take approximately 4 hours for the first treatment and 11/2 hours for following treatments.
The chemotherapy treatment will take about 30 minutes.
Can I bring relatives and friends with me?
You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person. Treatment areas are not suitable for young children.
How is the Mabthera given?
Before your Mabthera is started we will give you paracetamol and drugs called piriton (chlorpheramine) and hydrocortisone. These are given to prevent the side effects which can occur during the treatment.
The first Mabthera is given through a drip into a vein in the back of your hand or arm. Alternatively it may be suggested that a fine tube called a PICC is inserted into one of the large veins in your upper arm. This line can remain in place for the whole course of your treatment. Your doctor or nurse will discuss this further with you.
We have a leaflet that tells you more about PICC lines. Please ask if you would like a copy.
If the Mabthera is fully administered on the first day, you may have the Mabthera administered as an injection into your stomach for the rest of the treatments. This will involve an injection over 5 minutes followed by 15 minutes observation. If it is not fully administered on the first day you will continue to receive mabthera through the vein over approximately 90 minutes for your next treatments.
What are the side effects of Mabthera treatment?
Reactions during the treatment
Most side effects which can occur with Mabthera occur while the drug is infusing. This is why the first treatment is given more slowly. We will monitor you closely during the treatment. This will include having your temperature and blood pressure checked regularly.
If you experience any of the following during the treatment please tell your nurse straight away:
If any of these occur we will slow down or stop the Mabthera until you feel better. The treatment can then start again, usually without any further problems. If you have problems on the first treatment you will continue to have Mabthera through a drip rather than as an injection into your stomach.
Side effects following treatment
You may suffer from tiredness, headaches or dizziness. Please tell your doctor at your next clinic visit if these are a problem for you. You should not drive on the day of treatment or while you are affected by these side effects.
How will my chemotherapy be given?
Before your chemotherapy we will give you the prednisolone tablets and some anti sickness tablets. There are 20 small prednisolone tablets.
The chemotherapy will be given through the drip.
What are the possible side effects with CHOP chemotherapy?
There are a number of possible side effects which can occur with this chemotherapy. The doctor, nurses and pharmacists can give you advice or answer any questions you may have.
Unfortunately you will lose your hair with this chemotherapy. This is only temporary. Your hair will grow back when your treatment has finished. We can arrange a wig if you would like one, please ask your nurse for more information.
We have a leaflet that tells you more about coping with hair loss. Please ask your nurse for a copy.
Nausea and vomiting are uncommon these days as we will give you anti-sickness medicines which are usually extremely effective. If you are sick more than once in 24 hours despite taking regular anti-sickness medicine when you are at home after your chemotherapy treatment, contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.
If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening.
Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade. The telephone number is at the end of the leaflet.
Diarrhoea is not common with this chemotherapy. However, if you have four or more bowel movements in 24 hours above what is normal for you please contact Velindre Cancer Centre immediately. The telephone number is on page 9.
Tiredness and fatigue
Chemotherapy can make you feel more tired than usual. It is important to listen to your body and rest if you need to, but carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as taking rest.
Your mouth may become sore or you may notice small ulcers. Please follow the advice on caring for your mouth in the general chemotherapy leaflet. Your doctor may prescribe mouthwashes or medication to prevent or clear any infection.
Effects on your nerves
Vincristine can affect the nerves in your fingers and toes giving the feeling of numbness or pins and needles. The nerves to your bowel may also be affected. This may result in constipation. Some patients may also have jaw pain or headaches if the nerves to the head are affected. If you develop any of these problems please tell your doctor or nurse at your next visit to clinic.
Skin and tissue damage
Some chemotherapy drugs may damage the skin and surrounding area if they leak outside of your vein. This is known as extravasation. It is extremely rare but it is important that you tell us immediately if you notice any pain or burning at the site of the drip. If this occurs whilst the chemotherapy is being given, tell your nurse. If you notice pain, swelling or redness when you’re at home please contact us immediately (The telephone number is at the end of the leaflet).
Patients may receive reactions at the site of the mabthera injection in the stomach, such as redness, soreness or bruising, if this occurs, please contact Velindre Cancer centre for advice, the telephone number is at the end of the leaflet.
Some patients may also develop a rash. Usually this can be easily treated with some non perfumed cream or lotion. If the lotion does not help the rash then telephone Velindre Cancer Centre immediately for advice. The telephone number is at the end of the leaflet.
Mabthera may reduce the production of platelets (which help the blood to clot). This will increase your risk of bruising or bleeding. If you notice any bruising on your body or bleeding such as nosebleeds or bleeding from your gums you should contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further. It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.
Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.
Other side effects
Doxorubicin and rarely mabthera may occasionally cause heart problems. If you have a heart condition or you take any heart medication, please tell your doctor before you start chemotherapy.
Doxorubicin will harmlessly colour your urine red. If this lasts longer than 24 hours please contact Velindre Cancer Centre. The telephone number is at the end of the leaflet.
Women sometimes find that chemotherapy treatment affects their periods. They could become heavier, lighter or even stop altogether.
It is important you do not become pregnant or father a child whilst having chemotherapy treatment as chemotherapy could damage the unborn baby.
Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.
Manufacturer’s patient information leaflets
Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at www.medicines.org.uk. Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy
Contact telephone numbers
Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night. For example you should phone if you:
Pharmacy department 029 2061 5888 ext 6223
Monday – Friday 9am – 5pm for queries about your medicines
Tenovus freephone 0808 808 1010
7 days a week 8am – 8pm for general queries on cancer
This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.