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Regimen Information

For R + CHOP, including Side Effects

R + CHOP

For the treatment of Non-Hodgkin's Lymphoma

How R + CHOP chemotherapy is given and possible side effects.

R + CHOP for the treatment of Non-Hodgkin's Lymphoma

R + CHOP is the acronym for a chemotherapy regimen used in the treatment of non-hodgkin’s lymphoma.

Drugs in the R-CHOP combination:

R

= Rituximab

C

= Cyclophosphamide

H

= Doxorubicin Hydrochloride (Hydroxydaunomycin)

O

= Vincristine Sulfate (Oncovin)

P

= Prednisone

Chemotherapy is often given as a combination of drugs. Combinations usually work better than single drugs because different drugs kill cancer cells in different ways.

MOST COMMON SIDE EFFECTS OF R+ CHOP

  • Risk of Infection

  • Anemia

  • Nausea & Vomiting

  • Constipation

For more information, see the 'Expert Resources' tab below.

Community Responses

Often, the most helpful information regarding treatment side effects comes not from clinical brochures, but rather from other patients like you. We've collected the most helpful community resources to help you prepare for the side effects and coping tips for your chemotherapy regimen.

What side effects did you experience while on this medication?

The following have been voted the 3 most helpful responses to this question.

I'm bendeschaadsthinkingagain, and I'm a healthcare professional

I received 6 TX of R-CHOP. Takes about 4-5 hours every 2 weeks. Nurses were very effecient and comforting. Due to long period of 5 hr. a lunch from cafeteria was provided. The predisone was useful in giving me a ‘boost’ after each TX, however, once the prednsone wore off (about 3-5 days later I ‘crashed.’ Very tired, lethargic (doc provided small dose of ritalin daily for energy—very helpful), nausea (doc provided zofran which worked), muscle and bone pain-aches(doc provided pain meds which helped a little). Developed ‘chemo-fog’ i.e. forgetful, difficulty concentrating (nothing for this but it finally cleared after TX). Very low white blood count developed which left me open to infections (doc gave me a shot of neupogen)(avoided crowds, people with infections lot of had sanitizer…missed numerous family gatherings). Had pneumonia once and, mild cardiac toxicity (both cleared after TX completed). Heavy chills and ‘shakes’ came with TX (nothing for this except blankets). Extreme shortness of breath (cleared after TX). Could not continue working my job ( I retired). I did not lose weight as the predisone actually caused a weight gain. I was what the doctor called “an early responder” which is good. Had to budget my daily task and place myself first. I lost all of my hair (it grew back as before). Appetite was so-so with some foods tasting different and other foods causing me to vomit just from the smell. Had some mouth sores(used Biotene which helped a little). Drank lots of fluids i.e. water, gatorade etc. Wore a mask wherever I went and limited person to person contact to very brief encounters (majority of cancer pts. die from infection). I prayed and used visualization-meditation ( I had never meditated before). I will be 5 yr. cancer free November this yr. I am 63 yr of age this week. Recovery is long and takes a lot of work. Being a nurse I was not shy about asking for medications….ths is your life and your disease….claim it…own it….beat it.
You can access my journey at bendeschaadsthinking again as I kept a journal. Keep a copy of all lab work, x-rays etc as you may see other doctors. Get a second opinion.
Hope this is useful information.
Aaron

  • Thu Nov 8, 2012
Hi, I'm Rich

R+Chop x 6 doses for me for Non Hodgkins Lymphoma of the thyroid, just had #4 last Wednesday. Less side defects as I go on with the program. Prognosis is good.

After the first treatment I felt pretty awful, nauseous and poisoned. Only to be expected of course as I had indeed been poisoned. Next morning I woke with a hugely swollen neck, like a couple of lemons buried in there, and went straight to the hospital. All monitored, no problem, and the doc likes to see a reaction to the treatment anyway.

4 in. Prednisone really hacks me off, it keeps me up for the entire time I’m on it (5 days after each cycle). I end up completely wired, don’t take the car out etc, but get loads done around the house ;) After that, down to earth with a bump.

As I go on with the treatment I have some slight tingling of the fingertips, and some vision changes. Both are probably caused by the VIncristine, which has been reduced. It destroys nerve endings. Do bear in mind how chemo works. It attacks dividing cells. Thus your hair follicles, skin cells, mucous membranes (mouth to arse), white cells, platelets etc will all suffer.

Although I’m unable to work and am on the sort of income that will cost me the roof over my head as a result, I’m ok. Good doctors and nurses, good advice. Just be glad you’re getting some treatment, appreciate the daily stuff (daily!), and be glad to be alive.

  • Sun Jul 14, 2013
Hi, I'm wilhelm holly

I have Mantle Cell Lymphoma stage 4 with Mipi scale 2. I have completed 5 of 6 chemo cycles using RCHOP. the first cycle I was the weakest and had extremelynlow WBC and RBC counts. Dr. prescribed Levaquin to prevent infection. Unusually, I also developed a severe yeast infection caused by the increased glucose levels from the chemo. one pill from the doctor cured in three days, but it was very uncomfortable. before treatment I went through possible side effects with my Doctor and he prescribed preventative or propholactic medications.. I have learned not to be shy in battleing the disease or the symptoms or the side effects of treatment. I take Valtrex to prevent mouth sores, which so far I have not had, and use Biotene toothpaste, mouth spray and mouthwash. I take Emend™ on day 1,2 and 3 of chemo cycle to prevent nausea, I take zophran and compazine alternatively every 4 hours for 6 days, to prevent nausea and have had only mild nausea waves- except for my third treatment cycle. I experienced severe nausea in round three and Dr. prescribed the Sancuso™ patch to wear on my arm starting day 6 post chemo for 7 days. I have had no nausea since.
I take active culture probiotics to help with digestion, I take Nexium to help with the heartburn and reflux caused by the chemo and that has worked. I also take a mild laxative 2 times a day to manage the constipation caused by the chemo and the prednisone and the zophran- but only for 6 days. the symptoms from the nuelasta injection were the most surprising. This causes joint pain that can last for a few days. I take Claritan twice a day with two Tylenol for 7 days starting on the day of the Nuelasta injection. This helps a great deal. The Dr. recommended this course as the analgesic in the claritan reduces the joint discomfort. If the pain is too uncomfortable, I have a prescription for Hydrocodone that immediately alleviates any discomfort.
The fatigue is the most oppressive symptom from the chemo. I have learned that days 1 thru 5, because of the chemo and prednisone, I am both jumpy and fatigued. The prednisone also makes it difficult for me to sleep. But on day 6 and 7 I feel like I am crashing, barely able to stay awake or get comfortable. Days 8 thru 12 I feel very tired and lethargic. Taste for food changes, and certain smells can trigger a gag reflex. despite my best effort to avoid it, I have gained 8 pounds.
I have been fortunate to manage my low blood counts successfu

  • Fri Feb 1, 2013
Hi, I'm Rich

R+Chop x 6 doses for me for Non Hodgkins Lymphoma of the thyroid, just had #4 last Wednesday. Less side defects as I go on with the program. Prognosis is good.

After the first treatment I felt pretty awful, nauseous and poisoned. Only to be expected of course as I had indeed been poisoned. Next morning I woke with a hugely swollen neck, like a couple of lemons buried in there, and went straight to the hospital. All monitored, no problem, and the doc likes to see a reaction to the treatment anyway.

4 in. Prednisone really hacks me off, it keeps me up for the entire time I’m on it (5 days after each cycle). I end up completely wired, don’t take the car out etc, but get loads done around the house ;) After that, down to earth with a bump.

As I go on with the treatment I have some slight tingling of the fingertips, and some vision changes. Both are probably caused by the VIncristine, which has been reduced. It destroys nerve endings. Do bear in mind how chemo works. It attacks dividing cells. Thus your hair follicles, skin cells, mucous membranes (mouth to arse), white cells, platelets etc will all suffer.

Although I’m unable to work and am on the sort of income that will cost me the roof over my head as a result, I’m ok. Good doctors and nurses, good advice. Just be glad you’re getting some treatment, appreciate the daily stuff (daily!), and be glad to be alive.

  • Sun Jul 14, 2013
Hi, I'm MIRIAM E.

I have a question. I have made a mistake and took 20mg of prednisone (days 1 – 5), instead of the 80mg of prednisone!!! Should I restart and take the 60mg to compensate? Do I just wait and do it right next cycle of chemo?

  • Wed Sep 7, 2016
Hi, I'm Pipgarden

I have had 3 sessions of the R-CHOP for my Non-Hodgkins Lymphoma. I’ve been very lucky and have not experienced nausea. I have had fatigue. After this last session, the 2nd day I was severely sore on the outside of my skin. I took a Tylenol and drank lots of water and felt better the next day. Today I just feel very heavy boned.

I lost my hair after 2 1/2 weeks and have experienced a metallic taste in my mouth. After the second session i was eating all the time! This time it doesn’t seem to be so bad.

  • Tue Feb 28, 2017
Hi, I'm Allen R.

I developed neuropathy in my feet, before having the R-CHOP as a side effect of taking an immunosupressant drug called tacrolimus to protect my transplanted liver. I understand the R-CHOP exacerbated the problems with the neuropathy. I can no longer drive. I also understand chemotherapy continues as a residue in my tissues beyond the chemo treatments. Should I expect the neuropathy to continue getting worse still? If so, tell me how.

  • Wed Feb 13, 2019
Hi, I'm JOHN A P.

I received 6 treatments of R+CHOP inpatient on a 5-day IV infusion each treatment, for Burkitt Non-Hodgkins Lymphoma. Once I got used to the hospital routine, it was tolerable. I developed peripheral neuropathy at the fingertips and toes after the third treatment, and was taken off vincristine.

Also, after the third treatment, I developed burning urination, followed by blood in my urine. This was by far my most uncomfortable side effect. At the worst, I couldn’t be away from a bathroom for more than 10 minutes, and had very little urinary control. Urination was also very painful, which made me not want to drink as much water as I needed to. This, I was told, was a relatively uncommon side effect of the cyclophosphamide, which had attacked my bladder. I had to go to a urologist for a bladder exam and cauterization of a bleeding ulceration. After that, and some medications to help urine flow, my symptoms gradually diminished, and were gone after two weeks, except for an occasional twinge. I might have noticed the first symptoms sooner, but I was expecting to be uncomfortable during chemo, and didn’t think it was all that important when I first noticed urinary discomfort. After that experience, I got three weeks off, instead of two, before my next treatment. I also got a one-time removal of the “P” My last two treatments went back to it, but I also took a drug that was an effective antidote to the bladder effects.

With the anti-nausea medication, I never experienced dizziness or vomiting. However, my entire digestive tract was messed up, top to bottom, after about two days into the treatment. I had trouble swallowing, digesting what I ate, and severe constipation. It took about a week afterward for the constipation to wear off. My appetite, when I had one, shifted toward savory, spicy food, and I lost my taste for sweets. That only lasted a few days after each treatment. I was hungry enough afterward that I never lost weight, in fact gaining by the end.

With every treatment, my blood pressure dropped, along with my blood oxygen. Blood pressure was usually lowest around day 3 of 5, as low as 87/48, so I had to be careful about getting up, so that I wouldn’t pass out. My red blood cell count went down each time, so that I was more out of breath, but never low enough to require a transfusion. After finishing a treatment, day 6 it was best to just rest as much as I wanted. My mood as well as my energy tended to crash, recovering

  • Mon Jul 20, 2020
Hi, I'm ALAN F.

2 treatments down, 4 to go due to Diffuse Large B Cell Lymphoma. The first treatment took 8 hours, we lost and hour due to developing and itch from my shoulders up. I didn’t realize that it was the chemo, it snuck up on me. I would try to scratch and it seemed to move…an attentive nurse saw me, stopped the chemo, loaded another IV of antihistamine (Benadryl?) and another steroid IV. The crazy itch was gone as fast as it started.
RCHOP is a long day, I hear 6.5 hours is very typical, my second treatment seemed to go fast, the increased antihistamine and steroid were added already.
I pack sliced fruit, a sandwich, crackers, keep hydrated is so so so important of course. Make sure my phone is fully charged and I use corded headset, no problems. First treatment I took magazines too, but zero interest in reading.
After First treatment i went home and thought wow that was nothing, I feel great.

Until after a nap.

I Fatigue easily – I hope you can nap easily. To this day.
Waves of nausea – Started a couple days after treatment and lasts 4 or 5 days. At first sign of nausea I take ondansetron and prochlorper. Nausea Gone fast. Haven’t vomited…but the meds do Work fast.
Mouth sores: Developed 4 or 5 days after both treatment, lasts 3 or 4 days. They pop up, irritate the heck out me, then seem to disappear. Not necessarily painful, I get relief from the Baking soda and salt water gargle. ​
Hair Loss: 10 days after first treatment it started falling out. I just cut my hair short and let it go. It’s still shedding after second treatment, Of Course.
Constipation – UGH. Diet and treadmill. Load up on sliced papaya and prune juice. Still every few days since this started I need Milk of Magnesia. Gotta do what you gotta do.

Blood test one week after first treatment my WBC were “dangerously low”. the immunity shot thing the day after can take 7 to 10 days to kick in. I laid low, almost a quarantine, until two week after treatment blood test it was back to normal.

Blood test one week after Second treatment WBC were low but not as severe as first week. I expect next blood test will find me in range.

No fevers.

​Chemo Brain.. It’s real. Feels like i am constantly stoned, after all i am a child of the 70s. Don’t know what i can do other than keep my self occupied so i don’t realize how dumb I feel. I limit my driving to mornings when it is not so bad. Definitely gets worse as the day moves on.
Pray that this goes away w

  • Sat Jun 19, 2021
Hi, I'm Joanne

Had 3 treatments R-Chop so far for 3B follicular lymphoma. I must be very lucky or all my friends’ prayers are being answered. My side effects are mild; nausea managed with under the tongue Ondansetron and a great ginger drop recommended by my dietician, purchased on Amazon simply called Tummydrops. The Tummydrops also help with the bad taste in my mouth, as does Biotene and a piece of dark chocolate. Chills: blankets and a heating pad on my feet under the many blankets. Constipation: Senekot, Kale, and Organic Broccoli. I am trying to eat organic; healthy. Vision changes; nothing for that. I drive when only necessary. Chemo brain: I wander around my home quit a bit looking for stuff and jump from room to room; subject to subject. I have no focus. I just let it go! Sometimes I laugh about it. The prednisone: Jumpy, nervous; but I know after 5 days it will be over; so I count it down. I find the phone and texting annoying so I have asked my friends not to call or text for the first week after chemo. I told them I would reach out to them. I email them updates every 5 -7 days. And when I am up to it, I call them or send an all clear email. The prednisone crash lasts only one day. I just watch Hallmark movies that day and cut myself some slack. Normally I am a very active person so when I feel good and the weather is nice (above 60 degrees), I head out for a walk. I am not allowed to go and be amongst the living so I invite friends to walk outside with me. It really helps chase those blues away. I put a countdown clock on my phone with the last day of chemo. I like to watch the number go down.

I try to stay positive; tell myself it is only a 4 month treatment and 4 months out of what I hope to be a long life is not a long period of time.

  • Fri Mar 25, 2022
Hi, I'm Beeswaxed

I went through R-CHOP for follicular lymphoma — 6 sessions, with 3 weeks between each chemo.

A couple things learned:
1. Wear long sleeves, hats, gloves, etc because your skin can not handle the sun like it used to while going through chemo. I sunburned very easily.
2. Drink lots of water. Ask your doc because you can over do it, especially on chemo days, but it DOES help.
3. My wbc stayed fairly normal. The lowest mine got was 3.4. I don’t know why I didn’t deal with that problem but am grateful.
4. My immume system got weird near the last chemo. I became hyper-sensitive and allergens that never bothered me before became an issue. It took a while, after chemo was over, for my immune response to settle down.
5. I had burning days starting after the 4th chemo — where my mouth would, all of a sudden, out of the blue, feel like drops of liquid fire. It would usually start about a week after chemo and last for a couple days. I began carrying lots of ice cold water in a cooler to drink when that happened. It helped.
6. If you are into exercise, note that the steroids cover a LOT of damage. I felt great while on the steroids but learned that is deceptive and I need to give my body time to heal. When I tried walking, my heart went nuts. It had a very strange pattern of recovery for hills I normally ran, prior to chemo, even at a walk. I learned that if I wanted to walk during the weeks after chemo, I needed to stay away from hills and go VERY slow, walking only on flat ground. If my heart rate started going high or tachycardic, I needed to call it a day and stop exercising.
7. Regarding any injuries NOT related to chemo — Right before the sixth chemo, I turned my ankle. It took a long time after that for my ankle to recover so take into account all the other things your body is trying to fix during chemo and don’t injure something you need.

Strange things :
I would go mildly hypothermic the evening of every chemo treatment.
My hair fell out the 3rd week after my first chemo but started regrowing by the 4th treatment.
I thought chemo would burn. As caustic as they said the chemo chemicals were, I didn’t feel anything when the nurses injected them into my port.
Ports do feel REALLY weird but make things SO much easier.

Final note: All the side effects you hear about chemo can be terrifying but they were, for me anyway, cumulative. I didn’t feel the full brunt until the last few rounds so don’t try to buy, with worry

  • Tue May 10, 2022

This discussion needs your voice!

What were the specific side effects that you experienced while taking this medication? How did you manage them?

What coping tips would you give to new patients on this regimen?

I'm David Thompson, and I'm a survivor of Lymphoma

Please consider chewing ice during the “red devil” push of the treatment. This is to minimize mouth sores during this. No one told me this until my 2nd treatment. Also, suggest Nystatin if thrush appears in the mouth.

  • Mon Aug 19, 2019
Hi, I'm Pipgarden

Every session is different, every day is different. Love yourself and allow yourself to just be. Don’t “fight” with yourself.

  • Tue Feb 28, 2017

This discussion needs your voice!

What do you wish you had known before taking this medication? What information would you like to pass on to patients who are beginning this medication?

Treatment Overview

This chemotherapy regimen is commonly used to treat:

Other chemotherapy regimens for the treatment of Non-Hodgkin's Lymphoma:

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The Navigating Care Library includes articles about cancer, chemotherapy regimens and drugs from the the National Cancer Institute and other experts.

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