R-CHOP
Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone
R-CHOP is the standard treatment for B-cell non-Hodgkin lymphomas. Six drugs (including a targeted therapy) are given every 3 weeks.
21 days
Cycle length
6 cycles
Typical course
6
Side effects tracked
Common Side Effects
Infusion reactions (rituximab)
first infusion, first 2 hours
Tip: Rituximab infusion reactions are common on the first dose and much rarer after. Staff will premedicate and monitor closely.
Nausea
days 1–4
Tip: Anti-nausea medications are effective. Take them proactively on a schedule.
Hair loss
weeks 2–3 of first cycle
Tip: Complete hair loss is common with R-CHOP. It is temporary — hair returns after treatment.
Fatigue
days 5–14, cumulative
Tip: Energy typically returns in the week before the next cycle. Plan demanding tasks for recovery weeks.
Neutropenia
days 7–14 (nadir)
Tip: Fever during nadir is a medical emergency. G-CSF injections may be prescribed to boost counts.
Steroid effects (prednisone)
days 1–5
Tip: Blood sugar may rise (watch for diabetes). Sleep may be disrupted — take prednisone in the morning.
Critical Days in the Cycle
Day 1 — Infusion Day
Watch for
- •Rituximab reaction (fever, chills, flushing, difficulty breathing)
When to call:
Any reaction during infusion — nursing staff will manage.
Day 8 — Nadir Approaching
Watch for
- •Rising temperature
- •Fatigue worsening
- •Chills
When to call:
Fever ≥100.4°F — go to the ER immediately, do not wait for a callback. Neutropenic fever is an emergency.
Day 11 — Nadir
Watch for
- •Fever
- •Infection signs
- •Bleeding
When to call:
Any fever ≥100.4°F — go to the ER immediately, do not wait for a callback. Signs of serious bleeding — call oncology team.
Frequently Asked Questions
What is rituximab and why is it in R-CHOP?
Rituximab is a monoclonal antibody — a targeted therapy that specifically attacks B-cells bearing the CD20 protein. Adding it to standard CHOP chemotherapy significantly improved outcomes for B-cell lymphomas. It's now standard of care.
Will my hair grow back after R-CHOP?
Yes — hair loss from R-CHOP is temporary. Hair typically begins growing back 2–3 months after completing treatment, though texture may be different initially.
What do the prednisone days feel like?
The 5 days of prednisone often cause increased energy, insomnia, mood changes, and increased appetite. Blood sugar may rise, especially in diabetic patients. After stopping prednisone, fatigue often increases for a few days.
When should I call the oncology team?
For fever ≥100.4°F (especially days 7–14, nadir window) — go to the ER immediately, do not wait for a callback. Call the team for: severe vomiting, signs of infection, unusual bleeding, or any chest pain or difficulty breathing.
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