CHOP Chemotherapy for Lymphoma

CHOP is an abbreviated name for a combination of different medications. CHOP is one of the most common combinations of medications used for non-Hodgkin lymphoma, or NHL. CHOP is used for some common types of aggressive as well as indolent NHL. It consists of four different medications: cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone. CHOP is also frequently combined with rituximab in the R-CHOP regimen.

The first three drugs of the CHOP chemotherapy regimen are usually given as injections or infusions of veins on a single day, while prednisone is taken as pills for five days. Most commonly, the regimen known as R-CHOP is given in cycles 3 weeks apart weeks for 6-8 cycles.

The drugs are given in CHOP combat the cancer cells in different ways. When cyclophosphamide is used as cancer chemotherapy in CHOP, it works by slowing or stopping the growth of cancer cells in your body. It can have some collateral damage in that it also affects rapidly dividing cells in the body that are healthy, such as those that produce hair and those in the lining of the gut—so hair loss and gastrointestinal symptoms are possible side effects.

Doxorubicin is in a class of medications called anthracyclines, and it also works by slowing or stopping the growth of cancer cells. Vincristine works to prevent cancer cells from duplicating, in part by attacking the scaffolding of tubes that cell cells use to separate and divide. Cancer cells are more vulnerable to chemotherapy than normal cells, but the chemotherapy also has effects on normal cells, resulting in predictable side effect profiles.

Lymphomas Treated With CHOP vs. R-CHOP

Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), has been the mainstay of therapy for several decades for patients with diffuse large B-cell lymphoma (DLBCL). The majority of patients with DLBCL can be cured with standard rituximab + cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), however, outcomes are not as good for those who do not do well on this regimen.

CHOP chemotherapy is used for many of the common types of aggressive non-Hodgkin lymphomas, such as diffuse B-cell lymphoma (DLBCL). The R-CHOP protocol has become standard for treatment of aggressive, Stage I and Contiguous Stage II Adult NHL and aggressive, Noncontiguous Stage II/III/IV adult NHL.

Administration and Cautions

Adriamycin is usually given first as it can irritate your blood vessels. It's important that you tell the infusion nurse if you feel burning or pain at the infusion site. On the same day, you will also be given the next two drugs, Cytoxan and Vincristine.

You may see a change in the color of your urine from the red color of the Adriamycin for a couple of days after treatment.

Common Side Effects

• Hair loss: You will have total hair loss, including the hair on your head as well as eyebrows, eyelashes, and body hair. Usually, this starts two to three weeks after treatment, but it is temporary and your hair should return after treatment.
• Nausea and vomiting are common, from immediately after treatment through three days after treatment.
• Constipation is common due to the vincristine as well as other medications are often given for nausea and pain.
• Mouth sores may appear a week to two weeks after treatment.
• Fertility issues: Women often have a disruption of their menstrual cycles and may enter menopause permanently. Men may stop producing sperm, reducing fertility. These conditions may be permanent, so you should discuss fertility options with your healthcare provider before starting treatment. On the other hand, don't assume you will be infertile during treatment, use contraception to prevent pregnancy.
• You may be more prone to infection during CHOP treatment as it will temporarily reduce your white blood cells and red cells, impairing your immune system. It is wise to avoid contact with people who colds or the flu and to wash your hands frequently to prevent catching a virus or infection.
• Prednisone is a steroid and has many potential side effects, including mood swings, weight gain, and swelling.