R-CHOP is a chemotherapy regimen used to treat CD20-positive diffuse large B-cell lymphoma and follicular lymphoma. It consists of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone given intravenously every 21 days for 6-8 cycles. The document provides details on administration, dosing modifications, and supportive care for patients receiving R-CHOP chemotherapy.
R-CHOP is a chemotherapy regimen used to treat CD20-positive diffuse large B-cell lymphoma and follicular lymphoma. It consists of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone given intravenously every 21 days for 6-8 cycles. The document provides details on administration, dosing modifications, and supportive care for patients receiving R-CHOP chemotherapy.
R-CHOP is a chemotherapy regimen used to treat CD20-positive diffuse large B-cell lymphoma and follicular lymphoma. It consists of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone given intravenously every 21 days for 6-8 cycles. The document provides details on administration, dosing modifications, and supportive care for patients receiving R-CHOP chemotherapy.
R-CHOP is a chemotherapy regimen used to treat CD20-positive diffuse large B-cell lymphoma and follicular lymphoma. It consists of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone given intravenously every 21 days for 6-8 cycles. The document provides details on administration, dosing modifications, and supportive care for patients receiving R-CHOP chemotherapy.
R-CHOP Regimen Available for Routine Use in Derby in-patient
Burton in-patient
(First cycle if bulky disease
& risk of tumour lysis syndrome)
Burton day-case Burton community Burton out-patient Indication Treatment Intent Anti-Emetics Frequency & Duration
Derby day-case Derby community Derby out-patient
CD20-positive diffuse large-B-cell lymphoma at clinical
stage II, III or IV; follicular lymphoma Radical Pre-chemotherapy 2 Post-chemotherapy A Every 21 days for 6- 8 cycles
Day 1 Ondansetron Paracetamol
8mg 1g
Chlorphenamine
10mg
Hydrocortisone
100mg
Prednisolone
100mg
Rituximab
375mg/m2
Cyclophosphamide Doxorubicin Vincristine
Metoclopramide
750mg/m2 50mg/m2 1.4mg/m2 maximum 2mg (See notes) 10mg
Allopurinol Cotrimoxazole
300mg 960mg
Omeprazole Aciclovir
20mg 400mg
DATE OF ISSUE: 21.12.12
REVIEWED BY C.WARD REVIEW DATE: 21.12.14
As a single oral dose
As a single oral dose 30 minutes prior to rituximab As a single intravenous bolus 30 minutes prior to rituximab As a single intravenous bolus 30 minutes prior to rituximab Oral once daily for 5 daysgive first dose 30 minutes prior to rituximab Intravenous infusion in 500ml sodium chloride 0.9% Intravenous bolus Intravenous bolus Intravenous infusion in 50ml sodium chloride 0.9% over 510 minutes Oral four times daily for 2 days then as required Oral once daily for 1-2 cycles Oral twice daily Mondays and Thursdays for 21 days Oral once daily for 5 days Oral twice daily for 21 days
AUTHORISED BY Dr J Addada
*** VALID ON DATE OF PRINTING ONLY ***
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CSIS Regimen Name: R-CHOP
Notes: Baseline investigations Cardiac assessment (e.g. MUGA) in those patients 65 years or those with a cardiac history Rituximab This section should be read in conjunction with the Guidelines for the administration of Rituximab. 1. The day 1 dose of prednisolone should be given 30 mins prior to receiving rituximab. Premedication consisting of analgesia and an antihistamine and an intravenous corticosteroid should always be administered 30 minutes before each infusion of rituximab. (e.g. paracetamol 1g oral STAT and chlorphenamine 4mg oral or 10mg IV bolus STAT and hydrocortisone 100mg IV STAT). In addition pethidine 25mg IV should be available in case of a severe infusion reaction. 2. Rituximab doses should be rounded to the nearest 100mg Use rituximab rate calculator to assist with rate escalation of rituximab infusion. 3. Occurrence of an Infusion Related Event or Hypersensitivity: Stop the infusion and contact a doctor. When symptoms improve, continue the infusion at half the rate prior to the reaction. Accelerate the infusion rate more slowly as tolerated by the patient. Dose modifications and toxicities Patients older than 70: consider reducing the initial vincristine dose to a fixed dose of 1mg (elderly CHOP) ), giving a 1 week steroid pre-phase and/or escalating the dose of anthracycline progressively with each cycle, e.g. 50% cycle 1, 75% cycle 2, 100% cycle 3, according to patient tolerability.
DATE OF ISSUE: 21.12.12
REVIEWED BY C.WARD REVIEW DATE: 21.12.14
AUTHORISED BY Dr J Addada
*** VALID ON DATE OF PRINTING ONLY ***
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CSIS Regimen Name: R-CHOP
1. Haematological toxicity At the start of each cycle the neutrophil count should be > 1.0 x 109/l and platelets > 100 x 109/l a) Neutropenia Neutrophils <1.0 x 109/l
Grade 4 neutropenia* or febrile
neutropenia following any cycle of RCHOP Grade 4 neutropenia* leading to infection despite GCSF support
Grade 4 neutropenia* recurs despite
50% dose reduction in cyclophosphamide and doxrubicin b)Thrombocytopenia Platelets < 100 x 109/l Grade 3 or 4 thrombocytopenia* following any cycle of RCHOP
Grade 4 thrombocytopenia* recurs
despite 50% dose reduction in cyclophosphamide and doxorubicin
Delay one week and give
GCSF with subsequent cycles (days 7,9,11 initially) Give GCSF support with all subsequent cycles Consider 50% reduction of cyclophosphamide and doxorubicin for all subsequent cycles Consider termination of protocol
Delay one week
Reduce dose of cyclophosphamide and doxorubicin by 50% for all subsequent cycles Consider termination of protocol
2. Renal impairment Cyclophosphamide GFR ml/min >20 10-20 <10
Dose 100% 75% 50%
Dose reduction for renal impairment is not required for doxorubicin or
Vincristine Bilirubin micromol/L 26-51 or >51 & >51 &
AST/ALT Units/l 60-180 normal >180
Dose 50% 50% omit
4. Neurotoxicity Vincristine If grade 2 motor weakness* or grade 3 sensory toxicity*, reduce dose to 1mg. or replace vincristine by vinblastine 6mg/m2 (max 10mg). For higher grade toxicity omit. *NCI Common Toxicity Criteria
Toxicity Neutrophils x 109/l Platelets x 109/l Neuropathy (motor)
1 1.5-1.99 75-149
Grade 2 3 1.0-1.49 0.5-0.99 50-74
10-49
4 <0.5 <10
Subjective Mild Objective Paralysis weakness objective weakness but no weakness interfering objective interfering with activities DATE OF ISSUE: 21.12.12 VERSION 6 REVIEWED BY C.WARD AUTHORISED BY Dr J Addada PAGE 4 of 6 REVIEW DATE: 21.12.14
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CSIS Regimen Name: R-CHOP
findings
Neuropathy (sensory)
Loss of deep tendon reflexes or parasthesia (including tingling) but not interfering with function
with function, but not interfering with activities of daily living Objective sensory loss or parasthesia (including tingling) interfering with function, but not interfering with activities of daily living
of daily living
Sensory loss or parasthesia interfering with activities of daily living
Permanent sensory loss that interferes with function
Supportive care 1. It is advisable to give allopurinol (300mg) once a day for the first 1 or 2 courses of therapy whilst there is bulky disease. Reduce dose to 100mg daily if GFR <10mls/min. 2. All patients should receive Pneumocystis jirovecii prophylaxis throughout treatment: Cotrimoxazole 960mg twice daily twice weekly (on Mondays and Thursdays only). In cases of allergy to cotrimoxazole consider dapsone 100mg daily. 3. Omeprazole 20mg once daily for 5 days (i.e. concurrently with prednisolone). 4. GCSF 300 micrograms once daily by subcutaneous injection on days 7, 9, 11 (& 13) if 65 years or has developed neutropenic sepsis with previous cycles of chemotherapy.
References 1. NICE Technology Appraisal No. 65; Rituximab for aggressive nonHodgkins lymphoma, Issue date: September 2003 2. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large B-cell lymphoma. N Engl J Med. 2002;346:235-242.
DATE OF ISSUE: 21.12.12
REVIEWED BY C.WARD REVIEW DATE: 21.12.14
AUTHORISED BY Dr J Addada
*** VALID ON DATE OF PRINTING ONLY ***
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3. British Committee for Standards in Haematology - Guidelines on
diagnosis and therapy Nodal non-Hodgkin's lymphoma; August 2002 [draft 2] 4. Using Vinca Alkaloid Minibags (Adults/Adolescent Units); NPSA Rapid Response Alert 4; 11 August 2008
