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COVID-19: Obtenez les dernières mises à jour ou faites une autoévaluation.

Les traitements par chimiothérapie et autres traitements systémiques pourraient être modifiés en raison de la COVID-19. Vous trouverez de plus amples renseignements à la page Traitements systémiques pendant la pandémie de la COVID-19.

Certaines de ces informations ou toutes, dans certains cas, n’apparaissent qu’en Anglais. Vous pouvez demander la version française

CHOP+R Patient Information

This page gives general information about this cancer treatment.

You Will Learn:

  • who to contact for help
  • what the treatment is
  • how it is given
  • what to expect while on treatment

This information was created by Cancer Care Ontario together with patients and their caregivers who, like you, have gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.

This information does not replace the advice of your healthcare team. Always talk to your healthcare team about your treatment.

What Is This Treatment?

CHOP+R is the code name of your lymphoma treatment regimen.

A regimen is a combination of medications to treat cancer.

This regimen name is made up of 1 or more letters from the names of the 5 medications in your treatment. 

Here are the names of the medications in this regimen:

C = Cyclophosphamide

H = doxorubicin (also called Hydroxyldaunorubicin)

O = vincristine (also called Oncovin®)

P = Prednisone

+   

R = Rituximab

For most people, treatment lasts 18 weeks. The treatment is divided into 6 cycles. Each cycle is 3 weeks long.

Here is a picture of the schedule for CHOP+R treatment:

CHOP+R Treatment Schedule

For some people, treatment may last 24 weeks. The treatment is divided into 8 cycles. Each cycle is 3 weeks long.  Your healthcare team will tell you how many cycles you need.

During each 3 week cycle you will have CHOP+R treatment on day 1 at the hospital.  You will continue to take P (prednisone) tablets on days 2 to 5 at home.

Each cycle looks like this:

Day 1
Treatment Day:
Go to the hospital for CHOP+R treatment
2
Take your prednisone
3
Take your prednisone
4
Take your prednisone
5
Take your prednisone
6
No CHOP+R Treatment
7
No CHOP+R Treatment
8
No CHOP+R Treatment
9
No CHOP+R Treatment
10
No CHOP+R Treatment
11
No CHOP+R Treatment
12
No CHOP+R Treatment
13
No CHOP+R Treatment
14
No CHOP+R Treatment
15
No CHOP+R Treatment
16
No CHOP+R Treatment
17
No CHOP+R Treatment
18
No CHOP+R Treatment
19
No CHOP+R Treatment
20
No CHOP+R Treatment
21
No CHOP+R Treatment

Remember To:

Important Icon

  • Tell your healthcare team about all of the other medications you are taking.
  • Keep taking other medications that have been prescribed for you, unless you have been told not to by your healthcare team.

How Is This Treatment Given?

Cycle 1: For the first cycle in your treatment these medications will be given through an IV (injected into a vein) at the hospital:

C = Cyclophosphamide

H = doxorubicin (also called Hydroxyldaunorubicin),

O = vincristine (also called Oncovin®)

R = Rituximab

You will also take your Prednisone (P) by mouth.

Other cycles: If your first cycle of Rituximab goes well you may get this medication under your skin (subcutaneously or Subcut) for the rest of your cycles. This will happen on day 1 at the hospital. Getting the Rituximab under your skin instead of through an IV will make your treatment visit at the hospital go faster.

You will have a blood test before each treatment cycle to make sure it is safe for you to get treatment.

P (Prednisone) tablets in your treatment are taken by mouth.

  • Swallow tablets whole with a glass of water with a meal.
  • If possible, take prednisone tablets in the morning right after eating breakfast.

How to safely handle and store your medications:

  • Keep prednisone tablets in the original packaging at room temperature in a dry place, away from heat and light.
  • Keep out of sight and reach of children and pets.
  • Do not throw out any unused prednisone tablets at home. Bring them to your pharmacy to be thrown away safely.

What Other Medications Are Given With This Treatment?

To prevent nausea and vomiting

You will be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.

  • These are called anti-nausea medications and include medications such as ondansetron (Zofran®), granisetron (Kytril®), or others.

To prevent allergic reaction

You will be given medications before your treatment to help prevent allergic reactions before they start.

  • There are different types of medications to stop allergic reactions. They are called:
    • antihistamines (such as diphenhydramine or Benadryl®)
    • analgesics/antipyretics (such as acetaminophen or Tylenol®)
    • H2 blockers (such as ranitidine or famotidine)
    • corticosteroids (such as prednisone)
  • Prednisone is part of the CHOP-R regimen. You will take your prednisone by mouth on day 1 of your cycle before your IV treatment.

To prevent Tumor Lysis Syndrome (TLS)

TLS can happen when a large number of cancer cells die quickly and your body cannot get rid of them fast enough.  TLS can make you very sick.  Ask your healthcare team if you are at risk for TLS.

If you are at risk for TLS, you may be given medications before your CHOP+R treatment to help prevent it.

  • These are called anti-uricemics (such as allopurinol)

To prevent hepatitis B flare-ups

If you have ever been infected with hepatitis B, there is a risk that this treatment can cause it to flare up (come back).  Tell your healthcare team if you have had hepatitis B. You may need to take medication to prevent a hepatitis B flare-up.

To prevent infection

You may also be given a medication after each treatment day to increase your white blood cell count (neutrophils). This helps to prevent infection and make sure it is safe for you to get your next treatment.

The medication may be called filgrastim (Neupogen®, Grastofil®) or pegfilgrastim (Neulasta®).

DO This While on Treatment

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  • DO tell your healthcare team about any other medical conditions that you have such as heart, liver, lung, kidney and nerve problems, or any allergies.
  • DO check with your healthcare team before getting any vaccinations, surgery, dental work or other medical procedures.
  • DO drink plenty of fluids (unless told otherwise) and pee often for 2 or 3 days after your CHOP+R treatment to prevent bladder irritation. It is normal for your urine (pee) to be red for up to 2 days after CHOP+R. Tell your healthcare team if your pee stays red for more than 2 days.
  • DO tell your healthcare team if you have any new pain, numbness or tingling of your hands or feet. This is especially important if you are having trouble doing tasks (like doing up buttons, writing, walking) or if you have severe pain or numbness.   
  • DO talk to your healthcare team about your risk of getting other cancers and heart problems after this treatment.
  • DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.

DO NOT Do This While on Treatment

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  • DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products, without checking with your healthcare team.
  • DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your healthcare team.
  • DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. They may increase side effects.
  • DO NOT smoke or drink alcohol while on treatment without talking to your healthcare team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

Will This Treatment Interact with Other Medications or Natural Health Products?

Yes, the medications in this regimen can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.

Tell your healthcare team about all of your:

  • prescription and over-the-counter (non-prescription) medications
  • natural health products such as vitamins, herbal teas, homeopathic medicines and other supplements

Check with your healthcare team before starting or stopping any of them.

If you take medications to help with your blood pressure, your healthcare team may ask you to stop these medications 12 hours before and during your treatment.

If you take seizure medications (such as phenytoin), your healthcare team will monitor your blood levels closely and may adjust the dose.

medication icon

Talk to your healthcare team BEFORE taking or using these:

  • Anti-inflammatory medications such as ibuprofen (Advil® or Motrin®), naproxen (Aleve®) or Aspirin®
  • Over-the-counter products such as dimenhydrinate (Gravol®)
  • Natural health products such as St. John’s Wort
  • Supplements such as vitamin C
  • Alcoholic drinks
  • Tobacco
  • All other drugs, such as marijuana (medical or recreational)

What Should I Do If I Feel Unwell, Have Pain, a Headache or a Fever?

  • Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen [Tylenol] or ibuprofen [Advil]).
    • Fever can be a sign of infection that may need treatment right away.
    • If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.

How to check for fever

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).

  • You have a fever if your temperature taken in your mouth (oral temperature) is:
    • 38.3°C (100.9°F) or higher at any time

    OR

    • 38.0°C (100.4°F) or higher for at least 1 hour.

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If you do have a fever

  • Try to contact your healthcare team.  If you are not able to talk to them for advice, you MUST get emergency medical help right away.
  • Download theFever pamphlet for more information.

If you do not have a fever but have mild symptoms such as headache or mild pain:

Ask your healthcare team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.

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Talk to your healthcare team before you start taking Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
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Talk to your healthcare team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

How Will This Treatment Affect Sex, Pregnancy and Breast Feeding?

Talk to your healthcare team about:

  • How this treatment may affect your sexual health
  • Changes to your menstrual cycle (periods), if this applies to you
  • Symptoms of menopause such as hot flashes, vaginal dryness or changes in your mood, if this applies to you
  • How this treatment may affect your fertility (ability to have a baby), if this applies to you

This treatment may harm an unborn baby. Tell your healthcare team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding

  • If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time until 12 months after your last treatment dose. Talk to your healthcare team about which birth control options are best for you
  • Do not breastfeed while on this treatment

What Are the Side Effects of This Treatment?

The following table lists side effects that you may have when getting CHOP+R treatment. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed, and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Keep the link to this page during your treatment so that you can refer to it if you need to.

Very Common Side Effects (50 or more out of 100 people)

Side effect and what to do

When to contact healthcare team

Allergic reaction

(May be severe with IV rituximab)

What to look for:

  • Fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness. 
  • It may happen during or shortly after your treatment is given to you and may be severe.

What to do:

  • Tell your nurse right away if you feel any signs of allergic reaction during or just after your treatment.
  • Talk to your healthcare team for advice if you have a mild skin reaction.

Get emergency medical help right away for severe symptoms.

Hair thinning or loss

What to look for:

  • Your hair may become thin or fall out during or after treatment.
  • In most cases, your hair will grow back after treatment. The texture or colour may change. 
  • In very rare cases, hair loss may be permanent.

What to do:

  • Use a gentle soft brush.
  • Do not use hair sprays, bleaches, dyes and perms.

Talk to your healthcare team if this bothers you.

Low neutrophils (white blood cells) in the blood (neutropenia)

(May be severe)

When neutrophils are low, you are at risk of getting an infection more easily. Download theNeutropenia (Low white blood cell count) pamphlet for more information.

What to look for:

  • If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever. 
  • Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen).
  • Do not eat or drink anything hot or cold right before taking your temperature.

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time

OR

  • 38.0°C (100.4°F) or higher for at least 1 hour.

What to do:

If your healthcare team has told you that you have low neutrophils:

  • Wash your hands often to prevent infection.
  • Check with your doctor before getting any vaccines, surgeries, medical procedures or visiting your dentist.
  • Keep a digital thermometer at home so you can easily check for a fever.

If you have a fever:

If you have a fever, try to contact your healthcare team.  If you are unable to talk to the team for advice, you must get emergency medical help right away.

If you have a fever, try to contact  your healthcare team.  If you are unable to talk to the team for advice,  you MUST get emergency medical help right away.

Low platelets in the blood

(May be severe)

When your platelets are low you are at risk for bleeding and bruising. Download theLow Platelet Count pamphlet for more information.

What to look for:

  • Watch for signs of bleeding:
    • Bleeding from your gums
    • Unusual or heavy nosebleeds
    • Bruising easily or more than normal
    • Black coloured stools (poo) or blood in your stools (poo)
    • Coughing up red or brown coloured mucus
    • Dizziness, constant headache or changes in your vision
    • Heavy vaginal bleeding
    • Red or pink coloured urine (pee), except for the 2 days after your CHOP+R treatment

What to do:

If your healthcare team has told you that you have low platelets:

  • Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
  • Check with your healthcare team before you go to the dentist.
  • Take care of your mouth and use a soft toothbrush.
  • Try to prevent cuts and bruises.
  • Ask your healthcare team what activities are safe for you.
  • Your treatment may have to be delayed if you have low platelets.  Your healthcare team may recommend a blood transfusion.

If you have signs of bleeding:

  • If you have a small bleed, clean the area with soap and water or a saline (salt water) rinse. Apply pressure for at least 10 minutes.

If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.

Talk to your healthcare team if you have any signs of bleeding.  If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency medical help right away.

Common Side Effects (25 to 49 out of 100 people)

Side effect and what to do

When to contact healthcare team

Nausea and vomiting

What to look for:

  • Nausea is feeling like you need to throw up. You may also feel light-headed.
  • You may feel nausea within hours to days after your treatment. 

What to do:

To help prevent nausea:

  • It is easier to prevent nausea than to treat it once it happens. 
  • Take your anti-nausea medication(s) as prescribed, even if you do not feel like throwing up.
  • Drink clear liquids and have small meals. Get fresh air and rest.
  • Do not eat spicy, fried foods or foods with a strong smell.
  • Limit caffeine (like coffee, tea) and avoid alcohol.

If you have nausea or vomiting:

  • Take your rescue (as-needed) anti-nausea medication(s) as prescribed. 
  • Download theNausea & Vomiting pamphlet for more information.
  • Talk to your healthcare team if:
    • nausea lasts more than 48 hours
    • vomiting lasts more than 24 hours or if it is severe.

Talk to your healthcare team if nausea lasts more than 48 hours, or if vomiting lasts more than 24 hours or is severe.

Neuropathy (tingling, numb toes or fingers)

(May be severe)

What to look for:

  • Numbness or tingling of your fingers and toes may happen after starting your treatment.
  • Sometimes it can be painful and feel like a burning sensation, which may be severe.

What to do:

  • Talk to your healthcare team if you have symptoms of neuropathy.
  • Numbness may slowly get better after your treatment ends.

In rare cases, it may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your healthcare team for advice.

Talk to your healthcare team, especially if you have trouble doing tasks like doing up buttons, writing or moving, or if you have severe pain or numbness.

Reactions at the injection site


What to look for:

  • Your skin may become red, itchy, bruised, and/or swollen where the injection was given.
  • Site reactions are usually mild and go away within one to three days.

What to do:

  • You may need to apply hot compresses or ice/cold compresses if you have mild redness or discomfort. This depends on which medication caused the reaction.
  • Talk to your healthcare team to find out which treatment is right for you.

Talk to your healthcare team if this bothers you.

Mouth sores

What to look for:

  • Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks.
  • In more severe cases they may make it hard to swallow, eat or brush your teeth.
  • They may last for 3 days or longer.

What to do:

To help prevent mouth sores: 

  • Take care of your mouth by gently brushing and flossing regularly.
  • Rinse your mouth often with a homemade mouthwash.
  • To make a homemade mouthwash, mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.
  • Do not use store-bought mouthwashes, especially those with alcohol, because they may irritate your mouth.

If you have mouth sores:

  • Avoid hot, spicy, acidic, hard or crunchy foods.
  • Your doctor may prescribe a special mouthwash to relieve mouth sores and prevent infection.
  • Talk to your healthcare team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow.

Download theMouth Care pamphlet for more information.

Talk to your healthcare team as soon as you notice mouth or lip sores, or if it hurts to eat, drink or swallow.

Less Common Side Effects (10 to 24 out of 100 people)

Side effect and what to do

When to contact healthcare team

Fatigue

What to look for:

  • Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep.

What to do:

  • Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days.
  • Check with your healthcare team before starting any new exercise.
  • Pace yourself, do not rush. Put off less important activities. Rest when you need to.
  • Ask family or friends to help you with things like housework, shopping, and child or pet care.
  • Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your healthcare team has told you to drink more or less).
  • Avoid driving or using machinery if you are feeling tired.

Download theFatigue pamphlet for more information.

Talk to your healthcare team if it does not improve or if it is severe.

Headache, flu-like symptoms

You may feel like you have the flu for around 2 days after your IV treatment.  These flu-like symptoms may not be signs of an infection.

What to look for:

  • You may have chills, headache and muscle pain. 
  • You may feel tired and have a poor appetite.
  • Symptoms may happen at any time after you receive your treatment and usually go away as your body gets used to the medication.

What to do:

  • Check your temperature to see if you have a fever. Read the above section “What should I do if I feel unwell, have pain, a headache or a fever?”.
  • If you do have a fever, try to speak to your healthcare team.  If you are unable to talk to them for advice, you MUST get emergency medical help right away.

Talk to your healthcare team if it does not improve or if it is severe.

Rash; dry, itchy skin

(May be severe)

What to look for:

  • You may have cracked, rough, flaking or peeling areas of the skin.
  • Your skin may look red and feel warm, like a sunburn.
  • Your skin may itch, burn, sting or feel very tender when touched.

What to do:

To prevent and treat dry skin:

  • Use fragrance-free skin moisturizer.
  • Protect your skin from the sun and the cold.
  • Use sunscreen with UVA and UVB protection and an SPF of at least 30.
  • Avoid perfumed products and lotions that contain alcohol.
  • Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your healthcare team has told you to drink more or less.

Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.

Talk to your healthcare team if it does not improve or if it is severe.

Diarrhea

What to look for:

  • Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment.

What to do:

If you have diarrhea:

  • Take anti-diarrhea medication if your healthcare team prescribed it or told you to take it.
  • Do not eat foods or drinks with artificial sweetener (like chewing gum or diet drinks), coffee and alcohol.
  • Eat many small meals and snacks instead of 2 or 3 large meals.
  • Drink at least 6 to 8 cups of liquids each day, unless your healthcare team has told you to drink more or less.
  • Talk to your healthcare team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy.
  • Talk to your healthcare team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in 1 day.

Download theDiarrhea pamphlet for more information.

Talk to your healthcare team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in 1 day).

Constipation

What to look for:

  • Having bowel movements (going poo) less often than normal.
  • Small hard stools (poo) that look like pellets.
  • The need to push hard and strain to have any stool (poo) come out.
  • Stomach ache or cramps.
  • A bloated belly, feeling of fullness, or discomfort.
  • Leaking of watery stools (poo).
  • Lots of gas or burping.
  • Nausea or vomiting

What to do:

To help prevent constipation:

  • Try to eat more fibre-rich foods like fruits with skin, leafy greens and whole grains.
  • Drink at least 6 to 8 cups of liquids each day unless your healthcare team has told you to drink more or less.
  • Be Active. Exercise can help to keep you regular.
  • If you take opioid pain medication, ask your healthcare team if eating more fibre is right for you.

To help treat constipation:

  • If you have not had a bowel movement in 2 to 3 days you may need to take a laxative (medication to help you poo) to help you have regular bowel movements. Ask your healthcare team what to do.

Download theConstipation Pamphlet for more information.

Talk to your healthcare team if it does not improve or if it is severe.

Side effects of taking steroids

What to look for:

  • You may have:
    • Weight gain (that sometimes may be seen in places such as the cheeks or the back of the neck)
    • Weak muscles
    • High blood sugar
    • Upset stomach
    • Problems with sleeping
    • Changes in your mood
  • If you take steroids (such as prednisone) for many months or years, you may develop cataracts (clouding in your eyes) or osteoporosis (weak bones).

What to do:

  • Take your prednisone tablets in the morning with breakfast.
  • Eat a healthy, balanced diet and exercise regularly. Talk to your healthcare team first to know what exercise is safe for you.
  • Do not have close contact (such as hugs and kisses) with people who are sick.

Talk to your healthcare team if it does not improve or if it is severe.

Other Rare but Serious Side Effects Are Possible with This Treatment.

If you have any of the following, talk to your cancer healthcare team or get emergency medical help right away:

  • Pain and swelling or hardening of a vein in your arm or leg
  • New coughing or breathing problems
  • Coughing up blood
  • Any chest pain
  • Sudden confusion, trouble speaking, or difficulty moving your arms or legs
  • Any changes in your vision
  • Irregular heartbeat or passing out (fainting)
  • Any severe belly pain or bloating
  • Yellowish skin and eyes and red-brown coloured pee
  • Unexpected changes in your weight
  • Swelling of your body and not going pee as much as usual
  • New problems with balance
  • Redness/rash in areas where you’ve previously received radiation

For more information on how to manage your symptoms, ask your healthcare provider or go to Managing Symptoms, Side Effects & Well-Being.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.