Non-Hodgkin's Lymphoma Chemotherapy: CHOP

Recommended Books:

Regimen Drugs:

The following are the drugs used in the regimen.  Select a drug to see a page and pertinent information:

• Cyclophosphamide (brand names cytoxan, neosar)
• Adriamycin (doxorubicin / hydroxydoxorubicin (ref))
• Vincristine (Oncovin)
• Prednisone (sometimes called Deltasone or Orasone)

CHOP is sometimes used in conjunction with immunotherapy drugs such as Rituxan to see is the combination will produce better results.  This may be abbreviated CHOP-R or CHOP+R. (new)

Before starting the regimen, you might wish to:

Read information on each drug.  You should discuss your treatment thoroughly with your doctor/medical team.  Items to mention include if you are pregnant, have a history of heart problems, or if you smoke.  If you have had major medical problems in the past or have a family history of problems these should be discussed also.

This regimen may cause fertility problems.  You may want to discuss with your medical team options such as sperm banking or egg/embryo freezing.  

Hair loss (alopecia) may occur.  People have many ways of dealing with hair loss including hats and scarves.  The patient may want to investigate getting a headcovering before starting treatment.

Administration:

CHOP is commonly administered in cycles of 4 weeks.  A common treatment regimen is for at least 6 cycles. The exact number of cycles given is dependent on the treatment prescribed by the medical team. 

Adriamycin and vincristine are usually given as follows: you have a saline (salt water) intravenous drip and the drugs are injected into the IV tube while receiving  the saline.  Cyclophosphamide is often given the same way although the drug also comes in tablet form. Prednisone comes in pill form and is taken by mouth over a period of several days.

The doses are determined by square meters of body area.  So you don't have to measure every nook, they have tables - the body area is approximated from weight and height.  I have seen different dosing in the references below so I refrain from selecting one - please refer to qualified medical personnel for exact dosing.

Drugs that are often given in the same sitting are:

• Zofran or Kytril - for nausea

If you feel side effects while receiving the drugs in the medical facility notify the staff.  Common discomforts are chills (which can be remedied by a warm blanket) and frequent urination which may be discolored (due to the adriamycin - a red drug).  Burning or red streaks at the IV site should be noted immediately.

Items to consider while on this regimen:

• Ask about drinking more fluids. Adriamycin, cyclophosphamide, and vincristine may cause kidney problems and liquids may help.  Also some regimen drugs may cause constipation which should be closely monitored.  Your doctor may prescribe a laxative to help.
• Ask your medical team about which pain relievers to take while on this regimen - some drugs thin the blood which is not recommended while on chemotherapy.

Side Effects During Treatment:

• These drugs can cause nausea, vomiting, and loss of appetite. There are medications your doctor can prescribe such as Zofran or Kytril that may lessen chemotherapy induced nausea. 
• Fatigue is common during chemotherapy treatment.  Proper rest and pacing oneself may be helpful.
• Treatments can be delayed if the patient has a low white blood cell count (neutropenia). Blood counts can be raised by drugs such as Granulocyte Colony-Stimulating Factor (G-CSF, brand name Neupogen®) - a drug used to stimulate the production of granulocytes in the bone marrow.  
• The drugs will make your hair tend to fall out (alopecia) - you might consider headcoverings.
• For support, see the Surviving Lymphoma section

Long Term:

• According to NCI (1/99) late effects of NHL treatment have been observed. Pelvic irradiation and large cumulative doses of cyclophosphamide have been associated with a high risk of permanent sterility. For up to 2 decades after diagnosis, patients are at significantly elevated risk of second primary cancers, especially lung, brain, kidney, and bladder cancers and melanoma, Hodgkin's disease, and acute nonlymphocytic leukemia. Left ventricular dysfunction was a significant late effect identified in 8 of 57 long-term survivors of high-grade NHL who received more than 200 milligrams per meter squared of doxorubicin.
• Peripheral neuropathy (tingling in the hands and feet) which may lessen over time.

Books on Lymphoma Treatment including chemotherapy

Resources for information on CHOP:

• Chemotherapy Regimens for NHL from Medicine On Line
• CHOP information from Cancerbackup (UK)
• Tirgan Oncology page on CHOP

Studies: (new)

• Abstract of a 2002 study - CHOP chemotherapy plus Rituxan (rituximab) compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma.

Disclaimer: This information is general in nature. Please consult with a doctor or the literature provided with the drug packaging if you need specific information on a drug. The author is not responsible for missing or inaccurate information and the reader assumes full responsibility for their actions. As always, please consult with medical personnel before undertaking any medical treatment.

• Childhood Non-Hodgkin's Lymphoma: Chemotherapy
• Childhood Non-Hodgkin's Lymphoma: Treatment
• Childhood Non-Hodgkin's Information Pages

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• The Lymphoma Information Network

This page is a work in progress - if you have more complete information, references, or other information please contact the author. The author is not in the medical field and does not warrant the correctness of the material on this page or the sites linked - please take online information and consult with your own medical team to make informed decisions.

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Updated June 1, 2006