R-CHOP Chemotherapy in Lymphoma

Female doctor and patient using laptop in hospital office

Dan Dalton / Getty Images

R-CHOP is the acronym for the combination of drugs that are commonly used as chemotherapy for certain cancers, such as non-Hodgkin lymphomas (NHLs).

Each letter in R-CHOP stands for a different drug, but the acronym can be confusing in that a single drug sometimes has more than one name:

  • R = Rituximab
  • C = Cyclophosphamide
  • H = Doxorubicin Hydrochloride (Hydroxydaunomycin)
  • O = Vincristine Sulfate (Oncovin)
  • P = Prednisone

Rituximab is an antibody directed against the CD20 antigen, a protein located on normal and malignant pre-B and mature B lymphocytes (white blood cells). Rituximab triggers an immune response from the patient against CD20-positive cells.

Cyclophosphamide is known as an alkylating agent, and it has both anti-cancer and anti-immune activity. In the liver, cyclophosphamide is converted to metabolites that bind to DNA, thwarting cells from making copies of DNA, and initiating cell death.

Hydroxydaunomycin is a modified form of doxorubicin, known as an anthracycline type antibiotic, and it has anti-cancer activity.

Oncovin or vincristine binds to little structures in cells called microtubules and interferes with the cells' ability to divide.

Prednisone is a steroid agent with anti-inflammatory properties, and it has many different uses in medicine. In certain sensitive cancer cell types, prednisone can stimulate programmed cell death.

R-CHOP is widely used in non-Hodgkin lymphoma. It may be used alone, or it may be used along with other drugs or treatments, or to treat other types of cancer besides lymphoma.

Likewise, the individual constituents of R-CHOP, such as the rituximab, might be used alone in some malignancies and in certain patients, to help manage disease.

More on R-CHOP

As knowledge of the various types of lymphomas expands, scientists are learning that different subtypes of the same lymphoma may respond differently to a given regimen. Clinical trials are looking into the use of other agents, in combination with R-CHOP, for a variety of malignancies.

R-CHOP is considered a standard treatment for one of the most common types of NHL, diffuse large B-cell lymphoma (​DLBCL). When you look at NHL as a whole, DLBCL accounts for 25% to 35% of all new diagnoses globally each year. R-CHOP may also be used in certain cases of follicular lymphoma, according to the 2017 Guidelines from the National Comprehensive Cancer Network.

How Often Is Each Agent Given?

The particulars of the whole regimen, including how many times each medication is given, over what period of time, and in what sequence, can vary depending on the malignancy, the patient’s response, and the healthcare providers or institutions involved.

  • One sequence of medications is referred to as a cycle, so you may hear healthcare providers talking about “how many cycles of R-CHOP” are planned, for instance.
  • One protocol involves the administration of rituximab as an infusion over a few hours on the first day of treatment, while the drugs of the CHOP regimen may be started the next day. The entire course may be repeated every three weeks for some six to eight cycles. However, today clinicians also speak of "CHOP-like regimens," too, and there are a variety of different protocols healthcare providers may follow that use these medications.

As an example of some of the emerging variations on R-CHOP, something called “R-mini-CHOP” is being explored.

The Groupe d'Etude des Lymphomes de l'Adulte (GELA)—a research group with a very French name—examined the question of minimizing toxicity in people with DLBCL ages 80 to 95. They aimed to investigate the efficacy and safety of a decreased dose of CHOP (doxorubicin, cyclophosphamide, vincristine, and prednisone) chemotherapy with a conventional dose of rituximab—the monoclonal antibody targeting cells with the CD20 "tag"—in elderly patients with DLBCL.

So far, results have been encouraging, also highlighting the importance of individual patient factors in this age group. When a lower-dose chemotherapy regimen, or "R-mini-CHOP," was used, efficacy appeared to be roughly comparable at two years to the standard dose, but with a reduced frequency of chemotherapy-related hospitalization.

Common Side Effects

Both rituximab and CHOP have side effects, and the full list of potential side effects is beyond the scope of the present article. Here are a few, select potential side effects, however:

  • You usually lose all the hair on your head. Hair in the eyebrows and other areas may also thin or fall out. The hair loss usually starts after the first or second cycle of chemotherapy, and it is almost always temporary in that the hair will grow back after chemotherapy ends.
  • Nausea and vomiting or feeling sick is common and may occur from immediately after treatment through three days after treatment.
  • Constipation may arise due to the vincristine as well as other medications that might be given for nausea and pain.
  • Mouth sores may appear sometime after treatment, and this can make you more likely to get an infection in your mouth, so oral care is important.
  • R-CHOP may affect your ability to become pregnant or father a child.
  • You may be more prone to infection during CHOP treatment, so try to avoid contact with people who have colds or the flu and to wash your hands frequently to help cut your risk of catching a virus or infection.
  • R-CHOP can reduce the number of platelets that help the blood to clot, so be sure to tell your healthcare provider if you have any bruising or bleeding you can’t explain.
  • Prednisone is a steroid and has many potential side effects, including mood swings, weight gain, and swelling.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Messmer M, Tsai HL, Varadhan R, et al. R-CHOP without radiation in frontline management of primary mediastinal B-cell lymphomaLeuk Lymphoma. 2019;60(5):1261-1265. doi:10.1080/10428194.2018.1519812

  2. Wang J, Zhou M, Xu JY, et al. Prognostic role of pretreatment neutrophil-lymphocyte ratio in patients with diffuse large B-cell lymphoma treated with RCHOPMedicine (Baltimore). 2016;95(38):e4893. doi:10.1097/MD.0000000000004893

  3. National Comprehensive Cancer Network. NCCN Guidelines for Patients: Follicular Lymphoma. Version 4. Fort Washington, PA: NCCN; 2019.

  4. Coiffier B, Thieblemont C, Neste EVD, et al. Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: a study by the Groupe dEtudes des Lymphomes de lAdulteBlood. 2010;116(12):2040-2045. doi:10.1182/blood-2010-03-276246

  5. Miller E, Jacob E, Hockenberry MJ. Nausea, pain, fatigue, and multiple symptoms in hospitalized children with cancerOncol Nurs Forum. 2011;38(5):E382-93. doi:10.1188/11.onf.e382-e393

  6. McQuade RM, Stojanovska V, Abalo R, Bornstein JC, Nurgali K. Chemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging TreatmentsFront Pharmacol. 2016;7:414. doi:10.3389/fphar.2016.00414

  7. Dendle C, Gilbertson M, Spelman T, et al. Infection is an Independent Predictor of Death in Diffuse Large B Cell LymphomaSci Rep. 2017;7(1):4395. doi:10.1038/s41598-017-04495-x

  8. Ito K, Okamoto M, Inaguma Y, et al. Influence of R-CHOP Therapy on Immune System Restoration in Patients with B-Cell LymphomaOncology. 2016;91(6):302-310. doi:10.1159/000449251

  9. El-Osta H, Nair B. Rituximab-induced acute thrombocytopenia: an underappreciated entityLeuk Lymphoma. 2013;54(12):2736-2737. doi:10.3109/10428194.2013.784972

  10. Lee I, Kaminski HJ, McPherson T, Feese M, Cutter G. Gender differences in prednisone adverse effects: Survey result from the MG registryNeurol Neuroimmunol Neuroinflamm. 2018;5(6):e507. doi:10.1212/NXI.0000000000000507

Additional Reading
  • Bibas M, Castillo JJ. Current knowledge on HIV-associated Plasmablastic Lymphoma. Mediterr J Hematol Infect Dis. 2014;6(1):e2014064.
  • Eyre TA, Clifford R, Roberts C, et al. Single arm NCRI phase II study of CHOP in combination with Ofatumumab in induction and maintenance for patients with newly diagnosed Richter’s syndrome. BMC Cancer. 2015;15:52.
  • Offner F, Samoilova O, Osmanov E, et al. Frontline rituximab, cyclophosphamide, doxorubicin, and prednisone with bortezomib (VR-CAP) or vincristine (R-CHOP) for non-GCB DLBCL. Blood. 2015;126(16):1893-1901.

By Indranil Mallick, MD
 Indranil Mallick, MD, DNB, is a radiation oncologist with a special interest in lymphoma.