R-CHOP Explained

B-cell lymphoma, particularly diffuse large B-cell lymphoma, tends to grow quickly. The beauty of R-CHOP is that it destroys the target tumor DNA while simultaneously reducing inflammation.

“The mechanism by which each individual drug of R-CHOP shrinks tumors is very complicated,” Dr. Phillips says. “For whatever reason, these B-cell lymphoma cells that should have been programmed to die are not dying. So, the R-CHOP combination works together to encourage cells to undergo what’s called apoptosis, or programmed cell death.”

“At a cellular level, each drug in the combination works differently, but over time, studies have shown that R-CHOP is the best combination for aggressive b-cell lymphomas.”

Here’s how the acronym breaks down:

• R:  Rituximab (Rituxan) is a monoclonal antibody that attaches to a specific protein called CD20, which sits on the surface of B cells. It targets the cancerous cells and destroys them.
• C: Cyclophosphamide is a type of chemotherapy drug
• D: Doxorubicin hydrochloride (hydroxydaunomycin) is a type of chemotherapy drug
• V: Vincristine sulfate (Oncovin) is a type of chemotherapy drug
• P: Prednisone is a steroid, which lowers inflammation

In most cases, doctors deliver this regimen in cycles spaced three weeks apart to help minimize side effects and give patients time between treatment cycles. The number of cycles can range from 3 to 6, depending on the stage
of the lymphoma.

R-CHOP Hiccups

Like every cancer treatment regimen, R-CHOP doesn’t come without drawbacks. Common side effects include:

• Unexplained weight loss
• Nausea
• Hair loss
• Fatigue
• Increased risk of infection

The drug combination includes doxorubicin, which may also damage the heart.

Plus, R-CHOP doesn’t always work. If the lymphoma doesn’t resolve with treatment, or if it comes back, doctors may suggest another chemotherapy regimen, or recommend participation in a clinical trial. If the lymphoma shrinks and you are tolerating the
treatment well during the initial 1 to 2 cycles of treatment, you may be eligible for
continuing the treatment to complete the full number of cycles, with the monoclonal
antibody and/or combination of chemotherapy drugs.

Of course, the best chance for a cure may be R-CHOP followed by a stem cell transplant (stem cell transplants are only effective if the lymphoma responds to chemo). Other options may include immunotherapy, such as CAR T-cell therapy or targeted drug therapy.

It’s important to work with your health care team to learn about all of the available treatment options and importantly, which might work best for your unique case.

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