When Caught Early, Diffuse Large B-Cell Lymphoma Is Highly Treatable

The standard treatment for diffuse large B-cell lymphoma is a combination of four drugs that doctors nickname CHOP — the chemotherapy drugs cyclophosphamide, doxorubicin, and vincristine plus the steroid prednisone — which has been around since the 1970s. Added to that is the newer monoclonal antibody rituximab (Rituxan), which targets a specific protein called CD20 on the surface of cancer cells.

Combining drugs allows the treatment to attack the cancer in different ways. “We can use that to get a remission,” Dr. Schuster says.

In people with stage I or stage II diffuse large B-cell lymphoma, where the areas of cancer are next to one another, doctors can also use radiation, “which is the oldest form of therapy for lymphoma,” he adds. Radiation uses high-energy x-rays to kill cancer cells.

The success rate with this treatment is about 80% in people with stage I or II cancers. “So you’re getting two potentially curative approaches to your disease to get very high success rates,” Dr. Schuster says.

Inside the R-CHOP Treatment

You’ll get R-CHOP in cycles spaced three weeks apart. Each cycle involves getting the chemotherapy drugs and Rituxan through a vein. Then you’ll take prednisone as a pill by mouth.

For stage I or II cancer, the whole treatment should take about three months. “It’s three to four treatments with combination chemotherapy and monoclonal antibody therapy, and then a few weeks of radiation therapy and you’re done,” Dr. Schuster says. You may also receive six treatments of the combination chemotherapy without any radiation.

What Side Effects to Expect

Side effects are a reality with any type of cancer treatment you receive, and R-CHOP is no different. Chemotherapy indiscriminately kills quickly dividing cells, and sometimes healthy cells can get caught up and destroyed too.

Hair loss is one of the most noticeable side effects from chemotherapy, but your hair should grow back soon after you finish treatment. Other common side effects include:

• Fatigue
• Weakness
• Nausea and vomiting
• Shortness of breath
• Constipation
• Bruising and bleeding
• Mouth sores
• An increased risk of infection

Some of the drugs used in this therapy can cause nerve damage called neuropathy, with symptoms such as numbness and tingling in the fingers and toes.

“The side effects are not great,” Dr. Schuster admits. “But it’s a brief period in your life, and it’s a small price to pay for getting into remission and having this disease behind you.”

If the treatment didn’t have such a high success rate, it might not be worth the side effects. But because so many people have good results while on this treatment, “very few patients would not accept this therapy,” he adds.

He predicts that R-CHOP will remain the standard therapy for diffuse large B-cell lymphoma for “a long time,” because it would take a lot of research to find an alternative treatment that works as well.

If your doctor prescribes R-CHOP and you’re concerned about the side effects, have a conversation about what you can do to manage them. Many of the most bothersome chemotherapy side effects, including nausea and infections, are preventable with medications. And if you do find this treatment intolerable, your doctor might be able to adjust your dose to make it more bearable.

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