The first treatment given for diffuse large B-cell lymphoma (DLBCL) is usually a drug combination called R-CHOP. DLBCL is a fast-growing type of non-Hodgkin lymphoma (NHL) that affects white blood cells called B cells or B lymphocytes. If you or a loved one has been diagnosed with DLBCL, you may wonder what to expect with R-CHOP treatment, how well it works, or what side effects it can cause.

In this article, we’ll cover how R-CHOP targets cancerous B cells and what you can expect during treatment. If you have specific questions about your individual treatment, talk to your doctor. They can discuss your DLBCL treatment options and help you choose which might give you the best outcome.

5 Important Facts About R-CHOP

Here are five important facts to know about R-CHOP for DLBCL.

1. R-CHOP Is a Combination of Drugs

R-CHOP is a combination of five different drugs given together as one treatment. The name “R-CHOP” comes from the each drug name, as follows:

• Rituximab (Rituxan)
• Cyclophosphamide (Cytoxan)
• Doxorubicin (Adriamycin), also called hydroxydaunomycin
• Vincristine (formerly sold as Oncovin)
• Prednisone

Cyclophosphamide, doxorubicin, and vincristine are all different types of chemotherapy drugs. These drugs can destroy cells that divide quickly. This makes chemotherapy regimens useful for eliminating cancer cells, which divide much more quickly than normal cells.

Prednisone is a corticosteroid drug that also plays an important role. Corticosteroids — also called steroids or steroid hormones — act on the immune system to reduce inflammation.

Rituximab — a monoclonal antibody — is a type of immunotherapy, meaning it affects cells of the immune system. Rituximab targets B cells and can send the chemotherapy drugs directly to the lymphoma cells.

2. R-CHOP Is the Standard First-Line Treatment for DLBCL

R-CHOP is the standard of care for DLBCL, meaning most doctors agree that it’s the best treatment to start with. If you’ve never been treated for DLBCL, there’s a good chance that your doctor will recommend R-CHOP. However, people with some types and subtypes of DLBCL may not get the standard R-CHOP therapy.

Some cases of DLBCL are caused by HIV infection. A person with HIV-related DLBCL may get treated with a different, more aggressive therapy called R-EPOCH instead of R-CHOP. R-EPOCH includes the same drugs as R-CHOP plus another drug called etoposide.

Some older people may find R-CHOP too toxic to handle. In these cases, R-miniCHOP may be recommended. This therapy uses the same drugs in R-CHOP but at a lower dose, making it easier to tolerate the side effects.

3. R-CHOP Is Usually Given as Six Cycles of Treatment

Each time you go in for treatment counts as one R-CHOP treatment cycle. On average, a treatment regimen requires six cycles of R-CHOP. However, the exact number of treatment cycles you’ll get depends on your specific case.

In a typical R-CHOP regimen, you’ll be treated once every 21 days, although sometimes a 14-day regimen is used. During treatment, rituximab and the chemotherapy agents are given intravenously (into a vein) all on the same day — this is when a needle is used to deliver the medicine straight to your bloodstream. Only prednisone is a tablet that you can swallow.

For instance, if you have early-stage DLBCL — meaning the cancer cells haven’t spread that far throughout your body — you may need fewer than six cycles of R-CHOP. Your doctor may also recommend radiation therapy — also called radiotherapy — in addition to R-CHOP chemotherapy. This can help to kill cancer cells that are in your lymph nodes.

4. Side Effects of R-CHOP Can Vary

Like most cancer treatments, R-CHOP can cause many side effects. Some of these side effects are fairly common, while others are more rare.

Common Side Effects

R-CHOP often decreases your blood cell counts. This can happen for all types of blood cells, including red blood cells, white blood cells, and platelets.

White blood cells help your body to fight bacteria and viruses. When your white blood cell level gets too low, this puts you at a high risk of infection and can cause symptoms like:

• Fever
• Aches and chills
• Generally feeling ill
• Headaches

Red blood cells help to carry oxygen throughout your body. When you have anemia (low levels of red blood cells), you may easily get out of breath or feel tired.

Platelets allow your blood to clot, which helps your body to heal from injuries. If you have low platelet levels, you can bruise easily or bleed a lot, even from minor injuries.

Many people can also be sensitive to rituximab. If this applies to you, R-CHOP therapy could cause symptoms of an allergic reaction, including:

• An itchy rash
• Swollen lips, throat, or face
• Trouble breathing
• Fever and chills

There are many other common side effects of R-CHOP, such as:

• Swollen limbs
• Digestive problems like inflammation, constipation, diarrhea, or abdominal pain
• Problems urinating or urinating a lot
• Hair loss
• Numbness, tingling, or pain in your limbs
• Weight loss or weight gain

Even if they’re common, side effects of treatment can be very uncomfortable. Let your health care team know if you’re having side effects that are bothering you. They may change your treatment regimen to give you some relief or give you additional medications to help with side effects.

Less Common Side Effects

Other side effects happen in less than 10 percent of people with DLBCL. Less common side effects of R-CHOP treatment may include:

• Muscle spasms (twitching) or cramps
• Vision problems
• Night sweats
• Seizures
• Increased risk for other types of cancer like leukemia
• Weak bones that break or fracture easily
• Organ failure
• Mood problems like anxiety or depression

If you experience any side effects that are sudden or severe, contact your health care team to get medical attention right away.

5. R-CHOP Is Very Effective for Most People

For most people, R-CHOP is very effective at treating DLBCL. About 50 percent to 70 percent of people with DLBCL respond well to R-CHOP, and their cancer cells completely go away. However, R-CHOP doesn’t work as well in about 30 percent to 40 percent of people. Often, this is because their cancer is refractory to treatment — this means that most of the cancer cells couldn’t be destroyed. In other cases, the cancer can relapse — this is when the cancer responds to treatment at first but then comes back.

Other Treatment Options for DLBCL

Although R-CHOP is a good treatment for most people with DLBCL, it’s not right for everyone, and it’s not the only option. If you’re interested in learning about other options, talk to your doctor about the different therapies that are available for treating DLBCL. They’ll review your medical history and discuss treatment options that may be a good fit for you.

If You Have a Heart Condition

The drug doxorubicin can be harmful for people with certain heart conditions. If you have an underlying condition that would make it dangerous to get R-CHOP, your doctor may start with a different chemotherapy treatment that doesn’t use doxorubicin.

If Cancer Returns

If you do get R-CHOP therapy, there’s a chance that your cancer could relapse after treatment. If this happens, your doctor may recommend chemotherapy again — although it may not be R-CHOP — followed by a bone marrow transplant. This is a procedure that involves replacing the cells in your bone marrow with healthy cells to try to completely eliminate the cancer.

If Your First Treatments Don’t Work

If your cancer is refractory to R-CHOP or other types of chemotherapy, your doctor may recommend immunotherapy. Examples of immunotherapy include chimeric antigen receptor (CAR) T-cell therapies like brexucabtagene autoleucel (Tecartus) and tisagenlecleucel (Kymriah). CAR T-cell therapy involves changing your own T cells to better fight cancer. Bispecific antibodies are a newer type of immunotherapy. Bispecific antibodies approved to treat DLBCL include epcoritamab-bysp (Epkinly) and glofitamab-gxbm (Columvi). These drugs can target cancer cells and activate the immune system to destroy them.

Depending on the details of your cancer, the right therapy for you could be R-CHOP or another therapy. Together, you and your doctor can come up with a treatment plan to help meet your treatment goals.

Talk With Others Who Understand

MyLymphomaTeam is the social network for people with lymphoma and their loved ones. On MyLymphomaTeam, more than 17,000 members come together to ask questions, give advice, and share their stories with others who understand life with lymphoma.

Do you have more questions about R-CHOP for treating diffuse large B-cell lymphoma? Have you already had R-CHOP therapy? Share your experiences in the comments below, or start a conversation by posting on your Activities page.