DERBY-BURTON LOCAL CANCER NETWORK

R-CHOP.DOC

FILENAME

CONTROLLED DOC NO: HCCPG B24

CSIS Regimen Name:
R-CHOP

R-CHOP Regimen
Available for Routine Use in
Derby in-patient

Burton in-patient

(First cycle if bulky disease

& risk of tumour lysis
syndrome)

Burton day-case
Burton community
Burton out-patient
Indication
Treatment Intent
Anti-Emetics
Frequency &
Duration

Derby day-case
Derby community
Derby out-patient

CD20-positive diffuse large-B-cell lymphoma at clinical

stage II, III or IV; follicular lymphoma
Radical
Pre-chemotherapy
2
Post-chemotherapy A
Every 21 days for 6- 8 cycles

Day 1 Ondansetron
Paracetamol

8mg
1g

Chlorphenamine

10mg

Hydrocortisone

100mg

Prednisolone

100mg

Rituximab

375mg/m2

Cyclophosphamide
Doxorubicin
Vincristine

Metoclopramide

750mg/m2
50mg/m2
1.4mg/m2
maximum
2mg
(See notes)
10mg

Allopurinol
Cotrimoxazole

300mg
960mg

Omeprazole
Aciclovir

20mg
400mg

DATE OF ISSUE: 21.12.12

REVIEWED BY C.WARD
REVIEW DATE: 21.12.14

As a single oral dose

As a single oral dose 30
minutes prior to rituximab
As a single intravenous bolus
30 minutes prior to rituximab
As a single intravenous bolus
30 minutes prior to rituximab
Oral once daily for 5 daysgive first dose 30 minutes
prior to rituximab
Intravenous infusion in 500ml
sodium chloride 0.9%
Intravenous bolus
Intravenous bolus
Intravenous infusion in 50ml
sodium chloride 0.9% over 510 minutes
Oral four times daily for 2 days
then as required
Oral once daily for 1-2 cycles
Oral twice daily Mondays and
Thursdays for 21 days
Oral once daily for 5 days
Oral twice daily for 21 days

AUTHORISED BY Dr J Addada

*** VALID ON DATE OF PRINTING ONLY ***

VERSION 6
PAGE 1 of 6

DERBY-BURTON LOCAL CANCER NETWORK

FILENAME

R-CHOP.DOC

CONTROLLED DOC NO: HCCPG B24

CSIS Regimen Name:
R-CHOP

Notes:
Baseline investigations
Cardiac assessment (e.g. MUGA) in those patients 65 years or those
with a cardiac history
Rituximab
This section should be read in conjunction with the Guidelines for the
administration of Rituximab.
1. The day 1 dose of prednisolone should be given 30 mins prior to
receiving rituximab.
Premedication consisting of analgesia and an antihistamine and an
intravenous corticosteroid should always be administered 30 minutes
before each infusion of rituximab. (e.g. paracetamol 1g oral STAT and
chlorphenamine 4mg oral or 10mg IV bolus STAT and hydrocortisone
100mg IV STAT). In addition pethidine 25mg IV should be available in
case of a severe infusion reaction.
2. Rituximab doses should be rounded to the nearest 100mg
Use rituximab rate calculator to assist with rate escalation of rituximab
infusion.
3. Occurrence of an Infusion Related Event or Hypersensitivity:
Stop the infusion and contact a doctor.
When symptoms improve, continue the infusion at half the rate prior to
the reaction.
Accelerate the infusion rate more slowly as tolerated by the patient.
Dose modifications and toxicities
Patients older than 70: consider reducing the initial vincristine dose to a
fixed dose of 1mg (elderly CHOP) ), giving a 1 week steroid pre-phase
and/or escalating the dose of anthracycline progressively with each cycle,
e.g. 50% cycle 1, 75% cycle 2, 100% cycle 3, according to patient
tolerability.

DATE OF ISSUE: 21.12.12

REVIEWED BY C.WARD
REVIEW DATE: 21.12.14

AUTHORISED BY Dr J Addada

*** VALID ON DATE OF PRINTING ONLY ***

VERSION 6
PAGE 2 of 6

DERBY-BURTON LOCAL CANCER NETWORK

FILENAME

R-CHOP.DOC

CONTROLLED DOC NO: HCCPG B24

CSIS Regimen Name:
R-CHOP

1. Haematological toxicity
At the start of each cycle the neutrophil count should be > 1.0 x 109/l
and platelets > 100 x 109/l
a) Neutropenia
Neutrophils <1.0 x 109/l

Grade 4 neutropenia* or febrile

neutropenia following any cycle of
RCHOP
Grade 4 neutropenia* leading to
infection despite GCSF support

Grade 4 neutropenia* recurs despite

50% dose reduction in
cyclophosphamide and doxrubicin
b)Thrombocytopenia
Platelets < 100 x 109/l
Grade 3 or 4 thrombocytopenia*
following any cycle of RCHOP

Grade 4 thrombocytopenia* recurs

despite 50% dose reduction in
cyclophosphamide and doxorubicin

Delay one week and give

GCSF with subsequent cycles
(days 7,9,11 initially)
Give GCSF support with all
subsequent cycles
Consider 50% reduction of
cyclophosphamide and
doxorubicin for all subsequent
cycles
Consider termination of
protocol

Delay one week

Reduce dose of
cyclophosphamide and
doxorubicin by 50% for all
subsequent cycles
Consider termination of
protocol

2. Renal impairment
Cyclophosphamide
GFR ml/min
>20
10-20
<10

Dose
100%
75%
50%

Dose reduction for renal impairment is not required for doxorubicin or

vincristine.

DATE OF ISSUE: 21.12.12

REVIEWED BY C.WARD
REVIEW DATE: 21.12.14

AUTHORISED BY Dr J Addada

*** VALID ON DATE OF PRINTING ONLY ***

VERSION 6
PAGE 3 of 6

DERBY-BURTON LOCAL CANCER NETWORK

FILENAME

R-CHOP.DOC

CONTROLLED DOC NO: HCCPG B24

CSIS Regimen Name:
R-CHOP

3. Hepatic impairment
Doxorubicin
Bilirubin
micromol/L
<20
20-51
52-85
>85

Dose
100%
50%
25%
contraindicated

Or
AST
Dose
Units/L
2-3x ULN 75%
>3x ULN 50%

Vincristine
Bilirubin
micromol/L
26-51
or
>51
&
>51
&

AST/ALT
Units/l
60-180
normal
>180

Dose
50%
50%
omit

4. Neurotoxicity
Vincristine
If grade 2 motor weakness* or grade 3 sensory toxicity*, reduce dose to
1mg. or replace vincristine by vinblastine 6mg/m2 (max 10mg). For
higher grade toxicity omit.
*NCI Common Toxicity Criteria

Toxicity
Neutrophils
x 109/l
Platelets
x 109/l
Neuropathy
(motor)

1
1.5-1.99
75-149

Grade
2
3
1.0-1.49
0.5-0.99
50-74

10-49

4
<0.5
<10

Subjective
Mild
Objective
Paralysis
weakness
objective
weakness
but no
weakness
interfering
objective
interfering
with activities
DATE OF ISSUE: 21.12.12
VERSION 6
REVIEWED BY C.WARD
AUTHORISED BY Dr J Addada
PAGE 4 of 6
REVIEW DATE: 21.12.14

*** VALID ON DATE OF PRINTING ONLY ***

DERBY-BURTON LOCAL CANCER NETWORK

FILENAME

R-CHOP.DOC

CONTROLLED DOC NO: HCCPG B24

CSIS Regimen Name:
R-CHOP

findings

Neuropathy
(sensory)

Loss of deep
tendon
reflexes or
parasthesia
(including
tingling) but
not
interfering
with function

with function,
but not
interfering
with activities
of daily living
Objective
sensory loss
or
parasthesia
(including
tingling)
interfering
with function,
but not
interfering
with activities
of daily living

of daily living

Sensory loss
or
parasthesia
interfering
with activities
of daily living

Permanent
sensory
loss that
interferes
with
function

Supportive care
1. It is advisable to give allopurinol (300mg) once a day for the first 1 or 2
courses of therapy whilst there is bulky disease. Reduce dose to 100mg
daily if GFR <10mls/min.
2. All patients should receive Pneumocystis jirovecii prophylaxis
throughout treatment:
Cotrimoxazole 960mg twice daily twice weekly (on Mondays and
Thursdays only). In cases of allergy to cotrimoxazole consider dapsone
100mg daily.
3. Omeprazole 20mg once daily for 5 days (i.e. concurrently with
prednisolone).
4. GCSF 300 micrograms once daily by subcutaneous injection on days 7,
9, 11 (& 13) if 65 years or has developed neutropenic sepsis with
previous cycles of chemotherapy.

References
1. NICE Technology Appraisal No. 65; Rituximab for aggressive nonHodgkins lymphoma, Issue date: September 2003
2. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab
compared with CHOP alone in elderly patients with diffuse large B-cell
lymphoma. N Engl J Med. 2002;346:235-242.

DATE OF ISSUE: 21.12.12

REVIEWED BY C.WARD
REVIEW DATE: 21.12.14

AUTHORISED BY Dr J Addada

*** VALID ON DATE OF PRINTING ONLY ***

VERSION 6
PAGE 5 of 6

DERBY-BURTON LOCAL CANCER NETWORK

FILENAME

R-CHOP.DOC

CONTROLLED DOC NO: HCCPG B24

CSIS Regimen Name:
R-CHOP

3. British Committee for Standards in Haematology - Guidelines on

diagnosis and therapy Nodal non-Hodgkin's lymphoma; August 2002
[draft 2]
4. Using Vinca Alkaloid Minibags (Adults/Adolescent Units); NPSA Rapid
Response Alert 4; 11 August 2008

DATE OF ISSUE: 21.12.12

REVIEWED BY C.WARD
REVIEW DATE: 21.12.14

AUTHORISED BY Dr J Addada

*** VALID ON DATE OF PRINTING ONLY ***

VERSION 6
PAGE 6 of 6