What side effects can a patient expect after receiving R-CHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, and Prednisone) chemotherapy?

Expected Side Effects After R-CHOP Treatment

Patients can expect several common side effects in the days following R-CHOP therapy, with myelosuppression (particularly neutropenia), fatigue, and nausea being the most significant concerns that typically peak 7-14 days after treatment.

Immediate Side Effects (First 24-48 Hours)

• Infusion-related reactions: Most common with rituximab, occurring in up to 77% of patients during first infusion 1

  • Symptoms: fever, chills, rigors, hypotension, nausea, urticaria
  • Usually occur during first infusion and diminish with subsequent treatments
  • Most severe in first 30 minutes to 2 hours of infusion

• Nausea and vomiting: Common in the first 24-72 hours 2, 3

  • Patients reported postchemotherapy nausea as the "most troublesome" immediate side effect 3
  • Usually managed with antiemetics given during treatment

• Taste changes: Occur in approximately 74% of patients 3

  • May affect appetite and food enjoyment
  • Typically begins within 24-48 hours of treatment

Short-term Side Effects (Days 3-14)

• Myelosuppression: The most significant concern

  • Neutropenia: Occurs in 30-60% of patients (grade 3-4), with nadir typically 7-14 days after treatment 1
  • Thrombocytopenia: Occurs in 8-14% of patients (grade 3-4) 1
  • Anemia: Occurs in 3-11% of patients (grade 3-4) 1

• Fatigue: Second most common side effect (77% incidence) 3

  • Usually begins within days of treatment and may persist
  • Most problematic in the first part of the treatment course

• Increased risk of infection: Due to neutropenia

  • Bacterial infections most common (19%), followed by viral (10%) and fungal (1%) 1
  • Highest risk during neutropenic period (days 7-14)

• Gastrointestinal effects:

  • Constipation: Due to vincristine and supportive medications
  • Mucositis: Inflammation of mucous membranes
  • Diarrhea: Less common than constipation

• Sleep disturbances: Difficulty sleeping reported as one of the top five troublesome side effects 3

  • Often related to steroid component (prednisone)
  • Typically worse for the first 3-5 days while on prednisone

Other Important Considerations

• Hair loss (alopecia): Will begin 2-3 weeks after first treatment

  • All patients experience some hair loss by cycle 3 3

• IgM flare: In patients with certain lymphomas like Waldenström's macroglobulinemia

  • Can occur with rituximab, potentially causing hyperviscosity symptoms 4

• Peripheral neuropathy: Due to vincristine

  • May begin after first cycle but usually cumulative with subsequent cycles

Monitoring and Management

• Complete blood counts should be monitored regularly, particularly 7-14 days after treatment when neutropenia risk is highest 1

• Patients should monitor for fever (>38°C/100.4°F), which requires immediate medical attention during the neutropenic period

• Adequate hydration and antiemetics are important for managing nausea and preventing dehydration

• Fatigue management includes balanced rest and activity, with particular attention during days 7-14 when blood counts are lowest

Important Precautions

• Avoid crowds and people with infections during the neutropenic period (typically days 7-14)

• Practice good hand hygiene and food safety

• Report any fever or signs of infection immediately, as neutropenic fever is a medical emergency

• Be aware that symptoms may be cumulative with subsequent cycles of R-CHOP therapy

Most side effects are temporary and will improve before the next cycle of treatment. The patient's healthcare team should be contacted if symptoms are severe or concerning.