Side Effects of CHOP Chemotherapy in Non-Hodgkin's Lymphoma
Most Common Side Effects
Alopecia is universal, occurring in 100% of patients by cycle 3, making it the most frequent side effect of CHOP chemotherapy. 1
Hematologic Toxicity
- Myelosuppression is the primary dose-limiting toxicity, requiring monitoring before each cycle 2, 3
- Grade 4 neutropenia occurs frequently, particularly at higher doses, necessitating G-CSF support starting day 2-3 of each cycle 3, 4
- Treatment should be delayed if absolute neutrophil count <1,000/μL or platelets <75,000/μL 3
- Severe and potentially life-threatening neutropenia increases infection risk 5
Gastrointestinal Effects
- Nausea is rated by patients as the "most troublesome" problem, particularly severe in early treatment cycles 1
- Nausea occurs with significantly higher frequency compared to alternative regimens (P < 0.01) 5
- Taste changes affect 74% of patients 1
- Constipation is common and troublesome 1
- Mucositis occurs significantly more often with CHOP (P < 0.05) 5
Neurologic Toxicity
- Vincristine causes peripheral neuropathy and neurologic toxicity, occurring statistically more frequently than with alternative regimens 6, 5
- Neurologic side effects are dose-dependent and cumulative 5
Cardiovascular Toxicity
- Doxorubicin carries risk of cardiotoxicity, requiring baseline cardiac assessment and serial monitoring during and after treatment 3
- Cardiovascular toxicity incidence is similar across anthracycline-containing regimens 5
- For patients with poor left ventricular function, doxorubicin-sparing alternatives (RCEPP, RCDOP, RCNOP, RCEOP) should be used 3
Constitutional Symptoms
- Fatigue is the second most common side effect (77% incidence), most problematic in early treatment cycles 1
- Difficulty sleeping is frequently reported 1
Other Significant Toxicities
- Alopecia occurs significantly more with CHOP compared to alternative regimens (P < 0.001) 5
- Patients report a total of 80 different side effects across the treatment course 1
Critical Monitoring and Prevention
Infection Prophylaxis
- Pneumocystis jirovecii pneumonia prophylaxis with trimethoprim-sulfamethoxazole is mandatory throughout treatment and for 6-12 months after completion 3
- Herpes zoster prophylaxis with acyclovir or valacyclovir is required during treatment 3
Tumor Lysis Syndrome Prevention
- High tumor burden patients require aggressive IV hydration (2-3 L/m²/day) and rasburicase prophylaxis 7
- Monitor for hyperkalemia, hypocalcemia, and hyperphosphatemia 7
- Consider corticosteroid pre-phase for cases with high tumor load 7
Hepatitis Reactivation
- All patients must undergo hepatitis B testing (surface antigen and core antibody) before initiating treatment 2, 3
- For positive patients, check viral load and consult gastroenterology 2
Common Pitfalls to Avoid
- Never reduce chemotherapy doses for neutropenia—use G-CSF support instead to maintain dose intensity, which is critical for cure 3
- Ensure adequate hydration before cyclophosphamide administration and maintain good urine output 3
- Do not delay treatment to obtain PET-CT scans 2
- Antiemetics (5-HT3 antagonist plus dexamethasone) should be given on day 1 and continued for 2-3 days post-chemotherapy 3