Regimen R-CHOP

Indication Diffuse Large B Cell Lymphoma

Therapeutic Intent Radical/Curative

Day Medication Dose Route Administration Details

Add to sodium chloride 0.9%. See local
1 Rituximab 375mg/m2 IV protocol or product SPC for information of rate
of infusion.
Max dose 2mg. 50ml sodium chloride 0.9%
1 Vincristine 1.4mg/m2 IV
minibag over 5-10 minutes.
1 Doxorubicin 50mg/m2 IV Slow IV bolus injection.
Slow IV bolus injection or add to sodium
1 Cyclophosphamide 750mg/m2 IV
chloride 0.9% and give over 30 minutes.
As a single dose with food in the morning. N.B
1 to 5 Prednisolone 100mg PO Day 1 may be given prior to the Rituximab
infusion as part of the pre-med

Cycle Frequency Every 21 days for 3-6 cycles depending on stage of disease

Tests required prior to
initiation of course
Tests required prior to
individual cycle
Concurrent Medication
FBC, U&E, LFT, Bone profile, glucose, LDH, B2M, serum Igs, hep B screen,
electrophoresis.
Undertake relevant staging.
Consider cardiac function tests.
WHO performance status.
FBC, U&E, LFT.
Antihistamine, corticosteroids and paracetamol pre-medication prior to
rituximab as per local policy.
Allopurinol for at least the first cycle.
Anti-emetics as per local policy.
PPI.
Consider antifungal, antiviral, PCP prophylaxis and mouthwashes as per
local policy.

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Dose Modifications
Hepatic Serum Bilirubin AST/ ALT Modification
(micromol/L) (units)

If AST 2-3 x ULN 75% of doxorubicin dose

21-50 or If AST >3x ULN 50% of doxorubicin dose
51-85 25% of doxorubicin dose
>85 Omit doxorubicin
26-51 or 60-180 50% of vincristine dose
>51 and Normal 50% of vincristine dose
>51 and >180 Omit
Renal Creatinine clearance (ml/min) Modification
>20 100% of cyclophosphamide
10-20 75% of cyclophosphamide
<10 50% of cyclophosphamide
Haematological No dose modifications for first cycle
Neutrophils (x109/L) Modification
<1.5 on day treatment due Delay cycle one or two weeks. If count has not
recovered after 14 days, stop chemotherapy
Grade 4 neutropenia or any febrile All subsequent cycles given with G-CSF support
neutropenia following any cycle of
CHOP
Grade 4 neutropenia leading to Reduce dose of cyclophosphamide and doxorubicin
infection despite G-CSF support by 50% for all subsequent cycles
Grade 4 neutropenia recurs despite Stop chemotherapy
50% dose reduction in
cyclophosphamide and doxorubicin
Platelets (x109/L) Modification
Platelets <100 on day treatment Delay cycle one or two weeks. If count has not
due recovered after 14 days chemotherapy will be
stopped
Grade 3 or 4 thrombocytopenia Reduce dose of cyclophosphamide and doxorubicin
following any cycle of CHOP by 50% for all subsequent cycles
Grade 3 or 4 thrombocytopenia Stop chemotherapy
recurs despite 50% dose reduction
in cyclophosphamide and
doxorubicin
Neurotoxicity Grade 2 motor weakness or Grade Give 50% vincristine
3 sensory toxicity
Higher grades of neurological OMIT vincristine
toxicity

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 NICE TA65

R-CHOP may be given every 14 days for 6 cycles (commonly referred to as

Additional Information RCHOP-14) depending upon clinician preference. G-CSF is highly
recommended for “RCHOP-14” starting on day 4 of cycle. A further 2 doses
of rituximab should be given for cycles 7 and 8 as monotherapy (14 day
interval).

1. R-CHOP-14 vs. 21 protocol. July 2006. NCRN

2. Dose Adjustments for Cytotoxics in Hepatic Impairment January 2009,
available at www.eastmidlandscancernetwork.nhs.uk
References
3. Dose Adjustments for Cytotoxics in Renal Impairment January 2009,
available at www.eastmidlandscancernetwork.nhs.uk
4. www.medicines.org.uk

Author Pharmacy CNG

Approved & Checked by Haematology CNG (Review Date = Jan 2017)

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