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This information is about a chemotherapy| treatment for low grade B-cell lymphomas| called R-CVP.
R-CVP is named after the initials of the drugs used, which are:
Rituximab belongs to a group of drugs known as monoclonal antibodies|. It’s used to treat several different kinds of B-cell non- Hodgkin lymphoma.
Monoclonal antibodies recognise and lock on to specific proteins on the surface of cancer cells. This helps the body's immune system recognise the cancer cells and destroy them. Monoclonal antibodies are sometimes called targeted therapies, because they target cancer cells.
Rituximab locks on to a protein called CD20, which is found on the surface of white blood cells called B-lymphocytes, or B-cells. This triggers the body’s immune system to attack the cells and destroy them.
As well as being found on the surface of normal B-cells, CD20 is also present on most of the abnormal B-cells that occur in many types of non‑Hodgkin lymphomas| and on some of the abnormal B-cells found in chronic lymphocytic leukaemia| (CLL).
Rituximab destroys both abnormal (malignant) and normal B-cells. However, the body can replace normal B-cells that are damaged so their numbers recover once treatment is over.
R-CVP can usually be given to you as a day patient. The first treatment of R-CVP can take longer so you may need to stay overnight in hospital.
Before you start treatment you'll need to have a blood test, either on the same day or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy. All of this may take a couple of hours.
The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn't take long.
Some people have their chemotherapy given through a thin, plastic tube that is inserted under the skin and into a vein near the collarbone (a central line|) or passed through a vein in their arm (a PICC line|). Your doctor or nurse will explain more about this to you.
Once your chemotherapy is ready you'll be given anti-sickness (anti-emetic)| drugs. These are usually given by injection through the cannula or into your line but can also be given as tablets. You'll also be given drugs to prevent an allergic reaction that some people have when rituximab is given.
The first dose of rituximab is given slowly into the vein as a drip (infusion) over a few hours. This is because some people can have an allergic reaction| to it. If you do have a reaction the infusion can be stopped and started again more slowly when the symptoms have reduced. You may need to stay in hospital overnight for the first treatment so you can be monitored. After this you should be able to have your rituximab more quickly and all your treatment as an outpatient.
It may take about four hours for all the drugs to be given:
If you're having treatment as a day patient, you can go home when it's finished and the cannula will be removed before you go. If you have a central or PICC line, it will usually stay in place ready for your next cycle of chemotherapy. You'll be shown how to look after the line.
Before you go home you'll be given a course of prednisolone tablets. The first dose of the prednisolone is usually given with your chemotherapy. It's important to take all the tablets as prescribed by your doctor.
You'll also be given a supply of anti-sickness tablets to take home with you. It's important to take these regularly as directed even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than at stopping it once it has started.
Your doctor may use the word 'regimen|' (eg the R-CVP regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of the particular treatment you're having.
On the first day of your treatment, you'll be given rituximab, cyclophosphamide and vincristine.
On the same day you'll begin a five-day course of prednisolone tablets. When you have finished the tablets you'll have a rest period with no treatment for the next 16 days. This completes what is called a cycle of treatment. Each cycle takes 21 days (three weeks).
After the rest period the same treatment will be repeated, which begins the next cycle of your chemotherapy. Usually 6–8 cycles are given over a period of 4–6 months. This makes up a course of treatment.
Each person’s reaction to their treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who is having this treatment.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you do notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Some people have an allergic reaction to rituximab while it’s being given. Signs of this include flu-like symptoms (headaches, high temperature or chills), feeling sick, skin rashes and itching, breathlessness, or pain in your back, tummy or chest.
It‘s most common with the first infusion, so the first dose is given slowly over a number of hours. You’ll also be given medicines before the treatment to help prevent or reduce any reaction. You’ll be monitored closely during your infusion, but it's important to tell your nurse or doctor if you feel unwell or have any of the above symptoms. If you do have a reaction, it can be treated quickly.
Sometimes a reaction can happen a few hours after treatment. If you develop these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
This may happen during the infusion of rituximab, so your blood pressure will be regularly checked. If you usually take drugs to lower your blood pressure your doctor may advise you to take these at least 12 hours before you have rituximab. It’s important not to do this without discussing it with your doctor first.
R-CVP can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow|. If the number of your white blood cells is low you'll be more prone to infections|. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment. Your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
R-CVP can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion| if your platelet count is low.
R-CVP can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless|. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion| if the number of red blood cells becomes too low.
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting|. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Cyclophosphamide may irritate your bladder. It’s important to drink as much fluid as you can (at least two litres) during the 24 hours following chemotherapy to help prevent this. Let your doctor know if you have any discomfort when you pass urine or if you notice any blood in it.
This is due to the effect vincristine has on nerves and is known as peripheral neuropathy|. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly a few months after the treatment has finished. Sometimes symptoms can persist; talk to your doctor if this happens.
Vincristine can cause pain in your tummy (abdomen) and constipation|. Let your doctor know if you develop pain. It can usually be controlled with mild painkillers.
Constipation can usually be helped by drinking plenty of fluids, eating more fibre and doing some gentle exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Feeling tired| is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Hair usually thins| rather than falling out completely. This usually starts 2–4 weeks after the first cycle of treatment. You may also have thinning and loss of eyelashes, eyebrows and other body hair|. Hair loss is temporary and your hair usually starts to grow again when your treatment is over.
Your mouth may become sore| or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different|. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Prednisolone can irritate the lining of the stomach and may cause a stomach ulcer or make one worse. You should take the tablets with a meal or a drink of milk to reduce this side effect. Tell your doctor if you have indigestion, pain or discomfort in the tummy (abdomen). You may be prescribed medication to reduce irritation of the stomach.
You may notice you feel hungrier than usual while taking prednisolone, and this can make you want to eat more. If you’re concerned about gaining weight|, you can speak to your doctor, specialist nurse or dietitian.
Occasionally, prednisolone can cause your blood sugar level to rise. During treatment you may have regular blood tests to check this. Your urine may also be tested for sugar.
Tell your doctors if you get very thirsty or if you’re passing more urine than usual. This can be a sign that your blood sugar level is rising.
Prednisolone may affect the salt and water balance in your body. You may notice that your ankles and/or fingers swell. Some people have a bloated feeling in the abdomen. Let your doctor know if this happens. This is usually only a problem with long-term steroid treatment.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat.
Sometimes areas of skin that have been treated with radiotherapy| may become red and sore. Tell your doctor if this happens.
The chemotherapy may cause some changes to the lungs. Tell your doctor if you smoke or if you notice any coughing or breathlessness.
The colour of your nails may change. They may become darker and white lines may appear on them. These usually grow out over several months once the treatment has finished.
Occasionally, steroids can cause mood swings, difficulty sleeping and anxiety or irritability. Let your doctor know if there are any changes in your behaviour that are worrying you. Difficulty with sleeping may be helped by taking the steroids in the early part of the day, but discuss this with your doctor first.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies| and herbal drugs|.
You may have a sudden feeling of warmth and some reddening in your face. This can happen for a short period of time while rituximab is being given.
If this happens when vincristine is being given, the tissue in that area can become damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Your ability to become pregnant or father a child is likely to be affected by having this treatment. It's important to discuss fertility| with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having CVP as it may harm the developing baby. It’s important to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
Because of the effect chemotherapy has on the ovaries, women may find that their periods become irregular and may eventually stop. In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based upon our R-CVP chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.
Content last reviewed: 1 December 2011
Next planned review: 2013
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Watch our slideshow with tips for coping with a poor appetite
Watch our slideshow with tips for coping with a sore mouth
Watch our video about coping with fatigue
Watch our slideshow about avoiding infection when you have reduced immunity
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