This information is best read with our general information about chemotherapy and non-Hodgkin lymphoma.
The drugs used in R-DHAPBack to top
R-DHAP is named after the initials of the drugs used for treatment. The drugs are:
Rituximab is not a chemotherapy drug. It is a targeted therapy and belongs to a group of drugs called monoclonal antibodies.
You will usually be given R-DHAP during a short stay in hospital. Sometimes, you may have it as an outpatient. A chemotherapy nurse will give it to you. During treatment you usually see a cancer doctor, a blood specialist (haematologist), a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the first day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Before giving you chemotherapy, the nurse will give you anti-sickness (anti-emetic) drugs. You will be given extra fluids through a drip before and after cisplatin chemotherapy. This is to protect your kidneys. You may also be given a drug called mannitol. Mannitol increases the amount of urine your kidneys make.
The drugs and fluids can be given in one of two ways:
- through a fine tube that goes under the skin of your chest and into a vein close by (central line)
- through a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
The drugs are run through a pump, which gives you the treatment over a set time. You have lots of drugs and fluids given in R–DHAP, so you may have two drips running at the same time.
Dexamethasone is usually given as tablets but may be given as a drip (an infusion).
When the chemotherapy is being given
Some people might have side effects while the chemotherapy is being given:
Rituximab and, rarely, cisplatin may cause an allergic reaction. Your doctor or nurse will check you for this. Signs of a reaction can include:
- flu-like symptoms (headaches, high temperature or chills)
- feeling sick
- a rash
- feeling itchy or short of breath
- swelling of your face or lips
- pain in your back, tummy or chest
- feeling unwell.
Tell your nurse straight away if you have any of these symptoms.
Your course of R-DHAP
R-DHAP is given over four days.
On day one your nurse will give you dexamethasone. You will also have rituximab and cisplatin through a drip.
You’ll usually be given rituximab first. Some people have a reaction to rituximab. The nurse will give you drugs to help prevent or reduce this. It is more common to have a reaction with the first treatment, so you have it slowly over a few hours.
Your nurse will then give you cisplatin as a drip (infusion) over 24 hours.
On day two you have dexamethasone and cytarabine. The cytarabine is given as two infusions, 12 hours apart. Each infusion is given over two to three hours.
On days three to four you continue with dexamethasone.
After the four days of treatment, you have a rest period with no treatment for either 17 or 24 days (your doctor will explain which). This completes what is called a cycle of your chemotherapy treatment. Each cycle takes 21 or 28 days (three or four weeks).
At the end of this rest period, you start your second cycle of R-DHAP. This is the same as the first cycle, except your rituximab infusion may be given over a shorter time.
Your doctor or nurse will tell you the number of cycles you are likely to have.
You can usually go home after the first two days of your course of chemotherapy, when you have had all your chemotherapy infusions. Most people then have dexamethasone as tablets, which they take home to complete the four days of treatment. You will also be given other drugs to take to prevent side effects such as sickness. Take all your tablets exactly as your doctor or nurse explains.
You will be given steroid eye drops, which help prevent sore eyes. Your doctor or chemotherapy nurse will tell you how and when to use them.
Possible side effects of R-DHAPBack to top
We explain the most common side effects of R-DHAP here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this drug
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Risk of infection
R-DHAP can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia. Your doctor may prescribe you antibiotics to help prevent an infection (called prophylactic antibiotics).
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
R-DHAP can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
R–DHAP can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
Reaction to cytarabine
Cytarabine may cause a reaction 6 to 12 hours after it’s been given. Signs of a reaction can include:
- a high temperature or chills
- a rash
- pain in the eyes, bones, tummy or chest.
Tell your nurse or contact the hospital straight away if you have any of these symptoms.
This may happen in the first few days of your chemotherapy. The nurses will give you anti-sickness (anti-emetic) drugs regularly. If you still feel sick, tell your nurse or doctor. They can change the anti-sickness drug to one that works better for you.
Some anti-sickness drugs can make you constipated. Tell your doctor or nurse if this is a problem.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
R-DHAP may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe steroid eye drops to help prevent this. It’s important to use these as instructed.
It may also make your eyes more sensitive to light and cause blurry vision. Always tell your doctor or nurse if you have pain or notice any change in your vision.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Changes in hearing
Cisplatin can affect your hearing. You may have a hearing test before you start treatment. You may get ringing in your ears (tinnitus) and lose the ability to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Effects on the nervous system
R-DHAP can affect the nervous system. You may feel anxious or restless, have problems sleeping or experience mood changes. You may feel drowsy or confused or feel dizzy or unsteady. Tell your doctor or nurse straight away if you notice any of these symptoms.
Changes in the way the kidneys work
Cisplatin can affect how your kidneys work. You will have blood tests before, during and after treatment to check this. To protect your kidneys, you will have extra fluids through a drip before and after chemotherapy.
Your nurse will ask you to drink plenty of fluid. Tell them if there are any changes in how much urine you are producing.
Raised blood sugar
Steroids can raise your blood sugar levels. Your nurse will check your blood regularly for this. They may also test your urine for sugar. Symptoms of raised blood sugar include feeling thirsty, needing to pass urine more often and feeling tired. Tell your doctor or nurse if you have these symptoms.
If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this. You may need to adjust the dose of your insulin or diabetes tablets.
Less common side effects of R-DHAPBack to top
Raised levels of uric acid in the blood
R-DHAP may cause the lymphoma cells to break down quickly. This releases uric acid (a waste product) into the blood. Too much uric acid can cause swelling and pain in the joints, which is called gout, and kidney stones.
Your doctor may give you tablets called allopurinol to help prevent this. Drinking at least two litres (three and a half pints) of fluid a day will also help. You will have regular blood tests to check the uric acid levels.
Numb or tingling hands or feet
These symptoms are caused by the effect of cisplatin on the nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but in some people they may never go away. Talk to your doctor if you are worried about this.
Your hair may thin but you’re unlikely to lose all the hair from your head. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss.
Tummy pain and/or indigestion
Steroids can irritate the stomach lining. Let your nurse or doctor know if you have pain in your tummy or indigestion. They can prescribe drugs to help reduce stomach irritation.
Take your tablets with food to help protect your stomach.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about R-DHAPBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
R-DHAP may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid.
Changes to your periods
R-DHAP can sometimes stop the ovaries working. You might not get a period every month and they may eventually stop. In some women this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them the contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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