R-ESHAP is a chemotherapy treatment used to treat non-Hodgkin lymphoma (NHL).
This information is best read together with our general information about chemotherapy and NHL.
The drugs used in R-ESHAPBack to top
R-ESHAP is named after the initials of the drugs used for treatment. The drugs are:
Rituximab is not a chemotherapy drug. It belongs to a group of drugs called monoclonal antibodies.
You usually have R-ESHAP in the chemotherapy day unit or during a short stay in hospital. 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 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 the treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness (anti-emetic) drugs before giving you chemotherapy. You will also be given extra fluids through a drip before and after 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 chemotherapy, rituximab and fluids are usually given through:
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
They are run through a pump, which gives you the treatment over a set time. Because lots of drugs and fluids are given in R-ESHAP, you will often have two drips running at the same time.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy.
Rituximab, and rarely cisplatin, may cause a reaction. Signs of a reaction can include:
- flu-like symptoms (headaches, high temperature or chills)
- feeling sick
- a rash
- feeling itchy
- 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-ESHAP
R-ESHAP is given over five days.
On day one the nurse will give you an infusion of rituximab. Some people have a reaction to rituximab. The nurse will give you drugs to help prevent or reduce this. It is more common with the first treatment, so you have it slowly over a few hours.
The rituximab is followed by infusions of:
- cytarabine over two to three hours
- etoposide over an hour
- methylprednisolone over 15 to 30 minutes.
The nurse will also start the first of four 24-hour infusions of cisplatin that will run continuously for four days.
On day two you will continue with the cisplatin infusion and the nurse will repeat the etoposide and methylprednisolone infusions.
Days three and four are the same as day two.
On day five, the cisplatin infusion finishes and your nurse will give you methylprednisolone.
Sometimes cytarabine is given on day five instead of day one. The methylprednisolone is sometimes given by mouth as tablets. If you are given mannitol, you’ll usually be given this on days one to four.
It may be possible to have the cisplatin infusions through a small portable pump you can take home. You will need to return each day for the etoposide and methylprednisolone, and to have the cisplatin infusion changed. Your nurse or pharmacist will explain how the pump works and how to look after it.
After the five days of treatment, you will have a rest period with no treatment for either 16 or 23 days. Your doctor will explain how long your rest period will be. 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-ESHAP. 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.
Before you go home, the nurse or pharmacist will give you drugs to take at home to prevent side effects such as sickness. Take all your tablets exactly as your nurse or pharmacist has explained.
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-ESHAPBack to top
We explain the most common side effects of R-ESHAP 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 these drugs
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-ESHAP 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 nurse may give you injections of a drug called G-CSF under the skin. It encourages the bone marrow (where blood cells are made) to make more white blood cells.
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 – these 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-ESHAP 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-ESHAP 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 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.
You will probably feel very tired and need a lot of rest. Try to balance this with some gentle exercise, such as short walks, which will help. You’ll probably tire easily for some months after your treatment, but this will gradually get better.
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.
R-ESHAP 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.
You will usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. 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. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
You may get pain or discomfort in your tummy (abdomen). Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain doesn’t improve or gets worse.
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.
Numb or tingling hands or feet
These symptoms are caused by the effect of cisplatin on 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.
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.
Changes in the way the kidneys work
R-ESHAP can affect how your kidneys work. You will have blood tests before and during treatment to check this. Your nurse will ask you to drink plenty of fluid. Tell them if there are any changes in how much urine you are producing.
Effects on the nervous system
R-ESHAP 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.
Raised levels of uric acid in the blood
R-ESHAP 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.
Your doctor may give you tablets called allopurinol (Zyloric ®) to help prevent this. Drinking at least two litres (three and a half pints) of fluids a day will also help. You will have regular blood tests to check the uric acid levels.
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 your insulin or tablet dose.
Effects on the lungs
R-ESHAP can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
It’s important to let your nurse or doctor know straight away if you feel unwell or have side effects, even if they’re not mentioned above.
Other information about R-ESHAPBack 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-ESHAP 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
Chemotherapy 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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