What is CHOP?

CHOP is used to treat non-Hodgkin lymphoma (NHL).

It is best to read this information with our general information about chemotherapy and the type of cancer you have.

CHOP comes from the initials of the drugs used:

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

More information about this treatment

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

How CHOP is given

You will be given CHOP in the chemotherapy day unit or during a stay in hospital. A chemotherapy nurse will give it to you. 

During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist 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 your blood cells are at a safe level to have chemotherapy. 

You will see a doctor or nurse before you have chemotherapy. They will talk to you about your blood results and ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready. 

Your nurse usually gives you anti-sickness (anti-emetic) drugs before the chemotherapy. The chemotherapy drugs can be given through: 

  • a cannula – a short, thin tube the nurse puts into a vein in your arm or hand
  • a central line – a fine tube that goes under the skin of your chest and into a vein close by
  • a PICC line – a fine tube that is put into a vein in your arm and goes up into a vein in your chest
  • an implantable port (portacath) – a disc that is put under the skin on your chest or arm and goes into a vein in your chest.
  • Your course of CHOP

    During treatment, you should avoid grapefruit and grapefruit juice as it can react with cyclophosphamide.

    You usually have a course of several cycles of treatment over a few months. Each cycle of CHOP takes 21 days (3 weeks). 

    On day 1 the nurse will give you:

    • cyclophosphamide as a slow injection (bolus) or infusion (drip) into a vein
    • doxorubicin as a slow injection (bolus) into a vein
    • vincristine as an infusion
    • prednisolone tablets.

    On days 2 to 5, you take prednisolone tablets. It is important to take these exactly as your nurse or pharmacist explains.

    You then have a rest period for 16 days. This completes your first cycle of CHOP. After the rest period, you will start your second cycle of CHOP. This is the same as the first cycle.

    Your nurse or doctor will discuss your treatment plan with you and tell you the number of cycles you are likely to have.

    About side effects

    We explain the most common side effects of this treatment here. We also include some that are less common.

    You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

    Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

    • drugs to help control some side effects
    • advice about managing side effects. 

    It is important to take any drugs exactly as explained. This means they will be more likely to work for you. 

    Serious and life-threatening side effects

    Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

    Contact the hospital

    Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

    Side effects while treatment is being given

    Some people may have side effects while they are being given the chemotherapy or shortly after they have it:

    Allergic reaction

    Some people have an allergic reaction while having this treatment. Signs of a reaction can include: 

    • feeling hot or flushed 
    • shivering
    • itching
    • a skin rash
    • feeling dizzy or sick
    • a headache
    • feeling breathless or wheezy
    • swelling of your face or mouth
    • pain in your back, tummy or chest. 

    Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, they can treat it quickly. 

    Sometimes a reaction happens a few hours after treatment. If you develop any of these signs or feel unwell after you get home, contact the hospital straight away on the 24-hour number.

    The drug leaks outside the vein

    The drug may leak outside the vein. If this happens it can damage the tissue around the vein. This is called extravasation. Extravasation is not common but if it happens it is important that it is dealt with quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein. 

    Pain along the vein

    This treatment can cause pain:

    • at the place where the drip (infusion) is given 
    • along the vein. 

    If you feel pain, tell your nurse straight away. They can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.

    Flushes and blocked nose

    While you are having this treatment, you may suddenly feel warm and your face may go red. Cyclophosphamide may also cause a blocked or stuffy nose and a strange taste. These side effects do not last long. But if you notice this, you should always tell your nurse or doctor.

    Common side effects

    Risk of infection

    This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.

    An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

    • a temperature above 37.5°C  
    • a temperature below 36°C 
    • you feel unwell, even with a normal temperature
    • you have symptoms of an infection.

    Symptoms of an infection include:

    • feeling shivery and shaking
    • a sore throat
    • a cough 
    • breathlessness
    • diarrhoea
    • needing to pass urine (pee) often, or discomfort when you pass urine.

    It is important to follow any specific advice your cancer treatment team gives you.

    Your white blood cell count will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.

    Bruising and bleeding

    This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

    If the number of platelets is low, you may bruise or bleed easily. You may have:

    • nosebleeds
    • bleeding gums
    • heavy periods
    • blood in your urine (pee) or stools (poo)
    • tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

    If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

    Anaemia (low number of red blood cells)

    This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

    • very low in energy
    • breathless 
    • dizzy and light-headed. 

    If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

    Feeling sick

    Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

    If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

    Loss of appetite

    This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

    Feeling tired

    Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it ends. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired. 

    If you feel sleepy, do not drive or use machinery.

    Hair loss

    Your hair will get thinner. Or you may lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair. Hair loss usually starts after your first or second treatment.

    If you want to cover up hair loss, there are different ways you can do this. Your nurse will give you information about coping with hair loss

    Remember to protect your skin from the sun. Use suncream with a sun protection factor (SPF) of at least 30 on your scalp. Or cover up with a hat or scarf.

    Hair loss is almost always temporary. Your hair will usually grow back after treatment ends.

    Sore mouth and throat

    This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

    Contact the hospital straight away on the 24-hour number, if:

    • a sore mouth or throat affects how much you can drink or eat 
    • your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

    They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

    • drink plenty of fluids
    • avoid alcohol and tobacco
    • avoid food or drinks that irritate your mouth and throat.

    Constipation

    This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

    • Drink at least 2 litres (3½ pints) of fluids each day.
    • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
    • Do regular gentle exercise, like going for short walks.

    If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help. 

    If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

    Diarrhoea

    This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

    If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

    • taking anti-diarrhoea medicines 
    • drinking enough fluids to keep you hydrated and to replace lost salts and minerals
    • any changes to your diet that might help. 

    They might also ask you for a specimen of your stool to check for infection.

    Bladder irritation

    Cyclophosphamide may irritate your bladder and cause discomfort when you pass urine. Make sure you drink plenty of fluids during the 24 hours following chemotherapy. Try to drink at least 2 litres (3½ pints).

    It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go.

    If you are treated with higher doses of cyclophosphamide, you will be given fluids through a drip (infusion). You may also be given a drug called mesna (Uromitexan®) through a drip or tablets. This helps to prevent bladder irritation.

    Contact the hospital straight away if you feel any discomfort or stinging when you pass urine, or if you notice any blood in it.

    Pink or red urine

    Your urine may be pink or red for up to 48 hours after you have treatment. This is usually because of the colour of doxorubicin. It is not harmful. But always check with your nurse if you have any concerns.

    Numb or tingling hands or feet (peripheral neuropathy)

    This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may 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 vincristine. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

    Muscle or joint pain

    You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor, nurse or pharmacist. They can give you painkillers and advice. They can also tell you if any of the painkillers you usually take are suitable. 

    Tell them if the pain does not get better. Having warm baths and resting regularly may help. 

    Raised blood sugar 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. If you have a raised blood sugar level, you may: 

    • feel thirsty 
    • need to pass urine (pee) more often  
    • feel 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 change your insulin or tablet dose.

    Tummy pain or indigestion

    You may get pain in your tummy (abdomen), or have indigestion. Your doctor can give you drugs to help improve these symptoms. Tell them if the pain gets worse or does not get better.

    Steroids can also irritate the stomach. It may help to take the steroid tablets with food.

    Skin changes

    CHOP may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. CHOP can cause a rash, which may be itchy. 

    During treatment, and for several months afterwards, you will be more sensitive to the sun. Your skin may burn more easily than usual. You can still go out in the sun, but:

    • use a sun cream with a sun protection factor (SPF) of at least 30
    • cover up with clothing and a hat.

    Your skin may darken. If you have had radiotherapy (either recently or in the past), the area that was treated may become red or sore. 

    Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

    Nail changes

    This treatment can affect your nails. They may grow more slowly or break more easily. You might notice ridges or white or dark lines across your nails. These changes usually disappear as the nails grow out after treatment. Sometimes nails can become loose or fall out.

    If the skin around your nails becomes sore and swollen, contact the hospital straight away on the 24-hour number. These might be signs of an infection.

    Tips to look after your nails:

    • Keep your nails clipped short and clean. 
    • Avoid using very hot water when washing your hands or bathing.
    • Moisturise your nails and cuticles regularly.
    • Avoid false nails, gels or other acrylics during treatment – it is okay to use water-based nail polish. 
    • Wear gloves to protect your nails when working in the house or garden.
    • If your toenails are affected, wear well-fitting shoes, or shoes with open toes to cushion them.

    Tell your doctor or nurse about any changes to your nails. They can give you advice or arrange for you to see a podiatrist. They are a foot care specialist.

    Tumour lysis syndrome (TLS)

    Some people are at risk of developing a condition called tumour lysis syndrome (TLS) during this treatment. When treatment makes large numbers of cancer cells die and break down quickly, they release lots of waste products into the blood. This can affect how well the kidneys work. It may also cause problems with the heart rhythm.

    TLS can be prevented. You will have regular blood tests to check for TLS. If you are at risk of TLS, you may have:

    • extra fluids through a drip
    • medicines such as rasburicase through a drip, or allopurinol as tablets.

    Drinking at least 2 litres (3½ pints) of fluid a day will also help.

    Build-up of fluid

    You may put on weight or your ankles, legs and face may swell because of fluid building up. This is caused by steroids and is more common if you are taking them for a long time. Tell your doctor or nurse if fluid builds up. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling gets better after your treatment ends.

    Effects on the kidneys and liver

    This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys and liver are working.

    It is important to drink at least 2 litres (3½ pints) of fluids each day to help protect your kidneys.

    Jaw pain

    Vincristine may cause pain in your jaw. If you notice this, tell your nurse or doctor.

    Less common side effects

    Effects on the heart

    This treatment can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.

    If the treatment is causing heart problems, your doctor may change the type of treatment you are having.

    Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

    • breathlessness
    • dizziness
    • changes to your heartbeat
    • swollen feet and ankles.

    Other conditions can cause these symptoms, but it is important to get them checked by a doctor. 

    Always call 999 if you have:

    • chest pain, pressure, heaviness, tightness or squeezing across the chest
    • difficulty breathing.

    Effects on the lungs

    This treatment can cause changes to the lungs. Tell your doctor, nurse or pharmacist if you develop: 

    • a cough that does not go away
    • wheezing
    • breathlessness.

    You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

    Effects on the nervous system

    This treatment can affect the nervous system. You may feel dizzy or unsteady. Tell your doctor or nurse straight away if you notice any of these symptoms. They may make some changes to your treatment if they become a problem for you. It is important not to drive or operate machinery if you notice these effects. Rarely, this treatment can cause seizures (fits).

    Mood and behaviour changes

    Steroids can affect your mood and behaviour. They can cause:

    • feelings of anxiety or restlessness
    • mood swings (moods that go up and down)
    • low mood or depression

    Taking your steroids in the morning may help you sleep better.

    Eye problems

    This treatment may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe eye drops to help prevent this. It is important to use these as you are told to.

    Rarely, vincristine may affect your vision. If you have pain or notice any change in your vision, always tell your doctor or nurse.

    Changes to your hearing

    Some people may notice some hearing loss or deafness. Your hearing usually gets better after treatment ends. But sometimes hearing loss can be permanent. Tell your doctor if you notice any changes to your hearing.

    Second cancer

    This treatment can increase the risk of developing a second cancer years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.

    Other information

    Blood clot risk

    Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

    • throbbing pain or swelling in a leg or arm
    • reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
    • suddenly feeling breathless or coughing.

    Always call 999 if you have:

    • chest pain
    • difficulty breathing.

    A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

    Other medicines

    Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

    Vaccinations

    Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

    If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax®, which is a shingles vaccine, and the yellow fever vaccine.

    It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

    Contraception

    Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

    • what types of contraception to use 
    • how long after treatment you should continue to use contraception. 

    Breastfeeding

    You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

    Your doctor, nurse or pharmacist can give you more information.

    Fertility

    Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

    Changes to periods

    If you have a period, these may become irregular or stop while you are having this treatment. This may be temporary, but it can sometimes be permanent. Your menopause may start sooner than it would have done. Your doctor or nurse can give you more information.

    Sex

    It is possible that small amounts of chemotherapy may be passed on through vaginal fluids or semen. If you have sex in the first few days after treatment, your cancer team will usually advise using condoms or a dental dam to protect your partner.

    Medical and dental treatment

    If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

    If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.

    About our information

    • Reviewers

      This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

      Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

    The language we use

    We want everyone affected by cancer to feel our information is written for them.

    We want our information to be as clear as possible. To do this, we try to:

    • use plain English
    • explain medical words
    • use short sentences
    • use illustrations to explain text
    • structure the information clearly
    • make sure important points are clear.

    We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

    You can read more about how we produce our information here.

    Date reviewed

    Reviewed: 01 March 2022
    |
    Next review: 01 September 2024
    Trusted Information Creator - Patient Information Forum
    Trusted Information Creator - Patient Information Forum

    Our cancer information meets the PIF TICK quality mark.

    This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.