ESHAP chemotherapy

ESHAP is a cancer drug treatment. It is used to treat blood cancers such as Hodgkin lymphoma, non-Hodgkin lymphoma and myeloma.

What is ESHAP?

ESHAP is used to treat blood cancers such as Hodgkin lymphoma, non-Hodgkin lymphoma and myeloma. It may be given before a stem cell transplant. It is best to read this information with our information about chemotherapystem cell transplants and the type of cancer you have.

ESHAP is a combination of chemotherapy and a steroid drug:

Sometimes a drug called rituximab is given with ESHAP. This is called R-ESHAP. We have separate information about rituximab.

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 ESHAP is given

You will usually be given ESHAP during a stay in hospital. Some people might have ESHAP as an outpatient. A chemotherapy nurse will give it to you.

During a course of treatment, you will meet someone from your haematology team such as:

  • a blood cancer doctor (haematologist)
  • chemotherapy nurse or a specialist nurse
  • 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 it is safe for you to have treatment.

You will meet a doctor, nurse or pharmacist before you have chemotherapy.  They will talk to you about your blood results and ask how you have been feeling. If your blood results are okay, the pharmacy team will prepare your chemotherapy.

Your nurse will usually give you anti-sickness drugs before the cancer drugs. 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 encourages the kidneys to pass urine (pee).  This helps you pass the extra fluids you are given.

You will have your cancer treatment through 1 of the following:

  • 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.

The drugs run through a pump, which gives you the treatment over a set time. You may have 2 drips running at the same time.

Your course of chemotherapy

Each cycle of ESHAP is either 21 or 28 days depending on your blood test results. In each cycle, you have treatment on days 1-5 and then a rest period with no treatment for the following 16 or 23 days, until the next cycle begins.

Your cancer team will talk to you about how many cycles you will have and discuss your treatment plan with you.

The regime can vary slightly but it is often given in the following way.

Day 1

You have infusions of:

  • cisplatin over 24 hours 
  • cytarabine over 2 to 3 hours
  • etoposide over 1 hour
  • methylprednisolone over 15 to 30 minutes.

Days 2, 3 and 4

Each day you have:

  • cisplatin over 22 - 24 hours
  • etoposide over 1 hour
  • methylprednisolone over 15 to 30 minutes.

If you are given mannitol, you will usually have this on days 1 to 4. 

Day 5

The cisplatin infusion from day 4 finishes.

After day 5

You have a rest period with no treatment for either 16 or 23 days. This completes a cycle of chemotherapy treatment.

At the end of the 21 or 28 days, you start your second cycle of ESHAP. This is the same as the first cycle.

Other ways of giving ESHAP

Some hospitals give cytarabine on day 5 instead of day 1.

You may have methylprednisolone as tablets that you take by mouth (orally).

ESHAP as an outpatient

If you have ESHAP as an outpatient, you have the cisplatin infusions through a small portable pump that you can take home. Your nurse or pharmacist will explain how to look after the pump.

You need to return to the hospital each day for the etoposide and methylprednisolone, and to have the cisplatin infusion changed.

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.

Possible side effects

Cytarabine syndrome

Cytarabine may cause some symptoms 6 to 12 hours after it has been given. This is called cytarabine syndrome. Signs can include:

  • a high temperature or chills
  • a rash
  • pain in the eyes, bones, tummy or chest.

You may be given medicines before treatment to help prevent or reduce these symptoms.

If you have any of these symptoms, tell your nurse or contact the hospital straight away.

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. Your doctor may give you antibiotics and other drugs to take during this treatment. These may help reduce your risk of getting an infection. 

But it is still 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.

You may be given a drug called G-CSF. This encourages the body to make more white blood cells. You have it as a small injection under the skin.

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

The nurses will give you anti-sickness drugs regularly. This will help prevent or control sickness during your treatment in hospital. If you feel sick or are sick (vomit), tell your nurse or doctor straight away. They can change the anti-sickness treatment. Or they might change the way you have it to something that works better for you.

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.

Effects on the eyes

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

If you usually wear contact lenses, do not use them on the days you use eye drops or if your eyes are sore. Check with your doctor when it will be okay to use them again. 

Cytarabine may also: 

  • make your eyes more sensitive to light 
  • cause blurry vision
  • cause eye pain.

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

Hair loss

You will 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.

Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. Your scalp may be sensitive. It is important to cover your head to protect your skin when you are out in the sun.

Hair loss is usually temporary. Your hair will usually grow back after treatment finishes.

Skin changes

Chemotherapy can affect your skin. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.

This treatment can also:

  • cause a rash, which may be itchy 
  • make your skin darker in some areas 
  • make any area treated with radiotherapy become red or sore. If you have white skin the area will become red and if you have black or brown skin the area might become darker. 
  • make you more sensitive to the sun. 

Your skin may burn more easily during treatment and for several months after. Use a sun cream of at least SPF 30. SPF stands for sun protection factor. Cover up with clothing and wear a hat. 

Always tell your doctor, nurse or pharmacist about any skin changes. They can give you advice or prescribe creams or medicines to help. Changes to your skin are usually temporary and improve when treatment ends.

Abdominal (tummy) pain

Let your doctor know if you have pain in your tummy (abdomen). It can usually be controlled with mild painkillers. Tell your doctor if: 

  • the pain does not get better or becomes severe 
  • you have blood in your vomit (sick) or stools (poo).

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.

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.

Hearing changes

This treatment may cause hearing changes, including hearing loss. You may have ringing in the ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds. Hearing changes may get better after this treatment ends. But this does not always happen. If you notice any changes in your hearing, tell your doctor, nurse or pharmacist.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.

If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.

Effects on the kidneys

Cisplatin can affect how the kidneys work. You will have blood tests before and during treatment to check how well your kidneys are working.

Before and after each treatment, your nurse will give you extra fluids through a drip. This is to protect your kidneys. 

Drinking fluids also helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.

Contact the hospital on the 24-hour number if you are: 

  • not able to drink as much as you have been asked to – for example, if you feel sick
  • sick (vomit) or have diarrhoea 
  • passing less urine or peeing less often than usual.

Effects on the liver

This treatment may affect how your liver works. This is usually mild and goes back to normal after treatment ends.

Rarely, your skin and the whites of your eyes may turn yellow. This is called jaundice. During your treatment, you will have regular blood tests to check how well your liver is working.

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.

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 inflammation of the lungs. This is called pneumonitis. Contact the hospital straight away on the 24-hour number if you notice any of these changes during treatment or after it ends:

  • breathlessness
  • a cough that does not go away
  • wheezing
  • a fever, with a temperature over 37.5°C.

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

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

  • feel thirsty
  • need to pass urine (pee) more often than usual
  • feel more tired than usual.

Tell your doctor or nurse if you have these symptoms. They can do tests to check your blood sugar level and give you advice.

If you have diabetes, your blood sugar levels may be higher than usual. You may need to check them more often, or make changes to your diabetic treatment. Your doctor will talk to you about how to manage this. You may need to change your insulin or tablet dose.

Effects on your mood and sleeping

Steroids can affect your mood. They can cause:

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

If you having problems sleeping, it can help to have your steroid medication earlier in the day. 

If you notice any of these symptoms, tell your doctor or nurse.

Other important information

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.

Irradiated blood and platelets

After this treatment, if you need blood or platelet transfusions, they should be treated with radiation (irradiated) before you have them. This helps prevent a rare but serious reaction that can be caused by white blood cells in the donated blood. 

Irradiated blood is not radioactive and will not harm you or anyone you come into contact with.

Some people must have any blood or platelet transfusions irradiated for the rest of their lives. If you need this, your doctor will give you more information. They will give you a medical alert card to carry in case you need blood in an emergency or at another hospital.

Alcohol

Etoposide capsules do not contain alcohol. But if you have etoposide as an infusion (into a vein), it may contain alcohol. If having alcohol is a problem for you, tell your doctor, nurse or pharmacist. Your blood alcohol level may be above the legal limit after you have the treatment. Do not drive or operate machinery for a few hours after having this treatment, even if you feel okay.

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: 

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.

Vaccinations

After a stem cell transplant, you may lose your immunity to illnesses you were vaccinated against as a child. You may need to have some of these vaccinations again.

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.

We have more information about life after stem cell transplants using:

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.

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. 

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.

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.

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

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

Date reviewed

Reviewed: 01 June 2024
|
Next review: 01 June 2026
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.

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.