What is ESHAP?

ESHAP is used to treat 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 general information about chemotherapy, stem cell transplants and the type of cancer you have.

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

The drugs used in ESHAP

ESHAP is a combination treatment that uses:

Sometimes a drug called rituximab is given with ESHAP. This is called R-ESHAP.

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 treatment, you usually see a cancer doctor, or a blood cancer doctor (haematologist). You will also see 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 results are at a safe level to have chemotherapy. 

You will see a doctor or nurse before you have chemotherapy. They will ask you about 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 will give you anti-sickness (anti-emetic) drugs before your 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 helps the body produce more urine (pee) and pass out the extra fluids you are given.

You may have the chemotherapy, fluids and other drugs through: 

  • 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

ESHAP is given over 5 days. You then have no treatment for the following 16 or 23 days. Together this makes one cycle of treatment. Your doctor or nurse will tell you the number of cycles you are likely to have. 

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 an hour
  • methylprednisolone over 15 to 30 minutes.

Days 2, 3 and 4

Each day you have:

  • cisplatin over 24 hours
  • etoposide over an hour
  • methylprednisolone over 15 to 30 minutes.

Day 5

The cisplatin infusion from day 4 finishes.

You have methylprednisolone over 15 to 30 minutes. 

After day 5

You 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 a cycle of chemotherapy treatment. Each cycle takes 21 or 28 days (3 or 4 weeks).

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).

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

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. You need to return to the hospital each day for the etoposide and methylprednisolone, and to have the cisplatin infusion changed. Your nurse or pharmacist will explain how to look after the pump.

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 this from happening or to reduce any reaction.  

Tell your nurse or contact the hospital straight away if you have any of these symptoms.

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes 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. Contact the hospital straight away on the 24-hour contact number you have been given if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection
  • your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

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

Your doctor will give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines.

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

The number of white blood cells 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.

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.

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.

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

This treatment may make your eyes feel sore, red, dry or itchy. This is called conjunctivitis. Your doctor may prescribe steroid eye drops to help prevent this. It is important to use these as you are told to.

Do not wear contact lenses if you are using eye drops or if your eyes are sore. Your doctor can tell you when you can wear 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.

Skin changes

This treatment 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. Cytarabine can cause a rash, which may be itchy. It may also cause your skin to become red or blistered.

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

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. It will return to its usual colour after you finish treatment.

Hair loss

You will lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This is almost always temporary, and your hair will grow back after chemotherapy ends.

Until your hair grows back, it is important to protect your scalp by covering your head when you are out in the sun. Your nurse can give you advice about coping with hair loss.

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

Cisplatin 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 usually get better after treatment ends. But some hearing changes may be permanent. Tell your doctor if you notice any changes in your hearing.

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.

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 
  • 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.

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.

Other information about ESHAP

Second cancer

This treatment can increase the risk of developing a second cancer years later. But this is rare.

You can talk to your doctor or nurse about this. They can explain how the benefits of your treatment will outweigh the risk.

Irradiated blood

For a few months after your treatment, any blood or platelet transfusions you have may need to be treated with radiation (irradiated) first. This will depend on the type of cancer you have and any previous treatment. Irradiating blood and platelet transfusions prevents white blood cells in the donated blood from attacking your own tissue. Irradiated blood is not radioactive and will not harm you or anyone you come into contact with.

Some people may need any blood or platelet transfusions to be irradiated for the rest of their lives. Your doctor will talk to you about this. You will be given a medical alert card to carry in case you need blood in an emergency or at another hospital.

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

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 a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations. 

While your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations. 

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

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.

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.

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.

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.

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

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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.

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Date reviewed

Reviewed: 01 November 2021
|
Next review: 01 April 2024

This content is currently being reviewed. New information will be coming soon.

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