What is ESHAP?

ESHAP is used to treat Hodgkin lymphoma, non-Hodgkin lymphoma and myeloma. It is 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.

How ESHAP is given

You will usually be given ESHAP during a stay in hospital. Some people might have ESHAP as an outpatient. This is only usually for people who live close to the hospital or decide to stay in nearby accommodation. A chemotherapy nurse will give it to you.

During treatment, you usually see a cancer doctor, or a blood cancer doctor (haematologist), 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 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 increases the amount of urine your kidneys make.

The chemotherapy and fluids and other drugs can be 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).

The drugs will run through a pump, which gives you the treatment over a set time. Because lots of drugs and fluids are given in ESHAP, you will often have 2 drips running at the same time.

Your course of chemotherapy

ESHAP is given over 5 days.

Day 1

The nurse will give you infusions of:

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

Day 2, day 3 and day 4

On each day you will be given:

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

Day 5

The cisplatin infusion that began on day 4, finishes.

You will be given methylprednisolone over 15 to 30 minutes. 

After day 5

After 5 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 a cycle of your 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. Your doctor or nurse will tell you the number of cycles you are likely to have.

Other ways of giving ESHAP

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

Methylprednisolone is sometimes given as tablets that you take by mouth (orally).

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

If you have ESHAP as an outpatient you will have the cisplatin infusions through a small portable pump you take home. You will 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 the pump works and how to look after it.

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.

You may also have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

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

Contact the hospital

Before you leave hospital your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for these drugs. The leaflet lists all known side effects.

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.

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

Risk of infection

This treatment reduces 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 called neutropenia.

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

If you have an infection, it is important to treat it as soon as possible. If you are having treatment as an outpatient contact the hospital straight away on the 24-hour contact number you have 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.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

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.

G-CSF (granulocyte-colony stimulating factor) is a type of drug called a growth factor. It encourages the body to make more white blood cells.

Your doctor may give you G-CSF:

  • if the number of white blood cells is very low
  • to stop the number of white blood cells getting low.

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. 

Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them 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. 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. This is called a blood transfusion.

Feeling sick

You may feel sick in the first few days of your treatment. The nurses will give you anti-sickness 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.

Feeling tired

Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Effects on your mood

The steroid methylprednisolone can affect your mood. You may feel anxious or restless, or have problems sleeping. Tell your doctor or nurse if you notice any of these symptoms.

Sore mouth

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.

Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth.

Effects on the eyes

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.

This treatment may also make your eyes more sensitive to light and cause blurry vision. If you have pain or notice any change in your vision, always tell your doctor or nurse.

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.

Skin changes

Chemotherapy 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, and cover up with clothing and a hat. Your skin may darken. It will return to its normal 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. 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.

Tummy pain

Tell your doctor or nurse if you get pain or discomfort in your tummy (abdomen). Your doctor can prescribe drugs to help improve these symptoms.

Diarrhoea

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

If you have diarrhoea:

  • try to drink at least 2 litres (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

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

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 the drug. 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.

Effects on the kidneys

Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this.

Before and after each treatment, your nurses will give you extra fluids through a drip. This is to protect your kidneys. It is also important to drink at least 2 litres (3½ pints) of fluids each day.

If you pass less urine than usual, tell your nurse.

Tumour lysis syndrome (TLS)

This treatment causes cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid, but they may not be able to cope with large amounts. This can cause chemical imbalances in the blood that may affect the kidneys and the heart. This is called tumour lysis syndrome (TLS). You will have regular blood tests to check the uric acid levels.

Your doctor may give you drugs to help prevent TLS. Drinking at least 2 litres (3½ pints) of fluid a day will also help.

Raised blood sugar levels

Steroids can raise the levels of sugar in your blood. 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 pee (pass urine) more often and feeling tired. Tell your doctor or nurse if you have these symptoms.

If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this. You may need to adjust the dose of your insulin or diabetes tablets.

Effects on the lungs

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

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

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

Effects on the heart

Chemotherapy can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the type of chemotherapy you are having.

Contact a doctor straight away if you:

  • have pain or tightness in your chest
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

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

Other information about ESHAP

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

For a few months after your treatment, any blood or platelet transfusions you are given are first treated with radiation (irradiated). This is to prevent problems caused by white blood cells called lymphocytes, in the donated blood. 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. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain.

If you have any of these symptoms, contact a doctor straight away.

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Other medicines

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

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

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 also usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.

While your immune system is weak, you need to avoid live vaccinations. Your cancer doctor or GP can tell you more about live vaccinations.

We have more information about:

Fertility

This treatment can affect if you can get pregnant or make someone pregnant.

If you are a woman, your periods may become irregular or stop. This may be temporary, but for some women it is permanent. Your menopause may start sooner than it would have done.

There may be ways to preserve fertility for men and women. If you are worried about fertility, it is important to talk with your doctor before you start treatment.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Sex

If you have sex in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

Breastfeeding

Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

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

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

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