Pola-R-CHP
Pola-R-CHP is a cancer drug treatment. It is used to treat a type of blood cancer called non-Hodgkin lymphoma.
What is pola-R-CHP?
Pola-R-CHP is a combination of cancer drugs. It is used to treat a common type of non-Hodgkin lymphoma called diffuse large B-cell lymphoma (DLBCL).
It is best to read this information with our general information about cancer drug treatments and the type of cancer you have.
Pola-R-CHP includes the following drugs:
- Polatuzumab vedotin (Polivy®) is a targeted therapy drug that delivers a chemotherapy drug to B-cells. The chemotherapy damages these cells.
- Rituximab is a targeted therapy drug that triggers the body’s immune system to target and destroy B-cells
- Cyclophosphamide is a chemotherapy drug.
- Doxorubicin is a chemotherapy drug.
- Prednisolone is a steroid.
Your cancer team 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 pola-R-CHP is given
You usually have pola-R-CHP in a chemotherapy day unit or clinic as an outpatient.
During your course of treatment, you will meet someone from your cancer team, such as a:
- cancer doctor
- chemotherapy nurse or specialist nurse
- specialist pharmacist.
This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before or on the day of each treatment, you will have a blood test. This is to check that it is safe for you to have treatment.
You will meet with a doctor, nurse or pharmacist before you have treatment. 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 cancer drugs.
Before this treatment, your nurse usually gives you:
- anti-sickness (anti-emetic) drugs
- medicines to reduce the risk of an allergic reaction.
Your nurse will give you the prednisolone tablets to take by mouth. You have the other pola-R-CHP drugs as a drip (infusion) into a vein through 1 of the following:
- 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.
The nurse will run the drip for each drug through a pump, which will give you the treatment over a set time.
Your cancer team may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they tell you to.
Your course of pola-R-CHP
You usually have a course of 6 cycles of treatment over a few months. Each cycle of pola-R-CHP takes 21 days (3 weeks).
Your cancer team will discuss your treatment plan with you. They may give you a copy of the plan to take home.
You always take prednisolone tablets on days 1 to 5 of the cycle. The other drugs are given on day 1 and 2 of the cycle. But the order and timing may vary depending on your hospital.
On day 1 of the cycle, you may have the following drugs into a vein:
- rituximab
- polatuzumab vedotin
- cyclophosphamide
- doxorubicin.
But for your first cycle, these drugs may be given over 2 days. This is because you have rituximab and polatuzumab vedotin slowly to make sure you do not have a reaction.
Grapefruit
During treatment with cyclophosphamide, you should avoid grapefruit and grapefruit juice. It can affect how well cyclophosphamide works and may make the side effects worse.
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
Allergic reaction
Some people have an allergic reaction to these drugs while having them. This is most likely with rituximab or polatuzumab vedotin. But sometimes it happens with cyclophosphamide or doxorubicin. Before treatment, you will be given medicines to help prevent or reduce any reaction.
A reaction is most likely when you have the drug for the first time. This is why your first dose of rituximab and polatuzumab vedotin is given slowly over a few hours.
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 infusion. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated 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.
Always call 999 if swelling happens suddenly or you are struggling to breathe.
Blood pressure
Your blood pressure may fall when you are having rituximab. If you usually take medicine to lower your blood pressure, your doctor, nurse or pharmacist may ask you not to take it for 12 hours before having rituximab. Sometimes, rituximab can make your blood pressure go up. Your nurse will check your blood pressure regularly.
The drug leaks outside the vein
Sometimes cancer drugs that are given into a vein may leak outside the vein. If this happens, some drugs can damage the tissue near the vein. This is called extravasation. Extravasation is not common, but it is important that it is dealt with quickly. If you have any of the following symptoms around the vein during or after your treatment, tell your nurse straight away:
- stinging
- pain
- swelling
- if you have white skin, the area may become red
- if you have black or brown skin, the area may become darker.
Red urine during doxorubicin
Your urine may be a pink-red colour for up to 48 hours after you have your treatment. This is because of the red colour of doxorubicin and is not harmful. But always check with your nurse if you have any concerns.
Very 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. 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.
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.
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.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect the nerves. This can cause numbness, tingling or pain in your hands or feet. You may find it hard to do fiddly tasks such as fastening buttons or typing shoelaces. You may notice walking or balance problems.
Tell your doctor, nurse or pharmacist if you have these symptoms. They sometimes need to lower the dose of the polatuzumab vedotin. The symptoms usually improve slowly after treatment ends. But for some people, they continue and are a long-term side effect of treatment.
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.
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.
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.
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.
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.
Tummy pain or indigestion
Steroids can irritate the stomach lining. Tell your doctor, nurse or pharmacist if you have pain in your tummy or indigestion. They can give you drugs to help. Taking steroids with food can also help to protect your stomach.
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.
Other side effects
Bladder irritation
Cyclophosphamide may irritate your bladder and cause discomfort when you pass urine (pee).
Make sure you drink plenty of fluids during the 24 hours after your treatment. Try to drink at least 2 litres (3½ pints).
It is also important to empty your bladder regularly. Try to pass urine as soon as you feel the need to go. Contact the hospital straight away on the 24-hour number if you:
- find it difficult to pass urine
- feel any discomfort or stinging when you pass urine
- notice blood in your urine.
Raised blood sugar levels
This treatment may raise your blood sugar levels and increase the risk of diabetes.
You will have regular blood tests to check this.
Signs of raised blood sugar include:
- feeling thirsty
- needing to pass urine (pee) more often than usual
- feeling more tired than usual.
Contact the hospital on the 24-hour number if you have these symptoms during treatment or after it ends.
If you already have diabetes, your blood sugar levels may be higher than usual. You may need advice and support from your GP or diabetes team about managing 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.
Skin changes
This treatment can affect your skin. It might feel dry. You may develop a rash, which may be itchy. Always tell your doctor, nurse or pharmacist about any skin changes. They can give you advice or prescribe creams or medicines to help.
If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.
Serious skin changes
Rarely, this treatment can cause a serious skin reaction that needs to be treated immediately in hospital. Contact the hospital straight away on the 24-hour number if you have any of these symptoms:
- a skin rash that is spreading
- blistering or peeling skin
- flu-like symptoms, such as a high temperature and joint pain
- sores on your lips or in your mouth.
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 (palpitations)
- 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.
Tumour lysis syndrome (TLS)
Some people are at risk of developing a condition called tumour lysis syndrome (TLS). The risk is highest at the beginning of treatment. TLS happens when treatment makes large numbers of cancer cells die and break down quickly. This releases lots of waste products into the blood and can affect the kidneys and heart.
TLS can be prevented or treated. You will have regular blood tests to check for TLS. You may have:
- extra fluids through a drip
- medicines such as allopurinol tablets or rasburicase through a drip.
Drinking at least 2 litres (3½ pints) of fluid a day will also help.
Fluid build-up
This treatment can cause a build-up of fluid in the body. This will slowly get better after treatment ends. Contact the hospital on the 24-hour number if you:
- are gaining weight
- have swelling in your face, legs or ankles.
They can give you advice and treatment to help.
Effects on the liver
This treatment may affect how your liver works. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your liver is working.
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.
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 steroids in the morning may help you sleep better.
Effects on the nervous system
Rarely, this treatment can affect the brain and nerves. This can cause symptoms such as:
- a headache that does not get better
- memory loss
- problems with eyesight or speech
- confusion or drowsiness
- seizures (fits)
- weakness in an arm, a leg or the face muscles
- problems with walking or movement.
If you have any of these symptoms, it is important to either:
- contact the hospital straight away on the 24-hour number
- go to the hospital straight away.
You should not drive yourself to hospital.
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, nurse or pharmacist can give you more information.
Other important information
Hepatitis B reactivation
If you have had hepatitis B (a liver infection) in the past, this treatment can make it active again. Your doctor, nurse or pharmacist will talk to you about this. They will also test you for hepatitis B before you have this treatment.
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:
- medicines you have been prescribed
- medicines you buy in a shop, pharmacy or online
- vitamins or supplements
- herbal drugs and complementary or homeopathic therapies
- recreational drugs – for example, cannabis.
Vaccinations
Cancer doctors usually recommend that people with cancer have vaccinations for flu and coronavirus (covid). They may also recommend other vaccines, such as Shingrix® for shingles. These all help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.
You should not have live vaccines if your immune system is weak. This includes if you are having or recently had chemotherapy, radiotherapy or other cancer treatments that affect your immune system. Live vaccines can make you unwell because they contain a very weak version of the illness they protect you against. There are several live vaccines, including 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.
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.
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.
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.
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References
Visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for more detailed information. The leaflet lists all known side effects.
Date reviewed
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.
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We want our information to be as clear as possible. To do this, we try to:
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