What is R-CVP?

R-CVP is used to treat non-Hodgkin lymphoma. It is a combination of chemotherapy and a targeted therapy (a combination known as chemoimmunotherapy) plus a steroid drug.

It is best to read this information with our general information about chemotherapy, targeted therapysteroid, and the type of non-Hodgkin lymphoma you have. 

R-CVP is named after the initials of the drugs used:

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

How R-CVP is given

You will be given R-CVP in the chemotherapy day unit. A chemotherapy nurse will give it to you. 

During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have R-CVP. 

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

You take prednisolone tablets at least 30 minutes before the other drugs. Your nurse or pharmacist will advise you if you need to take this at home before coming into the chemotherapy unit. 

Your nurse usually gives you anti-sickness (anti-emetic) drugs before treatment as well. 

The drugs rituximab, cyclophosphamide and vincristine are given into a vein (intravenously). You may have them through: 

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

Rituximab is given as a drip (infusion) into your line or cannula. Rituximab can cause a reaction in some people. The nurse will give you drugs to help prevent or reduce this. A reaction is most likely the first time you have it, so the infusion is given slowly over a few hours. 

Your nurse will then give you cyclophosphamide as an infusion into your line or cannula. They will give it along with an infusion of fluid to flush it through. Then you have vincristine as an infusion, with an infusion of fluid before and after it.

Your course of chemotherapy

Each cycle of R-CVP takes 21 days (3 weeks).

  • On day 1, you take prednisolone tablets and then you have rituximab, cyclophosphamide, and vincristine.
  • On days 2, 3, 4 and 5, you take prednisolone tablets.
  • You will be given prednisolone tablets to take home with you for days 2 to 5.
  • You then have 16 days without any treatment, before starting your next cycle. This is the same as the first cycle.

You usually have a course of several cycles of treatment over a few months. Your doctor or nurse will tell you how many cycles you are likely to have. They may give you a copy of your treatment plan to take home.

As well as prednisolone, your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Always take your medicines exactly as explained. This is to make sure they work as well as possible for you.

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

Your doctor, nurse or pharmacist can give you drugs to help control some side effects. It is important to take them exactly as they tell you. This means the drugs will be more likely to work for you. Your doctor, nurse or pharmacist 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

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) for more detailed information.

Side effects while treatment is being given

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

Allergic reaction

Some people have an allergic reaction to monoclonal antibody treatment while they are having it. The first infusion is the most likely to cause a reaction, so it is usually given more slowly than later treatments. Before treatment, you will be given medicines to help prevent or reduce any reaction.

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 (abdomen) 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, they can treat it quickly.

Sometimes a reaction happens a few hours after treatment. If you develop any signs or feel unwell after you get home, contact the hospital straight away.

Blood pressure

Some people's blood pressure falls while they are having rituximab. If you usually take medicine to lower your blood pressure, your doctor 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.

Tumour pain

During the infusion, you may have mild pain in the parts of the body where you have cancer. You may be given painkillers to help with this.

Pain along the vein

This treatment can cause pain at the place where the drip (infusion) is given or along the vein. If you feel pain, tell your nurse or doctor straight away so that they can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.

The drug leaks outside the vein

If the drug leaks outside the vein, it can damage the surrounding tissue. This is called extravasation. Extravasation is not common but if it happens it is important to treat it quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein.

If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the contact telephone number they gave you.

Hot flushes and blocked nose

You may suddenly feel warm and your face may get red while these drugs are being given. You may also have a blocked or stuffy nose and a strange taste when cyclophosphamide is being given. These side effects do not last long. But if you notice this, you should always tell your nurse or doctor.

Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If 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.

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, 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)
  • blood when you cough
  • blood in your vomit
  • tiny red or purple spots on your skin that may look like a rash.

Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

Chemotherapy can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red cells is low, this is called anaemia. You may have symptoms such as:

  • pale skin
  • lack of energy
  • feeling breathless
  • feeling dizzy and light-headed.

Tell your doctor or nurse if you have these symptoms.

If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Sometimes doctors prescribe a drug called erythropoietin. This helps the body to make more red blood cells. It is given as an injection under the skin. But it is more common to have a blood transfusion for anaemia.

Feeling sick

Your doctor will give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.

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 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 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.

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 almost always temporary. Your hair will usually grow back after treatment finishes.

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.

If your mouth or throat 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 and throat.

Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.

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 so they can give you painkillers. Tell them if the pain does not get better. If you have painkillers you would like to use at home, check with your doctor, nurse or pharmacist whether they are suitable for you.

If you have muscle or joint pain, try:

  • placing a heat pad or covered hot water bottle against the painful area
  • taking warm baths
  • planning your activities to include regular rests.

Constipation

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

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

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

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

Diarrhoea

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is 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.

Bladder irritation

Cyclophosphamide may irritate your bladder and cause discomfort when you pass urine (pee). You will be given fluids through a drip to help prevent this. Some people may also be given a drug called mesna as a drip (infusion) or tablets. 

Make sure you drink plenty of fluids during the 24 hours following chemotherapy. Try to drink at least 2 litres (3½ pints).

It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go. Contact the hospital straight away if you:

  • find it difficult to pass urine
  • feel any discomfort or stinging when you pass urine
  • notice blood in your urine.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment may affect 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.

Raised blood sugar levels

This treatment can raise your blood sugar levels. If you have a raised blood sugar level, you may:

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

Tummy pain or indigestion

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

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

Increased appetite

Steroids can make you feel more hungry than usual and you may gain weight. Your appetite will go back to normal when you stop taking them. If you are worried about gaining weight, talk to your doctor or nurse.

Build-up of fluid

Prednisolone may make you gain weight. Your ankles and legs may also swell because of fluid building up. This is more common if you are taking prednisolone for a long time. Tell your doctor or nurse if fluid builds up. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling usually gets better after your treatment ends.

Skin changes

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

Very rarely, a more serious skin condition can develop. You may have a skin rash which then blisters, and your skin can peel. If this happens, contact the hospital immediately.

Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin usually do not last long and improve when treatment finishes.

Nail changes

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

There are things you can do to look after your nails:

  • Moisturise your nails and cuticles regularly.
  • Keep your nails clipped short.
  • Wear gloves to protect your nails when you are doing things in the house or garden.
  • Keep your hands and nails clean to help avoid infection, but avoid bathing in very hot water.
  • Do not use false nails, gels or other acrylics during this treatment, as they may increase the risk of infection.
  • It is fine to wear nail varnish, but try to use a water-based polish. Avoid using harsh chemicals, such as acetone, when taking off the polish.
  • If your toenails are affected, wear well-fitted shoes to cushion them.

Tell your doctor or nurse if you notice changes to your nails. They can give you advice or arrange for you to see a podiatrist for foot care advice if needed.

Effects on the liver

This treatment may affect how your liver works. This is usually mild. You will have blood tests to check how well your liver is working.

Jaw pain

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

Eye problems

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

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

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.

Less common side effects

Effects on the lungs

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

  • a cough
  • wheezing
  • breathlessness.

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

Effects on the heart

This treatment can affect how the heart works. You may have tests to see 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 your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
  • pain or tightness in your chest
  • breathlessness
  • dizziness
  • changes to your heartbeat.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.

Mood and behaviour changes

Steroids can affect your mood. You may feel anxious or restless, have mood swings or problems sleeping. Taking your steroids in the morning may help if you are having problems sleeping.

Tell your doctor or nurse if you have any of these side effects. They may make some changes to your treatment if the side effects become a problem.

Effects on the nervous system

Vincristine can affect the nervous system. Tell your doctor straight away if you:

  • feel dizzy or unsteady
  • have problems moving or walking
  • have problems speaking.

Rarely, this treatment can cause fits (seizures).

If you notice any of these effects, it is important not to drive or operate machinery.

Tumour lysis syndrome (TLS)

This treatment may cause cancer cells to die and break down quickly. When cancer cells break down very quickly, it can cause a sudden release of large amounts of chemicals into the blood. This is called tumour lysis syndrome (TLS).

Your kidneys can usually keep these chemicals balanced. But they might not be able to cope with very large amounts. The chemical imbalance can affect how well your kidneys work and cause problems with your heart rhythm.

You will have regular blood tests to check the levels of these chemicals.

If you are at risk of TLS, your doctor can give you treatment to help prevent it. You may have:

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

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

Hepatitis B reactivation

If you have had hepatitis B (a liver infection) in the past, rituximab can make it active again. Your doctor or nurse will talk to you about this and test you for hepatitis B.

If your test shows that you have had it in the past you may be given treatment to prevent it becoming active again.

If you have active hepatitis B, you will not have treatment with rituximab.

Second cancer

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

Other information

Blood clot risk

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

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

Always call 999 if you have:

  • chest pain
  • difficulty breathing.

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

Other medicines

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

Vaccinations

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus (covid) 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. 

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines 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.

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.

Breastfeeding

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

Your doctor or nurse 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.

Sex

If you have sex in the first few days after this treatment, you should use barrier protection such as a condom or dental dam. This will protect your partner if any of the drug is in your semen or vaginal fluids.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses 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.

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.

Date reviewed

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

Our cancer information meets the PIF TICK quality mark.

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