Prednisolone — the P in R-CHOP — is the only component not given by intravenous infusion. It is taken as tablets at home over the first few days of each cycle.
R-CHOP for Lymphoma: — What the Five Letters Mean
R-CHOP is the combination most commonly prescribed for B-cell lymphoma. Each letter represents a different medicine, and each medicine works in a different way — which is also why the side effects vary across the regimen.
- Five medicines, one regimen — R-CHOP combines one biological therapy and four chemotherapy drugs given together in cycles.
- The R is not chemotherapy — Rituximab is a monoclonal antibody that targets a specific protein on B-cell lymphoma cells.
- Typically given as day care — The infusion is given at the clinic, with tablets to take at home over the following days.
- Each letter, a different effect — Because the five medicines work differently, the side effects come from five different directions.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed September 2026
R-CHOP is a five-medicine combination for B-cell lymphoma: Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, and Prednisolone. Each drug targets cancer cells by a different mechanism. Treatment is given in cycles every three weeks, with the number of cycles decided by your oncologist based on your lymphoma type, stage, and how the disease is responding.
What does each letter in R-CHOP stand for?
R — Rituximab
A monoclonal antibody that recognises and binds to the CD20 protein on the surface of B-cell lymphoma cells. Rituximab is not a chemotherapy drug — it is a biological therapy added to the original CHOP regimen. It is given by slow intravenous infusion with pre-medications to reduce the risk of reactions, and you are monitored closely throughout, particularly during the first infusion.
C — Cyclophosphamide
An alkylating agent that damages cancer cell DNA and prevents the cells from dividing. Common effects include nausea, hair loss, and a reduction in blood cell counts. It can also irritate the bladder lining, so staying well hydrated on the day it is given is part of the standard approach.
H — Hydroxydaunorubicin (doxorubicin)
An anthracycline that interferes with the DNA replication of cancer cells. It can turn urine red or orange for a day or two after infusion — this is expected and not a cause for concern. Your team monitors heart function before and during the regimen because doxorubicin can affect heart muscle over cumulative doses.
O — Oncovin (vincristine)
A plant-derived medicine that stops cancer cells from dividing by disrupting the structures they need to separate chromosomes. Its most notable side effect is peripheral neuropathy — tingling or numbness that typically begins in the hands and feet. Constipation is also common. Reporting neuropathy early gives your team the information they need to review your care.
P — Prednisolone
A corticosteroid taken as tablets at home over the first few days of each cycle — not given by infusion. It has direct activity against lymphoma cells and supports the action of the other drugs. Common effects include increased appetite, disrupted sleep, mood changes, and raised blood sugar. These typically ease once the tablets are finished for that cycle.
How many cycles of R-CHOP will I need?
The number of cycles depends on your lymphoma type, stage, and how the disease responds to treatment. Your oncologist will tell you the planned number at the start and may review it during the course.
Cycles are given every three weeks. Between cycles you have a recovery period while your blood counts rebuild. Blood tests before each cycle confirm that your counts are adequate to proceed.
Response-assessment scans are typically done partway through the planned course and at the end, to evaluate how the lymphoma is responding and whether the plan needs to change.
Who is R-CHOP not suitable for?
R-CHOP targets B-cell lymphomas that carry the CD20 protein. It is not used in several situations:
- T-cell lymphomas: Rituximab has no target on T-cell lymphoma cells, so the regimen does not apply.
- CD20-negative B-cell lymphomas: If testing shows CD20 is absent, rituximab has no target and the regimen is not used.
- Significant heart disease: Doxorubicin can affect heart muscle over cumulative doses. Patients with reduced heart function may need a modified or alternative regimen.
- Active hepatitis B: Rituximab can reactivate dormant hepatitis B virus. Screening is done before starting, and antiviral treatment is given when needed.
- Active uncontrolled infection: The regimen significantly suppresses the immune system.
- Very poor general fitness: The ability to tolerate the full regimen is assessed before it is prescribed.
Eligibility is decided by an oncologist on each individual case, based on biopsy results, organ function tests, and overall health.
What side effects come from R-CHOP?
Because five different medicines are involved, side effects come from several directions at once. Hair loss, nausea, and low blood counts — which raise your infection risk — are the most common effects from the chemotherapy components.
Peripheral neuropathy — tingling or numbness that typically starts in the hands and feet — comes specifically from vincristine. Tell your team if you notice it, because reporting early gives them the information they need.
Heart function is monitored during the regimen because doxorubicin has a cumulative effect on heart muscle. This monitoring is routine, not a sign that something has already gone wrong. Tell your team if you notice new breathlessness or palpitations between cycles.
What should I watch for between cycles?
Blood count suppression is expected after each infusion, and infection risk is highest during the days when counts are at their lowest. Your team will tell you which symptoms and which temperature to act on.
Any new fever during this period needs a same-day call or emergency assessment — not a wait-and-watch approach. Infection when blood counts are low can become serious quickly.
If you have ever been exposed to the hepatitis B virus, tell your team before treatment begins. Rituximab can reactivate dormant hepatitis B, and antiviral prophylaxis is prescribed when needed.
Did you know?
Many people arrive expecting all five medicines to be given in the clinic on the same day. Knowing that one is an oral tablet taken at home helps in planning each cycle.
Source: British Society for Haematology and ESMO Clinical Practice Guidelines on R-CHOP
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- Which Regimen Is Used for Which Cancer?
Cycle Delays, Dose Reductions & Changes
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- Does a Reduced Dose Still Work?
- Growth Factor Support to Keep the Schedule
- How Many Delays Are Too Many?
- Infection Delaying a Cycle
- My Counts Were Too Low and the Cycle Was Postponed
- Organ Function Problems Delaying a Cycle
- Stopping Early: What Happens If You Do Not Complete the Course?
- Transfusion During Chemotherapy
- What If I Cannot Tolerate the Treatment?
- What Is a Dose Reduction and Why Was Mine Reduced?
- What to Ask If Your Plan Changes
- Why Chemotherapy Gets Delayed or Reduced
- Why Was My Regimen Switched?
HUB — Chemotherapy Regimens
HUB — Cycles, Schedules and What Happens on Infusion Day
How Chemotherapy Is Given
- Can Chemotherapy Be Given at Home?
- Can Chemotherapy Be Given at a Local Hospital?
- Continuous Infusion Chemotherapy and Portable Pumps
- Day Care vs Admission for Chemotherapy
- How Is Chemotherapy Given? All the Routes Explained
- How Long Does Each Chemotherapy Session Take?
- Intra-Arterial and Regional Chemotherapy
- Intraperitoneal Chemotherapy
- Intrathecal Chemotherapy: Into the Spinal Fluid
- Intravenous Chemotherapy: What the Drip Involves
- Intravesical Chemotherapy for the Bladder
- Is Oral Chemotherapy Weaker Than Injections?
- Oral Chemotherapy: Tablets Instead of a Drip
- Subcutaneous and Intramuscular Chemotherapy
- Topical Chemotherapy Creams
- What Safety Checks Happen Before Each Dose?
- Who Actually Gives Your Chemotherapy?
- Why Does the Route Sometimes Change During Treatment?
Regimens, Cycles & Schedules
- A Printable Chemotherapy Cycle Calendar
- Adding or Removing Cycles Mid-Course
- Blood Tests Before Every Cycle: What They Check
- Day 1, Day 8, Day 15: What the Day Numbers Mean
- Does Delaying a Cycle Reduce the Benefit?
- How Many Cycles Before the First Assessment?
- How the Dose Is Calculated for You
- Keeping a Chemotherapy Symptom Diary
- Planning Your Life Around Chemotherapy Cycles
- Rescheduling or Missing a Chemotherapy Appointment
- Weekly, Two-Weekly and Three-Weekly Schedules
- What Happens Between Cycles?
- What Happens at the Last Cycle?
- What Is Dose Intensity?
- What Is a Chemotherapy Cycle?
- What Is the Nadir and Why Does It Matter?
- Which Days of the Cycle Will I Feel Worst?
- Why Was My Cycle Postponed?
The Infusion Day
Your First Cycle
All How Chemotherapy Is Given: Regimens, Cycles & Infusion Days →
Frequently asked questions
What is the difference between CHOP and R-CHOP?
CHOP is the four-drug chemotherapy combination — Cyclophosphamide, Hydroxydaunorubicin, Oncovin, and Prednisolone. R-CHOP adds Rituximab, a monoclonal antibody that targets the CD20 protein on B-cell lymphoma cells. Rituximab is not a chemotherapy drug; it is a biological therapy given by intravenous infusion on the same day as the chemotherapy. The addition of rituximab is why most B-cell lymphoma regimens are now written as R-CHOP rather than CHOP.
Is prednisolone in this regimen just to manage side effects?
No. Prednisolone has direct activity against lymphoma cells and is an active component of the regimen, not a supportive add-on. It also supports the action of the other four drugs and helps reduce the risk of infusion reactions to rituximab. On the days you take it you may notice raised energy, disrupted sleep, or increased appetite. These effects settle once you finish the tablets at the end of each cycle.
Will R-CHOP damage my heart?
Doxorubicin — the H — can have a cumulative effect on heart muscle. Because of this, your heart function is assessed before treatment begins and monitored during the course. This monitoring is a routine part of the protocol, not a sign that something is already wrong. If your heart function changes, your oncologist will review the regimen. Tell your team promptly if you notice new breathlessness, swollen ankles, or palpitations between cycles.
Will I lose my hair on R-CHOP?
Hair loss is expected and comes mainly from cyclophosphamide and doxorubicin. It usually begins within the first few weeks of treatment. For most people it is temporary, and hair begins to regrow after the regimen is completed. Texture and colour may be slightly different initially. Your care team can connect you with support for head coverings and other practical assistance during treatment.
What happens if I react to the rituximab infusion?
Infusion reactions — chills, fever, flushing, or chest tightness — are most common during or shortly after the first rituximab infusion. Pre-medications are given before each infusion to reduce this risk, and you are monitored throughout. If a reaction occurs, the infusion is slowed or paused and medicines are given to settle the symptoms. Subsequent infusions can usually be given more quickly once the first is tolerated.
Is R-CHOP given as day care or does it need an overnight stay?
R-CHOP is typically given as day care — you come in for the infusion and go home the same day. The full infusion takes several hours, and the first cycle may take longer while rituximab is introduced slowly. Prednisolone tablets are taken at home over the following days. An inpatient admission may be needed if you develop a complication between cycles, such as fever with low blood counts, which requires prompt assessment.
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