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R-CHOP for diffuse large B-cell lymphoma, step by step | CION Cancer Clinics
R-CHOP is the most widely used first treatment for diffuse large B-cell lymphoma. It combines rituximab with four chemotherapy medicines, usually given as a day-care drip every three weeks, most often for six cycles. It suits most fit adults, while some older or frailer people and those with higher-risk lymphoma are offered a changed plan. Here is what to expect. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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The short answer
What is R-CHOP and why is it used for DLBCL?
R-CHOP is a combination of five medicines and the most widely used first treatment for diffuse large B-cell lymphoma (DLBCL). It is usually given as a drip in day care, once every three weeks. Most people have six cycles, though your haematologist may suggest fewer or a different plan.
Why a combination and not one drug
Each medicine attacks lymphoma cells in a different way. Used together, they reach more of the cells than any one could alone. The gap between cycles lets your blood counts and body recover before the next round.
What each letter stands for
R is rituximab, an antibody that finds a marker called CD20 on B cells. C is cyclophosphamide. H is doxorubicin, whose older name is hydroxydaunorubicin. O is vincristine, once sold as Oncovin. P is prednisolone, a steroid taken as tablets.
What this page cannot tell you
It cannot give you doses or tell you whether R-CHOP is right for you. The dose of each medicine is worked out from your height, weight, blood tests and fitness, and only your treating team sets or changes it. Never skip, stop or adjust a medicine on your own.
R-CHOP is also used for some other lymphomas. This page focuses on DLBCL.Before the first cycle
Which checks happen before R-CHOP starts?
These tests make treatment safer. They rarely take long, and they should not delay treatment for weeks.
Heart check
Doxorubicin can strain the heart. An echocardiogram, an ultrasound scan of the heart, shows how well it pumps before you start.
If your heart is already weak, your team may change the plan.Hepatitis B and C, and HIV tests
Rituximab can wake up a hidden hepatitis B infection. If you carry it, you will usually be given a medicine to keep it quiet during treatment.
Blood tests and scans
A full blood count, kidney and liver tests, uric acid and LDH. A PET-CT at the start gives a baseline for judging response later.
Sometimes also
- Bone marrow test
- Spinal fluid check, if the risk of brain spread is higher
Practical preparation
A dental check if you have bad teeth, a discussion about fertility if relevant, and a plan for getting to day care. Sugar control is reviewed if you have diabetes, because steroids raise blood sugar.
Not sure whether this applies to you?
Ask an oncologistOne cycle, start to finish
What happens during a typical R-CHOP cycle?
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The morning of treatment
Your blood count is checked and you see the doctor or nurse. If the counts are too low, the cycle may be delayed by a few days. That is a safety step, not a sign of failure.
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Medicines before the drip
You are given medicines to prevent sickness and reactions. Rituximab goes in first and slowly, especially the first time, because fever, shivering or rash can occur during the drip.
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The chemotherapy drips
Doxorubicin, vincristine and cyclophosphamide follow. The first cycle usually takes most of the day. Later cycles are often shorter. You go home the same evening in most cases.
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The days at home
You take prednisolone tablets for a few days, exactly as prescribed. Tiredness, poor appetite and constipation are common in the first week. Your urine may look red for a day because of doxorubicin.
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The low point and recovery
White cells usually fall in the second week, when infection risk is highest. Some people are given injections to help counts recover. By the next cycle, most people feel closer to normal.
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Fever during R-CHOP cannot wait
If you have a fever, shivering, or suddenly feel very unwell at any time during treatment, call your treatment team's emergency number at once. If you cannot reach them, go to the nearest emergency department or call 108, and say you are on chemotherapy. Do not wait until morning, and do not take a fever tablet first to see if it settles.
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What to expect
What side effects are common with R-CHOP?
- Hair loss, which usually grows back after treatment ends
- Tiredness that builds over the course
- A low white cell count and a higher infection risk
- Numbness or tingling in the fingers and toes from vincristine
- Constipation, mouth sores and feeling sick
- Raised blood sugar, mood swings and poor sleep from steroids
- Reactions during the first rituximab drip
- Rarely, damage to the heart, which is why it is checked
Not one size for all
Who might not be given standard R-CHOP?
Standard R-CHOP suits most adults with DLBCL who are reasonably fit. Some people are offered a changed version, and a few are offered something else entirely. This is careful planning, not second-best care.
Older or frailer adults
People who are very elderly or have several other illnesses may be given R-mini-CHOP, which uses lower doses. It is gentler and easier to complete. For some, completing a gentler plan safely is more valuable than stopping a stronger one early.
People with heart problems
If the heart already pumps weakly, doxorubicin may be left out or replaced with another medicine. Your haematologist and a heart specialist will weigh the options together.
Higher-risk lymphoma
Double hit lymphoma, lymphoma in the brain, or very high-risk disease may need a different or more intensive plan. For some people with DLBCL, a newer combination called Pola-R-CHP may be discussed instead.
Early, limited disease
If the lymphoma is small and in one area, fewer cycles may be enough, sometimes with radiotherapy. Ask your team how many cycles they suggest, and why.
Commonly believed
What do families often worry about with R-CHOP?
"If the cycle is delayed, the treatment has failed."
Delays usually happen because blood counts need a few more days to recover. The team delays to keep you safe. A short delay does not mean the lymphoma is winning.
"The lump has gone, so we can stop after three cycles."
Lymph nodes often shrink quickly, but lymphoma cells can remain that no one can feel or see. Stopping early can let the lymphoma come back. Finish the course your team plans unless they advise otherwise.
"Home remedies will protect him from side effects."
Some herbal products and supplements affect the liver or interact with chemotherapy. Tell your team about everything you take, including ayurvedic and homeopathic preparations, before adding anything new.
"She must stay completely indoors for six months."
Sensible care, such as hand washing, avoiding crowds during low-count days and eating freshly cooked food, matters more than isolation. Most people can walk, see family and live fairly normally between cycles.
Questions we are asked
Common questions about R-CHOP
How long does the full course of R-CHOP take?
With six cycles given every three weeks, the course usually lasts about four to five months, allowing for small delays. Some people with early disease have fewer cycles. Scans are usually done partway through and at the end to see how well the lymphoma has responded.
Do I need to stay in hospital for R-CHOP?
Most people have R-CHOP in day care and go home the same day. The first cycle may need a longer stay if the lymphoma is very large, kidney tests are abnormal, or you are unwell. Admission is also needed if an infection develops between cycles.
Can I keep working during R-CHOP?
Some people work part time, especially in desk jobs. Many find the first week of each cycle hardest. Avoid crowded workplaces when counts are low. Speak to your team and your employer early, so you can plan flexible days around treatment and scans.
What should I eat during R-CHOP?
Freshly cooked, hot food and safe drinking water are the most important points. Small frequent meals help when appetite is poor. Wash fruit well and avoid street food when counts are low. If you have diabetes, watch sugar closely on steroid days and follow your team's advice.
Will I lose all my hair?
Most people lose their scalp hair within a few weeks of the first cycle, and some lose body hair too. It usually starts to grow back a few months after treatment ends. The texture or colour may be slightly different at first. Scarves, caps or wigs can help.
How much does R-CHOP cost, and do schemes cover it?
The cost depends on the rituximab product used, the number of cycles, tests and any admissions. Aarogyasri, PM-JAY, CGHS, ECHS, EHS and many cashless insurers cover lymphoma treatment, but rules and packages change. Check your current entitlement, and ask for a written estimate before starting.
What happens if R-CHOP does not work?
If the lymphoma does not respond or comes back, there are further options. These include other chemotherapy combinations, stem cell transplant, CAR-T and bispecific antibodies. CION's haematology team reviews each case at a tumour board and coordinates care with qualified centres for treatments not given at CION.
Can I have vaccines during R-CHOP?
Live vaccines should be avoided during treatment and for some time after. Some inactivated vaccines, such as the flu vaccine, may be advised, though they may work less well while on rituximab. Ask your haematologist before any vaccine, and tell family members to check theirs too.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- Macmillan Cancer Support — R-CHOP
- National Cancer Institute — Definition of R-CHOP
- Cancer Research UK — Non-Hodgkin lymphoma
- National Cancer Institute — Adult Non-Hodgkin Lymphoma Treatment (PDQ) - Health Professional Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Pola-R-CHP and Newer First-Line OptionsThe newer alternative some people are offeredEnd-of-Treatment PET in DLBCLHow the team checks whether R-CHOP has workedBlood counts during chemotherapyUnderstanding the count checks before each cycleDLBCL Treatment Cost in IndiaIndicative costs and scheme cover
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Starting R-CHOP, or weighing up the plan you were given?
Share your reports with us. CION's haematology team will explain the plan, the checks before it and what to watch for at home.