Chemo Experts, the easiest way to learn about cancer treatment
Find a Treatment:
Cancer Types
or
Treatments
listen

Tap along the timeline to move to different parts of the audio file.

Treatment Name: CHOP (Cyclophos­phamide + Doxorubicin + Vincristine + Prednisone)

CHOP (Cyclophos­phamide + Doxorubicin + Vincristine + Prednisone) is a Chemotherapy Regimen for Lymphoma, T-Cell

How does CHOP work to treat T-cell lymphoma?
Each of the medications in CHOP are designed to kill cancerous cells known as T-lymphocytes.

C - Cyclophosphamide (Cytoxan)
H - Hydroxydaunorubicin (doxorubicin)
O - Oncovin (vincristine)
P - Prednisone (Deltasone)

Goals of therapy:
CHOP is given to shrink T-cell lymphoma and reduce symptoms caused by the lymphoma. CHOP is commonly given with the goal of cure.

listen

Tap along the timeline to move to different parts of the audio file.

Schedule

  • Cyclophosphamide I.V. infusion over 30 - 60 minutes on Day 1
  • Hydroxydaunorubicin (Doxorubicin) I.V. push over 3 - 5 minutes on Day 1
  • Oncovin® (Vincristine) I.V. push or I.V. infusion (generally over 30 minutes or less) on Day 1
  • Prednisone 100 mg (two 50 mg, or five 20 mg) oral tablets by mouth once daily on Days 1, 2, 3, 4, and 5

Estimated total infusion time for CHOP treatment:

  • Up to two hours for Day 1 of each cycle
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

CHOP is usually given in an outpatient infusion center allowing the person to go home afterwards. Prednisone tablets are typically taken at home all five days, for which the doctor will write a prescription to be filled at an outpatient pharmacy. CHOP may be given in the hospital if someone is too sick to go to an outpatient infusion center.

CHOP is repeated every 14 or 21 days. This is known as one Cycle. Each cycle may be repeated up to six times, depending upon the stage of the disease and tolerability. Duration of therapy may last up to six months, depending upon tolerability and number of cycles prescribed.

Click here for common CHOP starting doses.

listen

Tap along the timeline to move to different parts of the audio file.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported CHOP side effects are shown here. Side effects sometimes have percentage ranges [example: 70 – 72% had low white cells] because they differed between clinical studies:

  • Low white blood cells (70 - 72%)
  • Hair loss (58 - 63%)
  • Anemia [low red blood cells] (13 - 20%)
  • Increased bleeding risk [low platelet count; thrombocytopenia] (5 - 15%)
  • Nausea or vomiting (8 - 14%)
  • Infection (8 - 11%)
  • Mouth sores (7%)
  • Lung injury (4 - 5%)
  • Decreased heart function (3 - 5%)
  • Numbness or tingling in hands or feet (3 – 4%)
  • Kidney injury (1%)

Although not reported in the clinical studies, some patients may experience constipation as a side effect of vincristine.

Side effect videos Side Effect Videos
Hair LossHair LossAnemiaAnemiaNausea and VomitingNausea and VomitingNeutropenic FeverNeutropenic FeverPainPainConstipationConstipation

listen

Tap along the timeline to move to different parts of the audio file.

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment, and before each cycle thereafter. Labs for CHOP often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Lactate Dehydrogenase (LDH), blood phosphorous levels, uric acid levels, plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment and after 3 to 4 cycles to determine how well the chemotherapy is working. Imaging may include chest X-rays, computerized tomography (CT) scans, or positron emission tomography (PET) scans, plus any others your doctor may order.

How might blood test results/imaging affect treatment?
Depending upon the results of labs and imaging, your doctor may advise to continue CHOP as planned, delay a future cycle of CHOP, or switch to a different chemotherapy.

listen

Tap along the timeline to move to different parts of the audio file.

ChemoExperts Tips

  • Don't forget take your oral prednisone on Days 1 - 5 of each cycle! Your doctor will give you a prescription to fill at your outpatient pharmacy
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for T-Cell Lymphoma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for CHOP (Cyclophos­phamide + Doxorubicin + Vincristine + Prednisone), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for CHOP (Cyclophos­phamide + Doxorubicin + Vincristine + Prednisone). Depending upon your income, they may be able to help cover the cost of:

  • Cyclo­phospha­mide IV
  • Doxorubicin
  • Vincristine
  • Pred­nisone

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as CHOP (Cyclophos­phamide + Doxorubicin + Vincristine + Prednisone) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with CHOP (Cyclophos­phamide + Doxorubicin + Vincristine + Prednisone)

Individual Drug Label Information

Cyclo­phospha­mide IV (Cytoxan®)

  • Cyclophosphamide is administered as an intravenous (I.V.) infusion
  • May decrease the ability to become pregnant. Fertility preservation is recommended in couples wishing to become pregnant.
  • A smaller dosage may be required for patients receiving hemodialysis
  • Has been linked to the development of other cancers in a small number of people
General Cyclophosphamide (Cytoxan) Side Effects
  • Low white blood cell count which can increase the risk of infection
  • Nausea or vomiting, which can be acute (first 24 hours) or delayed (Days 2 – 5)
  • Hair loss, which is usually reversible
  • Click on the cyclophosphamide (Cytoxan) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingHair LossHair LossNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Doxorubicin (Adriamycin®)

  • Doxorubicin is administered as an intravenous infusion and is red in color
  • Can affect heart function. A heart study (echocardiogram) may be required before receiving the first dose
  • Dosage may be reduced in patients with poor liver function
  • Has been linked to the development of other cancers in a small number of people (1.5% chance at 10 years)
General Doxorubicin (Adriamycin) Side Effects
  • Nausea, vomiting, diarrhea, and mouth sores (stomatitis)
  • Leakage into skin or surrounding muscle during infusion may cause severe irritation (extravasation)
  • May temporarily turn urine orange
  • Hair loss, which is usually reversible
  • Increased risk of infection due to decrease white blood cell count (neutropenia)
  • Click on the doxorubicin (Adriamycin) package insert for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossPainPainNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Vincristine (Oncovin®)

  • ​Vincristine MUST only be given by intravenous infusion. May NOT be administered any other way
  • Dosage may be reduced in patients with poor liver function
  • May interact with certain antifungal medications
  • Vincristine will cause death if administered into spinal fluid
General Vincristine (Oncovin) Side Effects
  • Nerve pain in hands or feet may increase after each dose. It is usually reversible if treatment is stopped or dose is adjusted
  • Hair loss is NOT common if vincristine is given by itself
  • May cause constipation; preventative medicines may help decrease or avoid constipation
  • Leakage into skin or surrounding muscle may cause severe irritation (extravasation)
  • Click on the vincristine (Oncovin) package insert below for reported side effects and potential drug interactions

Side Effect Videos
ConstipationConstipationPainPain

See DailyMed package insert.

Pred­nisone

  • Prednisone is an oral medication, usually supplied as a white tablet
  • Prednisone may increase the risk of infection. Depending upon how much prednisone is taken, antibiotics may be prescribed to help prevent infections during treatment with prednisone
  • Should be taken with food and with a large glass of water to avoid stomach irritation or ulcers
  • Should be taken before 6 P.M. when possible, to avoid trouble falling asleep
  • May decrease the response to vaccines; vaccines may need to be repeated at a later date to obtain maximal response
  • If taken daily for several days or weeks, the dose of prednisone may need to be gradually decreased to avoid withdrawal symptoms
  • If you miss a dose, take the next dose as soon as possible
  • Should be stored at room temperature
General Prednisone Side Effects
  • May cause high blood sugar, weight gain, irritability, high blood pressure, difficulty sleeping, stomach ulcers, bone loss, muscle weakness
  • Click on the Prednisone package insert below for reported side effects and potential drug Interactions
See DailyMed package insert.

Share this page:

References

1) Pfreundschuh M, Trümper L, Kloess M, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. 2004;104:634-641.

2) Schmitz N, Trümper L, Ziepert M, et al. Treatment and prognosis of mature T-cell and NK-cell lymphoma: an analysis of patients with T-cell lymphoma treated in studies of the German High-Grade Non-Hodgkin Lymphoma Study Group. Blood. 2010;116:3418-3425.

Created: November 20, 2016 Updated: November 20, 2016

What is Lymphoma, T-Cell?

A disease of lymphocytes called T-lymphocytes, or "T-cells" that are found most commonly in the skin, spleen, blood, bone marrow, and/or lymph nodes. Peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) are the two main types of T-cell lymphoma; however, there are many different subtypes of PTCL and CTCL and all are very rare.

The exact cause of T-cell lymphomas is not known, but certain viral infections such as the Epstein-Barr Virus (EBV) and human T-cell leukemia virus have been associated with development of T-cell lymphomas. The stage of T-cell lymphoma can vary at diagnosis and throughout treatment. Stages of T-cell lymphoma include stage I, II, III, and IV. The effectiveness of the treatment may depend upon the stage and specific subtype at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Common CHOP starting doses

  • Cyclophosphamide 750 mg/m2 I.V. infusion over 30 - 60 minutes on Day 1
  • Hydroxydaunorubicin (Doxorubicin) 50 mg/m2 I.V. push infused over 2 - 5 minutes on Day 1
  • Oncovin® (Vincristine) 1.4 mg/m2 (max dose = 2 mg) I.V. push or I.V. infusion (generally over 30 minutes or less) on Day 1
  • Prednisone 100 mg (two 50 mg, or five 20 mg) oral tablets by mouth once daily on Days 1, 2, 3, 4, and 5

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1) Pfreundschuh M, Trümper L, Kloess M, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. 2004;104:634-641.

2) Schmitz N, Trümper L, Ziepert M, et al. Treatment and prognosis of mature T-cell and NK-cell lymphoma: an analysis of patients with T-cell lymphoma treated in studies of the German High-Grade Non-Hodgkin Lymphoma Study Group. Blood. 2010;116:3418-3425.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium