RCHOP B. Indication (cancer type, stage, goal of therapy) CD20-positive diffuse large-B-cell lymphoma at clinical stage II, III or IV; follicular lymphoma C. Common dosing and frequency Rituximab 375 mg/m2 doxorubicin 50 mg/m2 cyclophosphamide 750 mg/m2 vincristine 1.4 mg/m2 (max 2mg) prednisone 50 mg/m2 on days 1-5. Omeprazole 20mg once daily for 5 days (i.e. concurrently with prednisolone) every 21d for 6 to 8 cycles
D. Duration of administration of each drug
Rituximab: 1.5h infusion Doxo: IVP Cyclo: free flow Vincristine: IV over 15 to 20 min E. Diluent required (type, vol, stability) Rituximab: NS 500ml, Cyclo: NS 100ml F. Premeds required? Reason for premed? PO Paracetamol 1g, IV Diphenhydramine 25mg G. Antiemetic required? (acute/delayed/breakthrough) Emesis risk: HIGH (>90 percent frequency of emesis) Acute (IV Grani 3mg), Delayed (PO Grani, PO Maxolon) H. Hydration required? (Volume/Duration/Electrolytes/Diuretics) Nil I. Growth factor support required? Yes. The risk of febrile neutropenia with this regimen is 10 to 20 percent; primary prophylaxis with hematopoietic growth factors should be considered on an individual basis, particularly for high-risk patients such as those with preexisting neutropenia, advanced disease, poor performance status, or patients age 65 years or older. J. Antibiotic/Antiviral prophylaxis required? PCP prophylaxis K. Monitoring parameters (baseline and prior to each dose) FBC, LFT, U/E, MUGA/ECHO Adjustment of initial cyclophosphamide, doxorubicin, and vincristine doses may be needed for preexisting liver dysfunction In addition, dose adjustment of cyclophosphamide may be required for renal dysfunction. Hepatitis screening: Patients should be screened for hepatitis B and C prior to starting rituximab, and if positive, considered for antiviral prophylaxis. L. Possible side effects Neurotoxicity Infusion-related reactions manifested by chills, fever, tachycardia, bronchospasm, dyspnea, and hypotension Hep B reactivation, Severe (occasionally fatal) infusion-related reactions have been reported, usually with the first infusion. Severe and sometimes fatal mucocutaneous reactions (lichenoid dermatitis, paraneoplastic pemphigus, Stevens-Johnson syndrome, toxic epidermal necrolysis and vesiculobullous dermatitis) have been reported (Rituximab) M. Counselling points Steroids can raise your blood sugar levels.
N. Patient specific precautions (prior hypersensitivity, side effects