DA-EPOCH-R

Say it: D A EE-pock R

Dose adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab

DA-EPOCH-R is a strong chemotherapy and antibody plan for fast growing B-cell lymphomas, where doses are adjusted each cycle based on your blood counts.

Also called: EPOCH-R, DA-R-EPOCH, R-EPOCH, dose adjusted EPOCH-R, DA EPOCH R, R-DA-EPOCH, EPOCH

What it is

Some of the chemotherapy drips in slowly over 4 days, which may work better against some fast growing lymphomas. Rituximab helps the immune system find lymphoma cells. Doses go up or down each cycle based on how low your blood counts drop. The goal is cure.

Often used for

• primary mediastinal large B-cell lymphoma
• high grade B-cell lymphoma, including double hit lymphoma
• Burkitt lymphoma
• some other aggressive B-cell lymphomas

Dose adjustment

Doses of etoposide, doxorubicin and cyclophosphamide are raised or lowered each cycle based on blood count checks done twice a week.

With spinal fluid treatment

People at risk of lymphoma spreading to the brain may also get chemotherapy (usually methotrexate) into the spinal fluid with spinal taps.

Without rituximab (DA-EPOCH)

For some T-cell lymphomas, the same chemotherapy is given without rituximab.

The medicines in this plan

Etoposide

Chemotherapy given as a slow, continuous drip over 4 days (days 1 to 4).

Prednisone

Steroid pills taken twice a day on days 1 to 5.

Vincristine

Chemotherapy given as part of the same 4 day continuous drip.

Cyclophosphamide

Chemotherapy given through a vein on day 5.

Doxorubicin

Anthracycline chemotherapy given as part of the 4 day continuous drip.

Rituximab

Antibody given through a vein on day 1 that marks lymphoma cells for the immune system.

Filgrastim

Daily shots under the skin starting on day 6 to help white blood cells recover.

How you get it

You need a port or other central line because the drip runs for 4 days. Some centers give it in the hospital and others send you home with a small pump. Each cycle is 21 days, and most people get 6 cycles. Your schedule may be different.

A typical cycle

Day 1

Rituximab through the IV, then the 4 day drip of etoposide, vincristine and doxorubicin starts. Prednisone pills start.

Days 1 to 4

The continuous drip runs in the hospital or through a home pump. A new bag is hooked up each day.

Day 5

The drip ends. Cyclophosphamide is given through the IV. Last day of prednisone.

Day 6 onward

Daily filgrastim shots until counts recover. Blood tests twice a week to guide the next dose.

Days 7 to 14

Blood counts are lowest. Infection risk is highest.

Day 21

Next cycle starts if counts have recovered.

Common side effects and what helps

• Very low white blood cell counts, which raise the risk of serious infection. Wash your hands often and stay away from people who are sick.
• Tiredness and low red blood cells. Some people need a transfusion.
• Hair loss, usually starting 2 to 3 weeks after the first cycle.
• Nausea and mouth sores. Use anti-nausea medicines and gentle mouth rinses.
• Tingling or numbness in the hands and feet, and constipation, from vincristine. Ask about a stool softener.
• Fever, chills or rash during the first rituximab infusion. Medicines are given beforehand to help.
• Bone aches from filgrastim. Ask your team which pain medicine is safe.
• Mood changes, trouble sleeping and high blood sugar from prednisone. Take it with food.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Pump alarms that will not stop, a leaking line, or wet dressing over your port
• Trouble breathing, chest pain, or a fast or pounding heartbeat
• Bleeding that will not stop, blood in your urine or stool, or many new bruises
• Very bad constipation, with no bowel movement for 3 days
• Throwing up or diarrhea that keeps you from drinking or keeping down your medicines
• Redness, swelling or pain around your port

Good to know

• Blood counts are checked twice a week. These results decide the dose for the next cycle.
• Doxorubicin can affect the heart. You will have a heart test (echocardiogram) before starting.
• Your team will check for hepatitis B before rituximab, because it can wake up an old infection.
• In the first cycle, your team watches for tumor lysis (fast breakdown of lymphoma cells) and may give fluids and medicines to protect your kidneys.
• Some medicines in the drip can damage skin if they leak, which is why a central line is used.

At home

• If you go home with a pump, keep it in its carry case, keep the tubing free of kinks and do not get it wet.
• Give yourself filgrastim shots as taught, or arrange visits for them.
• Check your temperature twice a day during the low count days.
• Take prednisone with food in the morning and at midday, not late at night.
• Drink plenty of fluids and use stool softeners if your team suggests them.

Questions to ask

• Will I get the 4 day drip in the hospital or at home with a pump?
• How many cycles will I get?
• Do I need spinal taps to protect my brain?
• When are my twice weekly blood tests, and where?
• How will we know if the lymphoma is gone?

Lymphoma

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.