R-CHOP

Say it: AR-chop

Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone

R-CHOP is a mix of four IV (through a vein) medicines plus prednisone pills, and it is the most common first treatment for B-cell lymphoma.

Also called: RCHOP, R CHOP, CHOP, R-CHOP-21, R-mini-CHOP, Pola-R-CHP, CHOP-R

What it is

Each medicine attacks lymphoma cells in a different way, so together they work better than any one alone. Rituximab is an antibody that marks B cells so the immune system can destroy them. For diffuse large B-cell lymphoma, the goal is usually cure.

Often used for

• diffuse large B-cell lymphoma
• follicular lymphoma and other B-cell lymphomas
• some T-cell lymphomas (as CHOP, without rituximab)

CHOP (without rituximab)

Used for T-cell lymphomas, where rituximab does not help. For some T-cell lymphomas, brentuximab vedotin is given in place of vincristine (called A-CHP or BV-CHP).

Pola-R-CHP

Polatuzumab vedotin replaces vincristine. It is an option for some people with higher risk diffuse large B-cell lymphoma.

R-mini-CHOP

Lower amounts of the chemotherapy for people over about 80 or who are frail, to make treatment easier to handle.

Shorter course with radiation

For early stage lymphoma, some people get 3 or 4 cycles, sometimes followed by radiation, instead of 6.

The medicines in this plan

Rituximab

Antibody that targets a marker (CD20) on B cells. Given through a vein on day 1; the first dose is given slowly because of the chance of an infusion reaction.

Cyclophosphamide

Chemotherapy that damages the DNA of cancer cells. Given through a vein on day 1.

Doxorubicin

Anthracycline chemotherapy, a red medicine that may turn urine pink or red for a day or two. Given through a vein on day 1.

Vincristine

Chemotherapy that stops cancer cells from dividing. Given through a vein on day 1; it can cause tingling in the hands and feet.

Prednisone

Steroid pill that also kills lymphoma cells. Taken by mouth once a day on days 1 to 5.

How you get it

R-CHOP is given in an outpatient infusion clinic, usually every 21 days. The first day often takes 5 to 7 hours because rituximab goes in slowly; later visits are usually shorter. Many people have a port (a small device under the skin for IV access). Most people get 6 cycles, which takes about 4 to 5 months. Your schedule may be different.

A typical cycle

Day 1

Blood tests, then IV rituximab, cyclophosphamide, doxorubicin and vincristine in the infusion clinic. Start prednisone pills.

Day 2

Many people get a shot of a white blood cell booster (pegfilgrastim), or have an on-body injector placed the day before.

Days 1 to 5

Take prednisone pills each morning with food. Nausea and tiredness are most likely in these days.

Days 7 to 14

Blood counts are lowest, so infection risk is highest. Watch for fever.

Days 15 to 21

Counts recover and energy improves. Blood tests and a visit before the next cycle.

Common side effects and what helps

• Tiredness. Rest when you need to, and take short walks on good days.
• Low white blood cell counts, which raise infection risk. Wash hands often and stay away from people who are sick.
• Hair loss, usually starting 2 to 3 weeks after the first cycle. It grows back after treatment ends.
• Nausea. Take your anti-nausea medicine on schedule, not only when you feel sick.
• Tingling or numbness in fingers and toes from vincristine. Tell your team if buttons or writing get hard.
• Constipation from vincristine and anti-nausea medicines. Drink fluids and ask about a daily stool softener.
• Mouth sores. Rinse with a mild salt and baking soda rinse and use a soft toothbrush.
• Mood swings, trouble sleeping, high blood sugar and big appetite from prednisone. Take it in the morning.
• Pink or red urine for a day or two after doxorubicin. This is expected and harmless.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Chills, shaking, trouble breathing, rash or swelling of the face during or after the rituximab infusion
• Redness, pain or swelling where the IV went in
• No bowel movement for 3 days, or bad belly pain
• Vomiting or diarrhea that will not stop, or you cannot keep fluids down
• Chest pain, a racing heartbeat, or new swelling of the legs
• Yellow skin or eyes, or very dark urine
• Unusual bleeding or bruising

Good to know

• You will have a blood test for hepatitis B before starting, because rituximab can wake up an old hepatitis B infection.
• Doxorubicin can affect the heart, so most people have a heart ultrasound (echocardiogram) or similar test before starting.
• With the first cycle, lymphoma cells can break down fast (tumor lysis). Drink plenty of fluids; your team may give a medicine such as allopurinol and check blood tests.
• Blood tests are checked before each cycle to make sure counts have recovered.
• Some people get scans partway through and at the end to see how the lymphoma is responding.

At home

• Take your temperature if you feel unwell, and keep a thermometer at home.
• Take prednisone with breakfast to protect your stomach and help you sleep at night.
• Drink 8 to 10 cups of fluid a day unless your team tells you otherwise.
• Use a stool softener or gentle laxative if your team advises it, starting on day 1.
• Avoid crowds and people with colds when your counts are low (days 7 to 14).

Questions to ask

• How many cycles will I get, and will I need radiation?
• What is the goal of my treatment?
• Will I get a white blood cell booster shot?
• When will I have scans to see if it is working?
• Which side effects should make me call right away, and what number should I use at night?

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.