R-DHAP

Say it: R-D-hap

Rituximab, dexamethasone, cytarabine and cisplatin

R-DHAP is a strong four medicine plan used mostly for lymphoma that has come back, to shrink it before a stem cell transplant.

Also called: RDHAP, DHAP, R-DHAP salvage, R-DHAX (with oxaliplatin), R-DHAOx, DHAP for Hodgkin lymphoma

What it is

When lymphoma returns after the first treatment, a different set of medicines is used to get it under control again (sometimes called salvage treatment). If it works, many people then have high dose chemotherapy with their own stem cells (autologous transplant), which gives the best chance of long term control or cure. In mantle cell lymphoma, R-DHAP is part of the first treatment for some younger patients.

Often used for

• Large B-cell lymphoma that came back, before a stem cell transplant
• Mantle cell lymphoma in younger, fit people, often alternating with R-CHOP
• Hodgkin lymphoma that came back (DHAP, without rituximab)
• Other B-cell lymphomas that came back

DHAP without rituximab

Used for Hodgkin lymphoma and for lymphomas that do not carry the CD20 marker.

R-DHAX or R-DHAOx

Oxaliplatin is used instead of cisplatin, which can be easier on the kidneys and hearing.

The medicines in this plan

Rituximab

An antibody that targets CD20, a marker on B-cell lymphoma cells. Given through a vein on day 1.

Dexamethasone

A steroid that kills lymphoma cells. Given as a pill or IV on days 1 to 4.

Cytarabine (Ara-C)

High dose chemotherapy given through a vein as 2 doses, 12 hours apart, on day 2.

Cisplatin

Platinum chemotherapy given through a vein on day 1, often slowly over many hours, with lots of IV fluid to protect the kidneys.

How you get it

R-DHAP is often given in the hospital over 2 to 4 days, though some centers give it as an outpatient with very close follow up. Each cycle is 21 days, and most people get 2 to 3 cycles before stem cell collection and transplant. You will get a white blood cell booster shot after each cycle. Your schedule may be different.

A typical cycle

Day 1

Rituximab, then cisplatin with lots of IV fluid. Dexamethasone starts.

Day 2

Cytarabine through a vein, 2 doses 12 hours apart. Steroid eye drops start.

Days 3 to 4

Dexamethasone continues. Many people go home on day 3 or 4.

Days 5 to 21

Booster shot, then recovery. Blood counts are lowest around days 10 to 14, and transfusions may be needed.

After 2 to 3 cycles

A PET scan to check response, then stem cell collection and transplant if planned.

Common side effects and what helps

• Nausea and vomiting, which can be strong with cisplatin. Take anti-nausea medicines on schedule for several days.
• Low blood counts with high infection risk, and possible need for blood or platelet transfusions.
• Tiredness. Rest and short walks both help.
• Ringing in the ears or trouble hearing. Tell your team about any change.
• Kidney strain and low magnesium or potassium. Drink plenty of fluids.
• Red, sore eyes from cytarabine. Use the steroid eye drops as directed.
• Chills or fever during the first rituximab infusion. Your nurse will slow it down.
• Tingling in fingers and toes, high blood sugar and trouble sleeping.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Vomiting that keeps you from drinking or taking medicines
• Passing much less urine than usual, or dizziness when standing
• Bleeding that will not stop, or many new bruises
• Trouble walking, poor balance or slurred speech
• Sudden hearing loss, or new loud ringing in the ears
• Shortness of breath or chest pain

Good to know

• Kidney function, salt levels and blood counts are checked before and after each cycle.
• A hearing test may be done if you notice changes, since cisplatin can harm hearing.
• You will be tested for hepatitis B before rituximab, since it can wake up an old infection.
• Steroid eye drops help prevent eye irritation from high dose cytarabine.
• If a transplant is planned, your team will time stem cell collection with your blood count recovery.

At home

• Drink about 8 to 12 cups of fluid a day for several days after treatment, unless your team says otherwise.
• Take anti-nausea medicines on schedule, even if you feel okay.
• Check your temperature twice a day and any time you feel unwell.
• Use your eye drops on schedule.
• Avoid crowds and people who are sick while your counts are low.

Questions to ask

• Will I stay in the hospital, and for how long?
• How many cycles will I get before transplant?
• Am I a candidate for a stem cell transplant or CAR T-cell therapy?
• How will we know if this is working?
• Who do I call after hours?

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.