R-GemOx

Say it: R-JEM-ox

Rituximab, gemcitabine and oxaliplatin

R-GemOx is an outpatient chemotherapy plan for B-cell lymphoma that has come back, often used for people who will not have a stem cell transplant.

Also called: R-GEMOX, RGemOx, GemOx-R, Rituximab GemOx, GemOx

What it is

Rituximab helps the immune system target lymphoma cells, and gemcitabine and oxaliplatin are two chemotherapies that damage lymphoma cells in different ways. It is gentler than transplant level treatment and can be given in a clinic. The goal is to shrink the lymphoma and control it for as long as possible. Sometimes newer medicines are added to it in certain situations.

Often used for

• Large B-cell lymphoma that came back when a stem cell transplant is not planned
• Other B-cell lymphomas that came back
• Lymphoma in people who are not able to have stronger treatment

The medicines in this plan

Rituximab

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

Gemcitabine

Chemotherapy that stops lymphoma cells from copying their DNA. Given through a vein over about 30 minutes on day 1 (some plans use day 2).

Oxaliplatin

Platinum chemotherapy given through a vein over about 2 hours on day 1 (some plans use day 2). Causes cold sensitivity and tingling.

How you get it

R-GemOx is given in an outpatient infusion clinic. A treatment day takes about 4 to 6 hours, and longer for the first rituximab infusion. Each cycle is usually every 14 days, for up to about 8 cycles. Your schedule may be different.

A typical cycle

Day 1

Blood tests, pre-medicines, then rituximab, gemcitabine and oxaliplatin through a vein.

Days 2 to 5

Possible tiredness, nausea and cold sensitivity.

Days 6 to 14

Recovery. Blood counts, especially platelets, are often lowest in the second week.

Every few cycles

A scan to check how the lymphoma is responding.

Common side effects and what helps

• Low platelets and white blood cells. Watch for bruising and wash hands often.
• Tingling or numbness in fingers, toes or around the mouth, often set off by cold. Wear gloves and avoid cold drinks for a few days after treatment.
• Tiredness. Rest and light activity both help.
• Nausea. Take anti-nausea medicines as prescribed.
• Flu-like aches or a low fever the day after gemcitabine. Ask your team what to take.
• Chills or fever during the first rituximab infusion. Your nurse will slow it down and give medicine.
• Rash or mild swelling.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Bleeding that will not stop, or many new bruises or tiny red spots on the skin
• Shortness of breath or a new cough
• Throat tightness or trouble swallowing or breathing
• Passing very little urine, or swelling in the legs
• Diarrhea or vomiting that does not stop
• Yellow skin or eyes

Good to know

• Blood counts are checked before each cycle, and treatment may be delayed if they are low.
• You will be tested for hepatitis B before rituximab, since it can wake up an old infection.
• Nerve symptoms from oxaliplatin can build up over time. Tell your team about trouble with buttons, writing or walking.
• Rarely, gemcitabine can affect the lungs or kidneys, so tell your team about new breathing problems or swelling.

At home

• Avoid cold drinks, cold food and cold air on your face for several days after treatment.
• Drink plenty of fluids.
• Use a soft toothbrush and an electric razor while platelets are low.
• Check your temperature if you feel unwell, and keep the after hours number handy.

Questions to ask

• What is the goal of my treatment?
• How many cycles will I get, and when is my next scan?
• Am I a candidate for CAR T-cell therapy, a bispecific antibody, or a clinical trial?
• What should I do if the tingling in my hands gets worse?

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.