A.

Name/ Abbreviation of Regimen

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
experienced, protocol deviation, intervention done thus far)
O. Any other relevant information