R-CHOP: Probable Side Effects

The reaction to R-CHOP chemotherapy treatment varies from person to person with some experiencing very few while others undergoing more of them. The side effects elucidated would not be evident in all that are undergoing this treatment.

The most prevalent side effects are stated below:

• Flu-similar symptoms – In some cases, rituximab could lead to fever and chills, feeling weak, tired, giddy and headaches that could be experienced during the time the drug is administered, that are transitory in nature.
• Low blood pressure – While rituximab is being infused, the blood pressure could plummet. Hence, during the course of the treatment the blood pressure would be regularly monitored. Those consuming blood pressure lowering medications would be recommended to take them at least twelve hours prior to rituximab being given. It is imperative that the patient does not self-modify blood pressure medication without previously seeking medical advice.
• Allergic response – Rituximab is known to lead to slight allergic reactions like skin rashes, itchiness, swelling sensed in the tongue or throat, nasal passage irritation, feeling out of breath and coughing. The patient would be closely observed during the course of the treatment. To lower the chances of getting an allergic reaction, some drugs like antihistamines could be given prior to the infusion. The infusion might also be reduced or halted till the reaction subsides.
• Flushing – An abrupt sense of warmness and facial reddishness might be experienced for small spans of time while the rituximab is being infused.
• Reduced immunity to infection – The chemotherapy drugs could lower the production of white blood cells in the bone marrow, thus making one more likely to develop infection. This side effect could become evident a week following the treatment being started, with the resistance levels to infection dipping to its lowest during the ten to fourteenth day following chemotherapy. The blood cells would then progressively rise, and would generally have been reinstated to normal levels prior to the next chemotherapy cycle commencing.

One needs to seek medical advice or visit the hospital right away when:

• The body temperature shoots above 38 degree Celsius or 100.4 degree Fahrenheit.
• Unexpectedly falling sick in spite of normal temperature.

A blood test is done prior to undergoing further chemotherapy sessions for ensuring that the white blood cell count is normalised. Seldom, it might become necessary to postpone the treatment in case the blood count has not recovered.

• Inexplicable Bruising or bleeding – Chemotherapy could lower the patelet production that plays a crucial role in blood clotting. In case of incomprehensible bleeding from nose and gums, blood patches or skin rashes.
• Lowered red blood cell production – During the course of the treatment, one might develop anemia due to the lowered red blood cell production leading to a sense of fatigue and breathlessness.
• Feeling nauseous and vomiting – The doctor would recommend high-power, anti-emetic drugs for averting or reducing nausea and vomiting. One needs to inform one’s doctor in case the illness is uncontrollable or persists as other more effectual anti-emetic drugs could be suggested.
• Constipation – Constipation is one of the side effects of taking anti-emetic drugs like Vincristine.
• Fatigue – Extreme weariness is experienced during chemotherapy, especially during the concluding phase of the treatment. It is a prevailing side effect and one must take as much as rest as possible.
• Hair Loss – Hair loss normally starts close to a month following the initial course of the treatment. Hair normally totally falls out. Some might also experience hair thinning and loss of hair in the eyelashes, eyebrows or other body hair. Hair loss is transient and would re-grow once the treatment concludes.
• Oral Soreness and ulcers – The mouth could feel parched and painful, or one might notice small ulcerous growths while being treated. Staying hydrated at all times and maintaining optimal oral hygiene by using soft bristle toothbrushes could aid in lowering the likelihood of this occurring. The doctor must be informed as special mouthwashes and medicines could be prescribed for averting or clearing any form of mouth infection.
• Variation in taste – During the course of treatment one might experience an altered sense of taste while consuming food which would normalise as soon as the treatment concludes.
• Irritation of the gastric lining – Prednisolone could lower the stomach’s shielding layer that makes it more likely to face irritation. Certain medicines could be prescribed to allay the symptoms. The red prednisolone tablets has a coating for protecting the stomach, however the white tablets need to be consumed on full stomach or after a glass of milk.
• Raised appetite – A greater sense of hunger is experienced while on a course of prednisolone that would halt once the drug is no longer taken.
• Bladder irritation – Cyclophosphamide might cause irritation to the bladder lining. Hence, drinking plenty of fluids through the day (nearly 2 litres) after chemotherapy to averting irritation to the bladder. The doctor must be notified in case blood is noticed in the urine. Doxorubicin is red coloured that might transform the colour of the urine to pink-red in colour. This might last for a day’s time following treatment and is considered a normal occurrence.
• De-sensitised feeling in the hands and feet – This occurs due to vincristine having an effect on the nerves leading to peripheral neuropathy. The doctor must be informed in such a situation. The dose of the drug would need to be decreased. This problem normally shows improvement in some months subsequent to the treatment concluding.
• Variations in the blood glucose levels – Sporadically, prednisolone might lead to a soar in blood sugar levels. During the course of the treatment, regular blood or urinalysis tests would be carried out for verifying this. One must inform the doctor in case one feels excessive thirst or urination.
• Feeling Bloated and Fluid retention – Prednisolone might cause a fluctuation of salt and water balance in the body. There might be swelling noticed in the ankles and/or fingers. This is generally a problem that is associated with long-standing treatment. The doctor must be informed in case this occurs.
• Variations in skin colour – In rare occasions, the skin might show darkening that would normally reduce in some months following the conclusion of the treatment.  While being treated and for few months later on, the skin tends to exhibit greater sensitivity to the sun and could easily burn. Hence, it is imperative to wear high sun protection factor sunscreens prior to going out in the sun and keeping oneself covered with appropriate clothing and hat. At times, skin turns red and tender following radiotherapy treatment which must be notified to the doctor.
• Changing appearance of Nails – The nails tend to turn a darker tone and white lines might start showing. These changes generally outgrow over a span of few months once the treatment has concluded.
• Behavioural modifications – At times, prednisolone could lead to overpowering feelings and moodiness.
• Variations in the heart functioning – Though an atypical occurrence with normal doses of doxorubicin, but might infrequently occur in case high doses are employed. Cardiac function tests would be performed to check the heart’s functioning prior to the treatment starting.
• Heightened risk of blood clots – Cancer could raise the chances of blood clot formation that is heightened with chemotherapy treatment. Blood clots could lead to inflammation, swollen legs or breathing distress or chest pain. Majority of the clots could be ably treated with blood thinning drugs.
• Infertility and absence of periods – Infertility is known to affect both sexes due to the treatment. Women could experience erratic or even halted periods. Among younger women, this might be transitional, but if one is near the menopausal age then it might be a long-lasting effect.

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