Example orders for R-CHOP in lymphoma

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R-CHOP

R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone

Original references may be found at R-CHOP (Non-Hodgkin lymphoma)

Example regimen #1

• Cyclophosphamide (Cytoxan) 750 mg/m2 IV on day 1
  • Infuse over 30-45 minutes.
• Doxorubicin (Adriamycin) 50 mg/m2 IV on day 1
  • Administer IV push through running IV.
• Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV on day 1
  • Administer IV push through running IV. Make sure to address patient's bowel status.
• Prednisone (Sterapred) 100 mg PO on days 1-5
• Rituximab (Rituxan) 375 mg/m2 IV on day 1
  • Infusion rate per hospital policy.

21-day cycles x 6 cycles

Supportive medications:

• Pegfilgrastim (Neulasta) 6 mg SC x1 on day 3
• Acetaminophen (Tylenol) 650 mg PO 30-60 minutes prior to rituximab
• Diphenhydramine (Benadryl) 25-50 mg PO/IV 30-60 minutes prior to rituximab. 50 mg to be used for the first dose of rituximab. Dose may be reduced to 25 mg on subsequent rituximab treatments if tolerated.
• Ondansetron (Zofran) 8 mg IV 30 minutes prior to CHOP
• Hydrocortisone (Cortef) 50 mg IV prn rituximab infusion reaction, may repeat x1

Hydration:

• Prehydration with 500 ml NS at 500 mL/hour, to start 60 minutes before chemotherapy
• 500 ml NS at KVO rate to be used as running IV for chemotherapy infusion. Give up to 500 ml NS.

Monitoring:

• On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr as part of a comprehensive metabolic panel, alk phos, AST, ALT, total bilirubin, albumin, LDH
  • Physician to be notified if liver function tests or bilirubin are not within normal limits
• On day 8, check nadir CBC with differential, absolute neutrophil count (ANC). Need for further nadir count checks to be determined by degree of cytopenias.
• Check hepatitis B status prior to therapy with rituximab

Outpatient medications:

• Prednisone (Sterapred) as described above
• Ondansetron (Zofran) 8 mg PO Q8H prn nausea
• Acyclovir (Zovirax) 400 mg PO Q8H
• Allopurinol (Aloprim) 100-300 mg PO daily, adjusted for renal function

Clinical scenario & comments:

• 74 year-old gentleman with diffuse large B-cell lymphoma (DLBCL), using R-CHOP as first-line therapy. This patient had a creatinine of 1.4, with calculated creatinine clearance by Cockcroft-Gault of 55, but the team chose to be more conservative with allopurinol dosing and used 100 mg PO daily.