R-CHOP: what to expect, day by day

Infusion reaction (rituximab)

During or just after an infusion

A reaction during the first rituximab infusion (chills, fever, flushing, rarely breathing trouble) — much less likely on later infusions. You'll be pre-medicated and watched closely, and the drip is slowed if needed.

Call your team urgently: Any trouble breathing, throat tightness, or dizziness during the infusion — tell staff at once.

reported by about 77% first infusion (mostly mild) of people; severe in 7-12% · Timing is part of what this effect is · from Rituximab

NeutropeniaPROVISIONAL

Typically around days 8–21

A temporary drop in infection-fighting white cells; the low point is usually days 8-14. A white-cell booster (G-CSF) is often added, especially if the risk is high.

Call your team urgently: A temperature of 100.4°F (38.0°C) or higher — an emergency.

reported by about majority% of people; severe in 50-90% · Timing from the manufacturer’s prescribing information · from Cyclophosphamide, Doxorubicin

Febrile neutropenia

Typically around days 8–21

Fever while white cells are low — most likely after cycle 1. It's a medical emergency; a white-cell booster is often given to lower the risk.

Call your team urgently: Fever with feeling unwell — go to the ER and say you're on chemotherapy.

reported by about 20% after cycle 1 (no G-CSF) of people · Timing from the manufacturer’s prescribing information · from Cyclophosphamide, Doxorubicin

Hair loss

Typically around days 21–42

Hair loss is near-universal with this regimen and grows back after treatment ends.

reported by about ~100% of people · Timing from a drug-monograph reference · from Doxorubicin, Cyclophosphamide, Vincristine

Heart-muscle weakening (cardiotoxicity)

cumulative, dose-related; can appear months-years later

Doxorubicin (an anthracycline) can weaken the heart's pumping, with the risk rising with total lifetime dose. A standard 6-8 cycles keeps most people well under the higher-risk range. Your team checks heart function (echo/MUGA); report new breathlessness, swelling, or a racing heartbeat.

Call your team: New shortness of breath, swelling, or a rapid/irregular heartbeat.

reported by about ~1-2% CHF at ~300 mg/m² of people · from Doxorubicin

Peripheral neuropathy (cumulative)

builds over cycles; sensory first; often improves but may persist

Vincristine can cause numbness, tingling, or weakness in the hands and feet, and can slow the bowel (constipation). It builds with repeated doses; your team may reduce or cap the dose. Use the bowel routine they recommend.

Call your team: Numbness that makes it hard to button clothes or walk, or no bowel movement for 3 days with belly pain.

reported by about common with cumulative dosing% of people · from Vincristine

Hepatitis B reactivation

during or months after treatment

In people who have had hepatitis B, rituximab can reactivate the virus — sometimes seriously — even months after treatment. That's why you're screened before starting; if needed, you'll take an antiviral and be monitored.

Call your team: Yellowing of skin/eyes, dark urine, or severe tiredness.

reported by about screen all patients before starting% of people · from Rituximab

Nausea

Sickness in the first 24 hours is the "acute" phase and usually peaks 2-3 hours in; anything from 24 to 120 hours is the "delayed" phase.

Usually well controlled with anti-nausea medicine given before treatment; can be delayed over a few days.

Call your team: Can't keep fluids down for more than 12 hours.

reported by about common (moderate-high emetic risk)% of people · Timing from a clinical guideline · from Cyclophosphamide, Doxorubicin