Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

R-CHOP regimen: dose, schedule and practical points

Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone every 21 days

Updated: 28 October 20261 min read4 references

Summary for doctors

  • First line in DLBCL; 6 cycles in most patients [1].
  • Before starting: hepatitis B testing [2].
  • Highly emetogenic (anthracycline with cyclophosphamide); high risk of febrile neutropenia in older patients.

Dose and schedule

R-CHOP-21

Diffuse large B-cell lymphoma and other aggressive B-cell lymphomasCycle length: Every 21 days

Diffuse large B-cell lymphoma and other aggressive B-cell lymphomas

DrugDoseRouteSchedule
Rituximab375 mg/m²IV (or 1400 mg subcutaneous from cycle 2)Day 1
Cyclophosphamide750 mg/m²IVDay 1
Doxorubicin50 mg/m²IVDay 1
Vincristine1.4 mg/m² (maximum 2 mg)IVDay 1
Prednisone100 mgOralDays 1 to 5
Cycle length
Every 21 days
Duration
6 cycles (8 cycles in the original study)

Rituximab as in LNH98-5 [1]; the CHOP doses are those of the R-CHOP arm of the POLARIX study, given in the polatuzumab label.

Dose source: [3, 4].

Evidence: GELA LNH98-5 (2002)

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • Before anti-CD20 treatment: HBsAg, hepatitis B core antibody (anti-HBc) and anti-HBs; if HBsAg or anti-HBc is positive, prophylactic antiviral treatment (entecavir or tenofovir) from the start until at least 12 months after the last dose [2].
  • Antiemetics: NK1, 5-HT3 and dexamethasone (daily prednisone is enough).
  • G-CSF at age 60 and over or with comorbidities (G-CSF tool).
  • Bulky disease or high LDH: tumour lysis prevention; in frail older patients, a prednisone pre-phase of 5 to 7 days.
  • Rituximab: premedication with paracetamol and an antihistamine; the first dose at a slow rate.

Monitoring and dose adjustment

  • Echocardiogram before the anthracycline; blood counts before each cycle.
  • Vincristine: cap at 2 mg; reduce or stop with grade 2 to 3 neuropathy or severe constipation; preventive laxatives.
  • Assess the risk of CNS involvement with CNS-IPI (IPI tool).

Main evidence

Show detailsHide

LNH98-5: in patients aged 60 to 80, adding rituximab to CHOP increased complete response from 63% to 76% and 2-year survival from 57% to 70% [1].

Related cancer types

Lymphoma

Treatment regimens (physicians)

Pola-R-CHP in DLBCLABVD in Hodgkin lymphoma and AVD after a negative PETBV-AVD in advanced Hodgkin lymphomaBR regimen (bendamustine and rituximab)

Physician tools and lessons

Cumulative Anthracycline Dose and Doxorubicin EquivalentsTumour Lysis Syndrome: Cairo-Bishop Criteria and PreventionKhorana Score (Cancer-Associated Thrombosis Risk)HCT-CI Comorbidity Index Before Stem Cell TransplantationIPI, R-IPI, NCCN-IPI and CNS-IPI Calculator for DLBCLFollicular Lymphoma International Prognostic Index (FLIPI) CalculatorInternational Prognostic Score (IPS) for Advanced Hodgkin LymphomaMantle Cell Lymphoma International Prognostic Index (MIPI) CalculatorIndications for haematopoietic stem cell transplantation, donor selection and conditioningGraft-versus-host disease (GVHD): prophylaxis, grading and treatment

References

4 references
Show all references, 1 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphomaCoiffier B, Lepage E, Briere J, et al · N Engl J Med · 2002;346:235-42
    Study cardDOIPubMed Back to text: 1 2 3
  2. 2
    Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion UpdateHwang JP, Feld JJ, Hammond SP, et al · J Clin Oncol · 2020;38:3698-3715
    DOIPubMed Back to text: 1 2
  3. 3
    RITUXAN (RITUXIMAB) — Prescribing InformationGenentech, Inc · FDA label · 2026
    Source Back to text
  4. 4
    POLIVY (POLATUZUMAB VEDOTIN) — Prescribing InformationGenentech, Inc · FDA label · 2026
    Source Back to text

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/r-chop/

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