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What are CHOP and R-CHOP chemotherapy regimens?

Medically reviewed by Kristianne Hannemann, PharmD. Last updated on May 12, 2025.

Official Answer by Drugs.com

CHOP and R-CHOP are cornerstone chemotherapy regimens for treating indolent and aggressive non-Hodgkin lymphomas, including diffuse large B-cell lymphoma (DLBCL). The CHOP chemotherapy regimen combines four medications (cyclophosphamide, doxorubicin, vincristine, and prednisone), while R-CHOP adds a targeted monoclonal antibody called rituximab. The purpose of these medications is to kill cancer cells and reduce lymphoma progression.

What Does CHOP Stand For?

CHOP stands for:

Cyclophosphamide, doxorubicin, and vincristine are chemotherapy drugs that work to destroy cancer cells. Prednisone is a steroid that stops cancer cells from growing and kills them. This regimen is used as standard chemotherapy treatment for aggressive NHL and T-cell lymphomas.

What Is R-CHOP and How Is It Different?

R-CHOP contains all of the medications in the CHOP regimen, plus rituximab. Rituximab is a targeted immunotherapy agent that is added to CHOP to improve outcomes. It works by targeting a protein called CD20 on B-cells, which helps the immune system destroy these B-cells. R-CHOP is primarily used for diffuse large B-cell lymphoma (DLBCL) and other CD20+ B-cell NHLs.

How Are CHOP and R-CHOP Given?

Both regimens are administered in 21-day cycles, known as CHOP-21 and R-CHOP21.
Cyclophosphamide, doxorubicin, vincristine, and rituximab are given intravenously. You may receive these medications through a cannula, PICC line, central line, or implantable port. Prednisone is taken by mouth for the first 5 days of each cycle.

To prevent infusion-related reactions, your healthcare provider may give you pre-medications such as acetaminophen, an antihistamine, and a steroid. Antiemetics may be given to prevent nausea and vomiting.

A typical treatment course is 6–8 cycles, depending on disease stage and type. Below are examples of a 21-day CHOP and R-CHOP cycle.

CHOP Cycle

R-CHOP Cycle

How Effective Are CHOP and R-CHOP?

CHOP and R-CHOP are standard chemotherapy regimens for treating B-cell lymphomas, especially diffuse large B-cell lymphoma. R-CHOP is generally more effective than CHOP, particularly in improving survival and response rates. The effectiveness of CHOP and R-CHOP has been extensively studied in clinical trials and real-world practice.

CHOP has been a standard treatment for intermediate- and high-grade non-Hodgkin lymphomas for decades. However, outcomes can be improved with additional treatments such as radiotherapy or rituximab (R-CHOP).

In advanced-stage disease, CHOP achieves cure rates of about 30–40% in national cooperative group trials, with 3-year overall survival rates around 52% and disease-free survival rates near 41%. R-CHOP is the gold standard for DLBCL, with 50–70% cure rates.

Related questions

What Are the Side Effects of CHOP/R-CHOP?

CHOP and R-CHOP are associated with a range of side effects, some common and others rare or serious. Most side effects are similar for both regimens, but R-CHOP includes additional risks related to rituximab.

Shared Side Effects

Since CHOP and R-CHOP contain four of the same medications, they share many side effects. Side effects of both regimens may include:

Specific and Serious Side Effects

Some side effects are specific to certain medications in the regimen:

Managing Side Effects

Most side effects are temporary and resolve after treatment ends, but some (such as nerve damage or fertility issues) may be long-lasting. Supportive medications and close monitoring help manage many of these risks. It is important to report any new or worsening symptoms to your healthcare team promptly, as some side effects can be serious or life-threatening.

Who Receives R-CHOP vs CHOP Alone?

R-CHOP is standard of care for most patients with B-cell NHL expressing CD20, including DLBCL and follicular lymphoma, as rituximab targets the CD20 antigen found on B-cells. CHOP alone may be considered for patients with contraindications to rituximab, such as:

Biopsy and immunophenotyping are critical steps in determining the appropriate chemotherapy regimen-specifically, whether a patient should receive CHOP or R-CHOP:

Summary

CHOP and R-CHOP are two chemotherapy regimens. CHOP contains cyclophosphamide, doxorubicin, vincristine, and prednisone, while R-CHOP adds rituximab. R-CHOP is the standard treatment for most patients with B-cell non-Hodgkin lymphomas, especially DLBCL, due to its superior efficacy. CHOP alone is typically reserved for rare cases where rituximab cannot be used, or for non–B-cell lymphomas where rituximab is ineffective. Common side effects include hair loss, fatigue, nausea, increased infection risk, and blood count changes. R-CHOP adds the risk of allergic reactions from rituximab.

References
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