R-CHOP Chemotherapy For Non Hodgkin’s Lymphoma Abroad

R-CHOP is the treatment regimen used for the management of Non Hodgkin’s Lymphomas, which involves the inclusion of a drug ’Rituximab’ in addition to the conventional CHOP drug therapy ( which consists of three chemotherapy drugs and one steroid). R-CHOP has several scientifically proven advantages over the conventional chemotherapy used for the management of Non Hodgkin’s Lymphoma. Mexico, Turkey, Jordan, India, and Costa Rica are the preferred destinations to have the therapy conducted abroad.

Advantages of R-CHOP Chemotherapy:

• As per studies conducted by the American Society of Clinical Oncology (ASCO), R-CHOP chemotherapy has a proven advantage over the conventional CHOP therapy. R-CHOP chemotherapy gives a 2 years event free survival rate for over 90% of cases and has achieved an overall survival rate of more than 97%.
• Inclusion of ‘Rituximab’ in conventional CHOP treatment has been proven to be effective for many lymphomas including aggressive lymphomas ( diffuse large B cell Lymphoma) and follicular lymphoma
• The R-CHOP chemotherapy regimen is equally effective for young patients with good prognosis and young patients with poor prognosis, unlike the conventional CHOP treatment which has a survival rate of 5 years in 50% in young patients with poor prognosis.
• RCHOP chemotherapy treatment has also been proven to be more effective among elderly patients without increasing toxicity

R-CHOP Chemotherapy Regimen:

In addition to the chemotherapy drugs used in the CHOP regimen (Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone), R-CHOP includes the addition of a ‘Rituximab’, which is a monoclonal antibiotic which attaches itself with proteins, called CD 20, located on the surface of B-cells. B cells are the cancerous cells which are found in most of the types of non Hodgkin’s lymphoma. Rituximab helps immune cells to identify the B cells, by attaching itself on the cell surface. Once identified, B cells are destroyed by our immune system.

Like CHOP, R-CHOP chemotherapy is also given in three to eight cycles. Based on the number of days each cycle lasts, the chemotherapy regimen is classified as R-CHOP 14 (for a 14 day cycle) or R-CHOP 21 (for a 21 day cycle). The drugs and their doses remain same in both the treatment options, only the break time between the treatments is altered.

• Vincristine and Adriamycin are given with an IV drip of normal saline (salt water).
• Cyclophosphamide is given through the oral route or the intravenous route.
• Rituximab is given intravenously on the first day of the treatment for a few hours, while the other intravenous drugs of CHOP regimen may be given on the same or the subsequent day.
• Prednisone has to be taken orally for the next few days, in order to reduce the intensity of complications related to the drug combination and alleviate pain.

Common Side Effects of R-CHOP Chemotherapy for Non Hodgkin’s Lymphoma:

It is essential to understand that some of the side effects may be annoying, causing inconvenience but they don’t damage the overall health in the long run. However some of the side effects are serious medical conditions and inevitably require the intervention of the medical team. It is thus essential to discuss all the side effects with your medical team.

• Just like any other chemotherapy regimen RCHOP results in the drop in the white blood cell count making the person prone to infections.
• Fall in the red blood cell count may result in symptoms like tiredness, breathlessness, fatigue and muscle ache
• Drop in platelet count may result in bruising, nosebleeds, gum bleeds and thrombocytopenia purpura (i.e. tiny red black spots on the feet and arms)
• Flu like symptoms including fever, chills and rigors and headaches may occur as a reaction to the chemotherapy drugs.
• Hair loss and thinning of hairs is common for most chemotherapy regimen
• Allergic reactions to Rituximab are commonly observed with symptoms like itching, swelling and rash on the skin, irritation in the nose with frequent sneezing and coughing and sensation of swelling and irritation in the throat.
• The regimen may impact the reproductive organs causing infertility (though the actual causes are not known) or amenorrhea i.e. loss of menstrual flow among women. Medical advice is recommended prior to initiating the treatment especially by pregnant women as it may have harmful effects on the baby.
• Other systemic changes include puffiness of the face, indigestion and stomach pain, loss of appetite, darkening of the skin and increased photosensitivity.
• Patients may also experience mood swings, and insomnia (i.e. difficulty in sleeping).
• There is a rare possibility of a person developing a new primary cancer after the R-CHOP chemotherapy regimen

Some considerations before initiating RCHOP regimen for Non Hodgkin’s Lymphoma: 

• Hypertensive patients may be recommended to either reduce their dosage or frequency. This is due to the blood pressure reducing effect of Rituximab.
• Avoid immunization using live vaccine during or at least 6 months after the chemotherapy regimen. Other immunizations like oral vaccines are allowed, however, they would not prove very beneficial, as the immune system is weakened due to the treatment
• R-CHOP has harmful effects on a developing embryo. Hence it is mandated that you discuss your plans of having a baby with the doctor before initiating the treatment. Chemotherapy drugs are also known to transcend into your baby through breast milk, hence it is suggested that you avoid breastfeeding while on treatment and at least 6 months after.

Conclusion: 

R-CHOP chemotherapy regimen has several proven advantages over the standard CHOP regimen. It increases chances of survival and is effective for several more diffused and aggressive forms of Non Hodgkin’s Lymphomas. The chemotherapy also allows shorter cycles. However the extent of the complications and side effects remain same and depend largely on individual sensitivity to the drugs, age and other personal considerations.

R-CHOP chemotherapy for non Hodgkin’s lymphoma in India

India provides the most appropriate, apt, and high levels of medical care and management of non Hodgkin’s lymphoma through the R-CHOP regimen. The procedures are priced at low figures. Notably, lower costs do not signify that the levels of standard and quality are compromised. India grants top quality health care speedily and inexpensively.

R-CHOP chemotherapy for non Hodgkin’s lymphoma in Turkey

Turkey offers the R-CHOP treatment at a portion of the cost that is charged in the United States, while not making any kind of concessions with the level of excellence and quality. Adroit medical personnel and health care faculty, and the speedy management of cancer patients has put Turkey in the spot light.

R-CHOP chemotherapy for non Hodgkin’s lymphoma in Jordan

Jordan provides better improved and highly developed cancer management facilities, including modern and advanced methods and equipments. Cheap, cost effective, speedy, and ideal care is the hallmark of the country, when it comes to providing medical assistance.

R-CHOP chemotherapy for non Hodgkin’s lymphoma in Mexico

The country has specifically focused on the treatment and management of various kinds of cancers. This has given it a further boost over other countries in treatment of malignancies and cancers. It grants the R-CHOP regimen at affordable rates.

R-CHOP chemotherapy for non Hodgkin’s lymphoma in Costa Rica

Costa Rica provides the most appropriate and advanced levels of medical care and treatment for cancer patients. It offers international levels of optimum health care quickly and cheaply.

Resources:

Cyberknife in India
Cyberknife at Anadolu Medical Center, Turkey
Chemotherapy Treatment (CHOP) Abroad
Cyberknife Cancer Radiotherapy Overseas

Medical Tourism Corporation facilitates affordable R-CHOP Chemotherapy in Europe (Turkey) and other overseas world-class oncology treatment destinations.