R-ESHAP Chemotherapy
R-ESHAP is a combination of drugs used in the treatment of non Hodgkin lymphoma. Every letter of word R-ESHAP refers to the drugs used in R-ESHAP Chemotherapy.
R- Rituximab a monoclonal antibody that directly targets the cancer cells
E- Etoposide
SH- Methylprednisolone (A steroid)
A- Cytarabine (Also known as Ara C)
P- Cisplatin
All the drugs that compose R-ESHAP are given intravenously by a cannula or along the Central line (on chest) and PICC line (on the arm) by inserting a thin and flexible tube. The course of R-ESHAP chemotherapy constitutes 2-8 cycles. Each cycle continues for 28 days or 4 weeks.
The schedule of R-ESHAP chemotherapy follows the order outlined below:
Day 1:
On the very first day a slow drip of Rituximab is given followed by Etoposide which is provided as a drip for one hour. Methylprednisolone is the third drug to be introduced; it takes 15-20 minutes. Cytarabine is a drip for two hours. Lastly Cisplatin is infused for 96 hours or 4 days.
Day 2:
Cisplatin drug is continued on second day coupled with another dose of Etoposide and Methylprednisolone.
Day 3 and day 4: The next two days follow the schedule of day 2
Day 5: Another dose of Methylprednisolone and Cytarabine are given
Rest period: Following the medications received on first five days of the treatment the patient undergoes a rest period of three weeks sans chemotherapy. This completes one cycle of the R-ESHAP chemotherapy. The next cycles follow the same regime.
Patients are to stay in the hospital for the first five days of treatment. Cisplatin chemotherapy is known to cause some damage to the patient’s kidney hence doctors often give a drip of fluid for hydration. Additionally, a drug named Mannitol is prescribed to stimulate kidneys to produce more urine thus diluting the concentration of Cisplatin.
Chemotherapy drugs recognize the cancer cells by their rapidly dividing characteristic and destroy them thereafter. These drugs often fail to distinguish between a normal cell and a cancer cell. It thus destroys both equally. Some normal cells like hair follicle cells, stem cells, epidermal cells and gastrointestinal cells divide continuously to carry on their function. Use of chemotherapeutic drugs depletes these cells causing unusual side effects like:
- Alopecia or hair loss
- Anemia
- Lowered immunity to infections
- Bruising and bleeding
- Nausea and vomiting
- Low appetite and diarrhea
- Weakness and fatigue
Although these side effects are unusual and distressing one should not be troubled as these disappear once the treatment is over.