For patients starting rituximab + polatuzumab vedotin + cyclophosphamide + doxorubicin + prednisone
1) What This Treatment Is
- Pola-R-CHP is commonly used for diffuse large B-cell lymphoma (DLBCL).
- Given in 6 cycles, usually every 21 days.
- Day 1 of each cycle: IV infusions of rituximab, polatuzumab vedotin, cyclophosphamide, doxorubicin in clinic.
- Prednisone tablets are usually taken at home on Days 1–5 of each cycle.
- The first cycle may be infused more slowly to monitor for reactions.
- Goal: shrink or eliminate lymphoma cells—many patients are treated with intent to cure.
2) How to Take Prednisone
- When: Take once each morning (before 9–10 AM) on Days 1–5 of each cycle (unless your oncologist directs otherwise).
- How: Take with food and a full glass of water. Swallow whole unless your pharmacist says it’s okay to split/crush.
- Don’t skip or stop early. Sudden stopping can be harmful. If you miss a dose, take it the same day when remembered; if near the next dose, skip—don’t double.
- Common effects: increased appetite, jitteriness, mood changes, higher blood sugar, trouble sleeping (taking early helps). Call for severe symptoms.
3) Common and Serious Side-Effects
Common: tiredness, nausea, diarrhea or constipation, hair loss, mouth sores, skin/nail changes, decreased appetite, numbness/tingling in fingers or toes.
Blood counts: low white cells → infection risk; low red cells → fatigue; low platelets → bruising/bleeding.
Serious: febrile neutropenia (fever with very low white cells), infections, peripheral neuropathy, heart problems (doxorubicin), severe diarrhea or mouth sores.
4) Red-Flag Symptoms — Call Right Away
| Symptom | Why It Matters | What to Do |
|---|---|---|
| Fever ≥ 100.4 °F / 38 °C, chills, cough, burning with urination | Possible infection during low white-cell counts | Call the cancer team immediately (24/7) |
| Shortness of breath, chest pain, swelling, sudden weight gain | Could be heart-related or severe reaction | Call right away or go to ER / 911 |
| Flushing, itching, rash, throat tightness, dizziness during infusion | Possible infusion reaction | Tell your nurse immediately |
| New/worsening numbness or tingling in hands/feet | Nerve side-effect from polatuzumab | Report promptly (sooner if worsening) |
| Uncontrolled nausea, diarrhea/constipation, or mouth sores | May need early treatment | Call the clinic |
| Red-colored urine for 1–2 days after infusion | Expected from doxorubicin dye | Call if >2 days, painful, or appears bloody |
5) Staying Safe at Home
- Hand hygiene: wash often; ask visitors to do the same.
- Avoid sick contacts & crowded indoor spaces when counts are low; consider masking.
- Keep a thermometer at home; check temperature if you feel unwell.
- Support meds: take anti-nausea, anti-diarrheal, and other prescribed medicines exactly as directed.
- Avoid grapefruit/grapefruit juice while receiving cyclophosphamide.
- Hydration, small frequent meals; gentle mouth rinses (alcohol-free) to prevent sores.
- Protect skin/scalp from sun; moisturize regularly.
- Bring all meds/supplements to appointments and check before starting anything new.
6) Longer-Term Considerations
- Fertility: chemotherapy may affect reproductive health—ask about options before or early in treatment.
- Peripheral neuropathy: can persist or worsen—report early so doses can be adjusted.
- Heart health: tell your team about any history of heart disease or new shortness of breath, swelling, or cough.
7) Emotional & Practical Support
Fatigue often increases with later cycles. Rest as needed but try gentle activity (e.g., short walks) to preserve strength. Seek help from family, caregivers, counseling, or support groups as needed.
8) Emergency & Contact Information
Your cancer center will provide a 24-hour contact number—keep it handy and bring it to all visits. Call anytime for fever, chest pain, trouble breathing, or any alarming symptom. Call 911 for severe breathing difficulty or chest pressure.
Key Take-Home Message
Pola-R-CHP is an effective regimen for many people with DLBCL. Promptly report fevers or new/worsening symptoms, follow prednisone instructions carefully, and stay in close contact with your care team to keep you safe and on track.
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