Chemotherapy Regimen Initiation After Prephase Treatment

Rationale for R-CHOP-21 as Standard

• The addition of rituximab to CHOP significantly improves outcomes compared to chemotherapy alone, as recommended by the American Society of Hematology 1, 2

Critical Supportive Care Measures

• Mandatory prophylaxis includes PCP prophylaxis with sulfamethoxazole/trimethoprim (or equivalent) throughout treatment and for 6-12 months after rituximab completion, as recommended by the National Comprehensive Cancer Network 3, 4
• Herpes virus prophylaxis with acyclovir or equivalent is also recommended, as per the National Comprehensive Cancer Network and Blood journal guidelines 3, 4

Blood Product Support

• Irradiate all blood products to prevent transfusion-associated GVHD in patients receiving rituximab-containing regimens, as recommended by the National Comprehensive Cancer Network 3

Common Pitfalls to Avoid

• The European Society for Medical Oncology recommends proceeding immediately with full-dose R-CHOP on day 0, without delaying chemotherapy start 6