DHAP

DHAP is the name of a chemotherapy combination. It includes the drugs we list below, next to each drug we have how you pronounce the drug in brackets.

• D – dexamethasone (deks-uh-meth-uh-zone), which is a steroid

• HA – high dose Ara C, also known as cytarabine (sigh-tar-a-been)

• P – cisplatin (sis-plait-in)

It is a treatment for:

• high grade non-Hodgkin lymphoma that has come back

• Hodgkin lymphoma that has come back

• Hodgkin lymphoma that got worse during or after treatment

How does DHAP work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells. Dexamethasone is a steroid and can help the chemotherapy to work better.

How do you have DHAP?

Ara C and cisplatin are clear fluids and you have them into your bloodstream (intravenously).

You usually have the steroid drug dexamethasone as daily tablets (orally) but you may have it into your bloodstream instead. 

into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

Taking your tablets

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you have DHAP?

You usually have DHAP chemotherapy as cycles of treatment . You may have between 2 and 6 cycles and each cycle lasts 3 weeks.

You have each cycle of treatment in the following way:

If you have the dexamethasone as tablets you will be able to go home and carry on taking the tablets at home. If you have the dexamethasone into your vein, you will need to go back to the hospital for 2 more days.

You then start the next cycle.

Drugs to help with the side effects

You have fluids (hydration) into your vein during your first two days of treatment. This is because DHAP can cause kidney damage and the extra fluids help to keep your kidneys working properly. You may also take a drug called allopurinol on your first cycle of treatment. This is to help keep the levels of uric acid in your blood stable. 

Your doctor will give you steroid eye drops to take for 5 to 7 days. The drops help to stop your eyes getting sore.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before treatment starts, you have a blood test to check for viruses such as hepatitis B, hepatitis C, HIV or cytomegalovirus (CMV) . This treatment can mean that your immune system  doesn't work as well as it normally does. So infection with these viruses can become active again if you’ve had them in the past. 

What are the side effects of DHAP?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Risk of bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Mouth sores and ulcers 

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Sore anus 

Your anus could become inflamed, sore and develop ulcers. This can be painful. Contact your advice line or talk to your doctor or nurse if this happens. 

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Changes to how your liver works

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Cytarabine syndrome

This can happen about 6 to 12 hours after having cytarabine.

It is a combination of symptoms including a high temperature, aching muscles, bone pain, occasionally chest pain, a rash, sore eyes, and extreme weakness. You have steroids to help to prevent this syndrome. Contact your advice line or tell your doctor or nurse if this happens. 

Skin problems 

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.

A less common side effect is skin ulcers. 

With high dose cytarabine your skin might also peel. 

High temperature

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Low level of sodium in the blood 

You may have changes in levels of minerals and salts in your blood, such as low sodium. This will most likely go back to normal when you finish treatment. You have regular blood tests during treatment to check this.

Feeling sleepy (drowsy)

High doses of cytarabine can make you drowsy. 

Changes to how you think and feel 

High dose cytarabine can:

• make you feel confused
• cause slurred speech
• affect your level of consciousness making you sleepy or not alert

Contact your advice line or tell your doctor or nurse if you or someone else notice these changes. 

Eye problems

High dose cytarabine can cause eye problems.

You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your healthcare team if you have this. They can give you eye drops or other medication to help. 

Lung and breathing problems

High dose cytarabine can cause a life threatening syndrome called acute respiratory distress syndrome (ARDS). Symptoms are:

•  severe shortness of breath
• rapid, shallow breathing
• tiredness, drowsiness or confusion
• feeling faint

You might also get fluid on the lung which can cause difficulty breathing.

Contact your advice line or tell your doctor or nurse if you have any of these symptoms. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• infection or inflammation of the lining of the bowels causing feeling bloated, swelling of the tummy (abdomen), blood in your poo, diarrhoea, loss of appetite and being sick

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms.

• a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering. Contact your advice line straight away if you have any of these symptoms.

• changes to your heartbeat. This can be either slower or faster.

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than1%). You might have one or more of them. They include:

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness. Some allergic reactions can be life threatening, alert your nurse or doctor if notice any of these symptoms.

• a low level of magnesium in the blood

• hearing problems including loss of hearing

• a blood cancer (leukaemia). Talk to your doctor if you are concerned about this.

• a metallic taste in the mouth

Possible side effects of dexamethasone

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• changes to your personality

• changes to your mood such as feeling high, feeling low, depression, anxiety, thinking about suicide

• mood swings

• feelings of being alone

• hearing or seeing things that aren’t there (hallucinations)

• feeling agitated and restless

• unable to settle

• unable to concentrate

• poor sleep or unable to sleep (insomnia)

• an increase in appetite

• high levels of sugar in the blood. Talk to your doctor about this if you are a diabetic.

• swelling of the face (moon face)

Contact your advice line or tell your doctor or nurse if you have any of these symptoms. 

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• loss of appetite

• pain, redness and inflammation at the injection site

• dizziness

• inflammation of the tissue surrounding the heart

• inflammation of the veins

• inflammation of the pancreas

• ulcers and inflammation of the food pipe (oesophagus)

• yellowing of the white of the eyes and skin (jaundice)

• red, sore and peeling of the skin of the soles of the feet and palms of the hands

• chest pain

• not enough fluid in the body (dehydration)

• stroke

• sore muscles and muscle spasms

• kidneys not working

If you have side effects that aren’t listed on this page you can read the individual drug pages:

• dexamethasone
• cytarabine
• cisplatin

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. 

Breastfeeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.