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Dose Adjusted Epoch R

Posts: 1
Joined: Aug 2016
Hello all,
I am the primary care-giver for my mother, who has just begun epoch and rituximab treatment for her aggressive double hit lymphoma cancer, dose adjusted as based on her blood counts at the end of each cycle. For her first two cycles her dose has remained the same, in order for her to get the best level of treatment should her does not be adjusted upwards each cycle so that she gets more chemotherapy to kill off this cancer? As the entire point of "dose-adjusted" seems to lie in the "adjusted" part I worry that unless the dose is changing upwards she is not getting the benefit that I have read about from this treatment. 
If any of you think that you would be able to shed some light on this for me it would mean a lot, as I am very confused and worried right now...
Kindest regards,
James Moore
Max Former Hodg...
Posts: 3693
Joined: May 2012


I am not completely sure that I understand your question, but in most cases, an oncologist determines a patient's dose based mostly on their weight.

Dosage is usually NOT adjusted throughout treatment unless a person has a weight change of 10% or more, or some form of toxic reaction.

lindary's picture
Posts: 710
Joined: Mar 2015

Are you sure they were talking about dosage or the rate of delivery?

I know from my own experience the dosage I got has been pretty much the same. But for some drugs they do start with a slower delivery to allow the body to adjust to it and then speed it up as the treatment goes on. This has been especially true of the Rituxan. 

Max Former Hodg...
Posts: 3693
Joined: May 2012

I had thought of that initially also, Linda.  I recall that at my first-ever infusion, the RN began with the Rituxan (R-ABVD is all given at one setting).

He began it at what he described as a very slow rate, gradually increasing. By the end of the bag, he said I was tolerating it "wide open," whatever that means, due to no signs of allergic reactions.  Even "fast," my Rituxan took about two hours as I recall, and everything (R-ABVD) was around 8 hours each infusion, so I was glad the ritux was running quickly.  I don't recall him ever adjusting the rates on the other 4 drugs, but I'm sure some others require that rate be monitored and adjusted if necessary.


Posts: 592
Joined: Jul 2009

Hi Jamesmoore76,

I think your question is best addressed to your mother's  oncologist.  I understand your concern as your mom's lymphoma is one of the more difficult to treat.  Dose adjusted chemo is a very hard chemo as if the patient can handle it the dosages usually are escalated with each cycle.  With the usual RCHOP it is not too unusual for the dosage to go down, not up.  But if your mom's blood counts can not handle a larger dose her doctor is doing the right thing by not forcing it.  I'm sure the doctor can answer your questions and concerns.

Sending healing thoughts out to both you and your mom.


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