DHAX: Dexamethasone, Cytarabine, Oxaliplatin (The James)

DHAX: Dexamethasone, Cytarabine, Oxaliplatin (The James)

 

What is DHAX?

DHAX is the short name for this cancer treatment. The 3 drugs you will receive during this treatment are Rituximab (or “R”), Dexamethasone (or “D”), Cytarabine (or “H”, high-dose Ara-C), and Oxaliplatin (or “X”).

 

What is dexamethasone (deks-a-METH-a-sone) and how does it work?

Dexamethasone is a medicine (also called a steroid) that helps kill the cancer cells. This medicine helps reduce swelling in the body, but may make it harder for your body to fight infection.

 

What is cytarabine (sye-TARE-a-been) and how does it work?

Cytarabine is a type of targeted cancer therapy called an “antimetabolite”. It is made in a laboratory. Once inside the cancer cell, Cytarabine tricks the cancer cell into using it as a building block. This can stop fast growing cancer cells from dividing and making new cancer cells.

 

What is oxaliplatin (ox-AL-i-pla-tin) and how does it work?

Oxaliplatin is a chemotherapy drug known as an “alkylating agent.” Oxaliplatin works to stop fast growing cancer cells from dividing and making new cells by destroying the DNA of the cell.

 

Why am I getting three chemotherapy drugs for my cancer?

All these drugs work to stop fast growing cancer cells from dividing and making new cells, but each medicine attacks the cancer cells differently. Giving the three drugs together makes the treatment more effective.

 

What should I tell my doctor before getting chemotherapy?

Talk to your doctor about the following:

  • If you have ever had chemotherapy and the names of the chemotherapy drugs you were given.
  • If you have ever had heart, liver, or kidney problems.
  • If you are pregnant or think you may be pregnant. Your doctor will talk with you about birth control while getting chemotherapy.
  • If you are breastfeeding.
  • If you have been told that you need to start a new medicine.
  • The medicines/pills you are taking, including:
    • Medicines prescribed by any of your doctors
    • Herbs
    • Vitamins
    • Over-the-counter medicines

 

How does my doctor decide my chemotherapy dose?

To determine your treatment dose, your doctor will review the following: your height, your weight, your medicines, how well your liver and kidneys are working, and any other health problems you have. You will receive this chemotherapy treatment every 3 weeks. The doctor or nurse practitioner will meet with you before each dose of your “DHAX” chemotherapy.

 

Should I eat or drink before my treatment?

It is best to eat a small meal before getting your chemotherapy. Drinking plenty of non-caffeinated fluids may also be helpful. However, if you have been told to limit fluids, check with your doctor about how much you can drink.

 

How will my treatment be given?

You will be given several medicines, 30 to 60 minutes before your treatment, to prevent nausea and vomiting. .

Dexamethasone is taken by mouth one time each day for 4 days. This medicine should be taken in the morning with food. Your first dose of this medicine will be given to you with your chemotherapy treatment in the clinic. You will then take 1 dose each day for 3 days at home.

Oxaliplatin is given directly into your blood stream through a tube (IV) placed in your arm or chest. This treatment will take about 2 hours. You will be given this medicine on day 1 of each treatment.

Cytarabine is given directly into your blood stream through a tube (IV) placed in your arm or chest. The treatment will take about 3 hours. You will be sent home with a pump that will automatically infuse the second dose of cytarabine 12 hours later. This treatment will take about 3 hours. You will be given this medicine on day 2 of each treatment. You will come back to the clinic on day 3 to have the pump removed.

Dexamethasone eye drops will be prescribed to help prevent eye irritation from cytarabine. You will start using these eye drops on the first day and continue to use the drops for 48 hours after your last dose of cytarabine.

Pegfilgrastim (Neulasta) is a shot given under the skin to increase your white blood cells to help fight infection. Pegfilgrastim is given 24 to 72 hours after your chemotherapy..

Tell your nurse right away if you feel any pain, stinging or burning while getting these chemotherapy drugs.

 

Day 1

  • Receive Oxaliplatin
  • Receive Dexamethasone

 

 

 

Day 2

  • Take Cytarabine
  • Receive Cytarabine (12 hours later, through pump)
  • Take Dexamethasone

 

 

Day 3

  • Take Dexamethasone
  • Return to clinic to have pump removed

 

 

 

Day 4

  • Take Dexamethasone

 

 

 

 

 

Day 5 Day 6Day 7
Day 8Day 9Day 10Day 11Day 12Day 13Day 14 
Day 15Day 16Day 17Day 18Day 19Day 20Day 21 

 

What are the side effects of this treatment?

Every person responds differently to treatment. Some of the more common side effects of this chemotherapy are:

  • Nausea and/or vomiting lasting for several days
  • Fatigue
  • Fever
  • Hair loss
  • Mouth pain or open sores in the mouth
  • Low white blood cell count (may increase your risk for infection, you will be prescribed medicine(s) to prevent infection)
  • Low hemoglobin (may cause you to have less energy and tire more easily)
  • Low platelet count (may cause you to bleed more easily or longer than normal and have more bruising)
  • “Jittery” feeling, trouble sleeping
  • High blood sugar
  • Headache
  • Sore or red eyes (use dexamethasone eye drops to prevent)
  • Numbness, tingling or burning sensation in your hands or feet
  • Sensitivity to cold – feel burning or tingling when you touch cold objects, and burning or throat spasms when you drink cold liquids or breathe in cold air.
  • Signs of an allergic reaction with rituximab, including:
    • Difficulty breathing, wheezing, chest pain or tightness
    • Swelling in your face, lips, tongue, or throat
    • Rash
    • Shaking or chills

 

When should I call my doctor?

You should call your doctor right away if you have any of the following signs or symptoms:

  • Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
A fever can be life-threatening if not treated. Your doctor may ask you to go to the hospital.
  • Chills, sore throat, cough or a wound that does not get better
  • Dizziness and feeling off-balance
  • Open sores in your mouth
  • Nausea that prevents you from eating or drinking
  • Vomiting even after you have taken your anti-nausea medicine
  • Bleeding or bruising, including bloody or black stools or blood in your urine
  • Diarrhea (4 or more loose stools in 24 hours)
  • Changes in your heartbeat
  • Shortness of breath or difficulty breathing
  • Swelling in feet or ankles
  • Fast weight gain
  • Extreme fatigue (unable to carry on self-care activities)

 

Is there anything else I should know about this treatment?

  • Do not eat or drink anything cold for at least 3 days after your chemotherapy.
  •  Chemotherapy may make it harder for your body to fight infections. Wash your hands often and stay away from people who are sick.
  • This treatment requires special precautions to prevent the chemotherapy drugs from coming into contact (through blood, urine, bowel movements, vomit and vaginal or seminal fluids) with others. Your chemotherapy nurse will give you guidelines to follow for 48 hours after receiving chemotherapy.
  • Chemotherapy can change how your body reacts to vaccines. Talk to your doctor before getting any vaccines.
  • Patients who get treatment with these drugs have a slightly higher risk of getting a rare form of blood cancer, called “leukemia”. Your doctor can tell you more about this risk.
  • You should drink 8 to 10 eight-ounce glasses of non-caffeinated fluid each day throughout your treatment. This is important to keep you hydrated while you are receiving chemotherapy.
  • Do not take over the counter pain medicines (acetaminophen or NSAIDs) unless directed by your doctor. These can hide a fever.
  • Stay out of the sun as much as possible. Use broad-spectrum sunscreen (SPF 30 or higher) and wear protective clothing to protect your skin.
  • Maintain good nutrition and get plenty of rest.
  • This treatment may cause women to stop having menstrual cycles. Depending on your age, your menstrual cycles may or may not return.
  • This treatment may affect your ability to have children. Talk to your doctor before getting chemotherapy if you are planning to have children in the future.

 

For more information about cancer, chemotherapy, side effects or how to care for yourself during treatment, refer to your Chemotherapy and You book, or ask your doctor, nurse or pharmacist.

You may also find it helpful to watch The James Patient Education videos at http://cancer.osu.edu/patientedvideos to help you learn tips for managing treatment side effects.

 

 

© March 9, 2022. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.