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Systemic Anti-Cancer Therapy Regimen Library

Home > LYM NHL B-cell Diffuse large - Pola-R-CHP [polatuzumab vedotin, RITUximab, CYCLOPHOSPHamide, DOXOrubicin and prEDNISone]

LYM NHL B-cell Diffuse large - Pola-R-CHP [polatuzumab vedotin, RITUximab, CYCLOPHOSPHamide, DOXOrubicin and prEDNISone]

Treatment Overview

This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycles 1 to 6 - 21 days - Pola-R-CHP

Cycle length:
21

RITUximab, first dose:

  • Consider withholding routine anti-hypertensives for 12 hours prior to first rituximab dose.
  • For patients at high risk of infusion-related reaction, consider additional pre-medications such as an extra antihistamine dose the day before, an H2 receptor antagonist and montelukast.

pegfilgrastim: Administer at least 24 hours, up to 3 days after chemotherapy.

Cycles 7 to 8 - 21 days - RITUximab monotherapy

Cycle length:
21

rituximab: Consider administering corticosteroid premedication prior to rituximab if previous doses not well tolerated or if clinically indicated as per institutional practice

Cycle details

Cycles 1 to 6 - 21 days - Pola-R-CHP

Medication Dose Route Days Max Duration
prEDNISone 100 mg flat dosing Once daily oral administration 1 to 5
paracetamol * 1000 mg flat dosing oral administration 1
loratadine * 10 mg oral administration 1
RITUximab * 375 mg/m² intravenous 1 6 hours
polatuzumab vedotin 1.8 mg/kg intravenous 1 90 minutes
DOXOrubicin 50 mg/m² intravenous 1 15 minutes
CYCLOPHOSPHamide 750 mg/m² intravenous 1 60 minutes
pegFILGRASTIM 6 mg subcutaneous injection 2

RITUximab, first dose:

  • Consider withholding routine anti-hypertensives for 12 hours prior to first rituximab dose.
  • For patients at high risk of infusion-related reaction, consider additional pre-medications such as an extra antihistamine dose the day before, an H2 receptor antagonist and montelukast.

pegfilgrastim: Administer at least 24 hours, up to 3 days after chemotherapy.

Cycles 7 to 8 - 21 days - RITUximab monotherapy

Medication Dose Route Days Max Duration
paracetamol * 1000 mg flat dosing oral administration 1
loratadine * 10 mg oral administration 1
RITUximab * 375 mg/m² intravenous 1 6 hours

rituximab: Consider administering corticosteroid premedication prior to rituximab if previous doses not well tolerated or if clinically indicated as per institutional practice

Full details

Cycles 1 to 6 - 21 days - Pola-R-CHP

Day: 1

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food, at least ONE hour prior to rituximab.
paracetamol * 1000 mg flat dosing oral administration
Instructions:

30 to 60 minutes prior to rituximab.
loratadine * 10 mg oral administration
Instructions:

30 to 60 minutes prior to rituximab.
RITUximab * 375 mg/m² intravenous 6 hours
Instructions:

First administration: 

  • Consider withholding routine anti-hypertensives for 12 hours prior to first rituximab dose.
  • For patients at high risk of infusion-related reaction, consider additional pre-medications such as an extra antihistamine dose the day before, an H2 receptor antagonist and montelukast.
  • Start infusion at 50 mg/hour. If tolerated, rate can be increased by 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour.

Further administrations: 

  • Start infusion at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes to a maximum rate of 400 mg/hour or as per institutional practice.
  • OR for those who did not experience a grade 3/4 infusion-related reaction in a previous cycle a rapid infusion schedule (over 90 minutes) can be considered as per institutional practice. Start infusion at a rate to give 20% of the total dose over the first 30 minutes; if tolerated, rate can be increased to give the remaining 80% of the total dose over the next 60 minutes.
polatuzumab vedotin 1.8 mg/kg intravenous 90 minutes
Instructions:
  • Administer via a sterile, non-pyrogenic, low protein binding 0.2 or 0.22 micron in-line or add-on filter.
  • After the initial dose an observation period of at least 90 minutes post-infusion is recommended; if the initial dose is well tolerated, subsequent doses may be administered over 30 minutes and an observation period of at least 30 minutes post-infusion is recommended.
DOXOrubicin 50 mg/m² intravenous 15 minutes
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
CYCLOPHOSPHamide 750 mg/m² intravenous 60 minutes

Day: 2

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.
pegFILGRASTIM 6 mg subcutaneous injection
Instructions:

Administer at least 24 hours, up to 3 days after chemotherapy.

Day: 3

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Day: 4

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Day: 5

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Cycles 7 to 8 - 21 days - RITUximab monotherapy

Day: 1

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:

30 to 60 minutes prior to rituximab.
loratadine * 10 mg oral administration
Instructions:

30 to 60 minutes prior to rituximab.
RITUximab * 375 mg/m² intravenous 6 hours
Instructions:
  • Consider administering corticosteroid premedication if previous doses not well tolerated or if clinically indicated as per institutional practice.
  • Start infusion at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes to a maximum rate of 400 mg/hour, or as per institutional practice.
  • OR for those who did not experience a grade 3/4 infusion-related reaction in a previous cycle a rapid infusion schedule (over 90 minutes) can be considered as per institutional practice. Start infusion at a rate to give 20% of the total dose over the first 30 minutes; if tolerated, rate can be increased to give the remaining 80% of the total dose over the next 60 minutes.

Supportive Care Factors

Factor Value
Antiviral prophylaxis for hepatitis B virus: Required for anti–HBc positive patients at risk of reactivation
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis may be considered
Emetogenicity: Variable
Gastroprotection: Gastroprotection may be considered
Growth factor support: Recommended for primary prophylaxis
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis is recommended

Emetogenicity:

  • MEDIUM cycles 1 to 6.
  • MINIMAL cycles 7 and 8.

Tumour lysis syndrome (TLS) prophylaxis: Recommended for cycle 1 and consider for subsequent cycles.

References

Tilly H, Morschhauser F, Sehn LH, et al. Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma. N Engl J Med. 2022 Jan 27;386(4):351-363. doi: 10.1056/NEJMoa2115304. Epub 2021 Dec 14., PMID: 34904799

Yamada T, Nakamura N, Goto H, et al. Polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) therapy in diffuse large B-cell lymphoma in patients aged 80 years or older: a real-world study. Ann Hematol. 2025 Oct;104(10):5191-5200., PMID: 41068304

Tabernero J, Vyas M, Giuliani R, et al. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142. doi: 10.1136/esmoopen-2016-000142., PMID: 28848668

Lyman GH, Balaban E, Diaz M, et al. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14., PMID: 29443651

Doyle J, Raggatt M, Slavin M, McLachlan SA, Strasser SI, Sasadeusz JJ, Howell J, Hajkowicz K, Nandurkar H, Johnston A, Bak N, Thompson AJ. Hepatitis B management during immunosuppression for haematological and solid organ malignancies: an Australian consensus statement. Med J Aust. 2019 Jun;210(10):462-468. doi: 10.5694/mja2.50160. Epub 2019 May 19., PMID: 31104328

Medicines and Hepatitis B Reactivation Prescriber Update 38(1): 2-3 March 2017 https://medsafe.govt.nz/profs/PUArticles/March2017/MedicinesAndHepatitisB.htm

Rituximab and Hepatitis B Reactivation Prescriber Update 34(3):27 September 2013 https://www.medsafe.govt.nz/profs/PUArticles/Sept2013RituximabHepB.htm

Roche Products (New Zealand) Limited. Polivy (polatuzumab vedotin) New Zealand Data Sheet 27 October 2025. https://medsafe.govt.nz/profs/Datasheet/p/polivyinj.pdf (Accessed 4 June 2026).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.