Non-Hodgkin Lymphoma: Chemotherapy

What is chemotherapy?

Chemotherapy, or chemo, is a treatment for cancer that uses medicines. These medicines destroy fast-growing cells in the body, such as cancer cells. Chemotherapy is an important part of treatment for most people with non-Hodgkin lymphoma. For this treatment, you will see a medical oncologist. This is a doctor who specializes in using medicines to treat cancer.

How is chemotherapy given for non-Hodgkin Lymphoma?

Your doctor has several options for how to give you chemotherapy medicines.

• IV injection or drip. You may get an IV (intravenous injection) into a vein, often over a few minutes. Another way to get the medicine into your vein is by an IV drip. In that case, a bag is filled with medicine that drips through a tube into your vein over a longer period of time. This is the most common way to get chemotherapy for non-Hodgkin lymphoma.

• Injection. You get these medicines by a needle injected into your muscle or under your skin. 

• Oral. You swallow these medicines as pills.

• Intrathecal. If the lymphoma has reached your brain or spinal cord, you may get medicines infused into your spinal fluid. 

How you get chemotherapy and how often you get it depends on the medicines you take. Most people have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. But depending on the medicines you are getting and your health, you may need to stay in the hospital during treatment. 

You may need to have an IV for chemotherapy more than once. So it can be helpful to have a central venous catheter, also called a venous access device. This catheter is a small tube that stays in place for a long period of time. This means you don't need a new IV started each time you get treatment. One end of the tube is placed into a vein near your heart. The other end is placed just under your skin. Or it may even come out through your skin so it can be easily linked to the chemotherapy. The catheter is put in place during a minor surgery. Talk with your healthcare team about the risks and benefits of having a venous catheter.

You get chemotherapy in cycles over a period of time. That means you take the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Having treatment in cycles helps by:

• Killing more cancer cells. The medicine can kill more cancer cells over time, because cells aren't all dividing at the same time. (Cells are most vulnerable to chemotherapy when they are dividing.)

• Giving your body a rest. Treatment is hard on other cells in your body that divide quickly. This includes cells in the lining of your mouth and stomach. This causes side effects, such as sores and upset stomach (nausea). Between cycles, your body can get a rest from the side effects of chemotherapy.

• Giving your mind a rest. Having chemotherapy can be stressful. Taking breaks between cycles can let you get an emotional rest between treatments.

What are the common medicines used to treat non-Hodgkin lymphoma?

You are likely to have more than 1 type of medicine. This is called combination chemotherapy. Taking more than 1 type of medicine reduces the risk that the lymphoma will become resistant to, or won’t be affected by, 1 medicine. That improves your chance of successful treatment. Which medicines you get and how often you take them will depend on many factors. These include the type of lymphoma you have and your overall health.

B-cell lymphoma

For B-cell lymphoma, these are the chemotherapy medicines most often used. The first 4 are often combined in a regimen called CHOP:

• Cyclophosphamide

• Doxorubicin

• Vincristine

• Prednisone or dexamethasone

• Chlorambucil

• Cytarabine

• Mitoxantrone

• Etoposide

• Methotrexate

• Fludarabine

• Pentostatin

• Cladribine, also known as 2-CdA

• Bendamustine

T-cell lymphoma

For T-cell lymphoma, these are the chemotherapy medicines most often used:

• Cyclophosphamide

• Doxorubicin

• Vincristine

• Cytarabine

• Mitoxantrone

• Etoposide

• Methotrexate

• Prednisone or dexamethasone

• Carboplatin or cisplatin

• Ifosfamide

• Gemcitabine

• Oxaliplatin

• Pralatrexate

For many types of non-Hodgkin lymphoma, chemotherapy medicines are given along with other medicines called monoclonal antibodies such as rituximab.  

What are common side effects of chemotherapy?

The side effects from chemotherapy depend on the specific medicines you take, how you take them, and how your body reacts to them. Most side effects often get better or go away when the treatment ends. Talk with your doctor or nurse about what to expect and how to ease your side effects.

Here are some of the more common side effects from chemotherapy:

• Hair loss

• Infections from low white blood cell counts

• Mouth sores

• Easy bruising or bleeding from low blood platelets  

• Fatigue from low red blood cell counts (anemia)

• Loss of appetite, nausea, and vomiting

• Constipation or diarrhea

• Nerve damage, which can cause numbness, tingling, or pain in your hands or feet

Your doctor will likely take blood tests from you often while you’re getting chemotherapy. Make sure you ask which signs mean that you should call your doctor or nurse right away. For instance, chemotherapy can make you more at risk for infections. So you should call your doctor if you have any of these symptoms:

• Fever of 100.5°F (38.0°C) or higher

• Sore throat

• Shaking chills

• Redness, swelling, and warmth at the site of an injury

• New cough or shortness of breath

• Burning when you urinate

Chemotherapy for lymphoma can also cause some other serious side effects, although these are less common:

• Tumor lysis syndrome. This is caused by the breakdown of large numbers of lymphoma cells. This can affect your kidneys, heart, and nervous system. It is seen most often with the first chemotherapy treatment for larger lymphomas. If your doctor thinks this might happen, he or she will give you fluids and medicines to help reduce this risk.

• Organ damage. This can include damage to kidneys, liver, testicles, ovaries, brain, heart, or lungs.

• Leukemia. This is a rare, but serious, late complication of chemotherapy.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down all your medicines. Ask your healthcare team how they work, and what side effects they might have. Keep a written diary of your treatment schedule. Record any signs or symptoms you have.

Talk with your healthcare providers about what signs to look for, and when to call them. Chemotherapy can make you more likely to get infections.

It may be helpful to keep a diary of your side effects. Write down physical and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your medical team to make a plan to manage your side effects.