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About chemotherapy for non Hodgkin’s lymphoma

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate in the bloodstream around the body. They can work in many different ways. 

Chemotherapy for low grade lymphomas

For low grade (slowly growing) lymphomas you usually have CVP chemotherapy (cyclophosphamide, vincristine and the steroid prednisolone) with the monoclonal antibody rituximab. If you are not fit enough for combination treatment you may have chlorambucil chemotherapy tablets to take at home.

Some types of low grade lymphoma tend to come back after a period of time and you will need more treatment. There are many different possible chemotherapy combinations. Usually the chemotherapy is combined with rituximab.

In some situations, doctors may suggest very intensive chemotherapy with a stem cell transplant or bone marrow transplant.

Chemotherapy for high grade lymphomas

High grade lymphomas tend to grow more quickly than low grade. Doctors treat most high grade lymphomas with a combination of several chemotherapy drugs and a monoclonal antibody such as rituximab. This treatment usually lasts for several months. The type of chemotherapy you have depends on a number of factors including the exact type of lymphoma, the stage of the lymphoma, and whether you have had treatment before.

Chemotherapy to prevent spread to the brain

In certain situations, you may need to have treatment to prevent lymphoma spreading to your brain. The most common way of giving this treatment is to have injections of a chemotherapy drug called methotrexate into the fluid around your spinal cord.
 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating NHL section.

 

 

How chemotherapy works

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body so they can reach the lymphoma cells wherever they are.

 

Chemotherapy for low grade lymphomas

For low grade lymphoma you may have chemotherapy into a vein, or as chemotherapy tablets. The treatment that is best for you will depend on the type of lymphoma and your general health. Follicular lymphoma is the most common type of low grade NHL. 

Chemotherapy into a vein

You usually have CVP chemotherapy (cyclophosphamide, vincristine and the steroid prednisolone) with rituximab (Mabthera). If your lymphoma has come back since you were first treated, or it is a stage 3 or 4 you may have several different chemotherapy drugs in combination with a monoclonal antibody drug. You may have more CVP and rituximab or one of the following chemotherapy combinations, which are often given with rituximab.

You usually have your chemotherapy treatments in the outpatient clinic and go home the same day. But with some drugs you may have to stay in hospital overnight. You may have the treatments as liquids given into a vein (intravenous treatment) or as a combination of intravenous treatment and tablets or capsules.

We have information about having treatment into a vein.

Chemotherapy tablets

For some types of low grade lymphoma you may have chemotherapy tablets to take at home. Chlorambucil is a drug that doctors often use for people who are not fit enough to have combination treatment. You take the tablets for 1 or 2 weeks at a time and then have 2 or 3 weeks off. The treatment usually goes on for about 6 months.

You can read about chlorambucil treatment and its side effects.

Intensive treatment

In some situations, doctors may suggest very intensive chemotherapy with a bone marrow or stem cell transplant. You may have this if all signs of your lymphoma have gone (remission) but it is likely to come back. Or your doctor may suggest it if other treatment has not got rid of the lymphoma. Intensive chemotherapy is an experimental treatment for low grade lymphoma. Your doctor may also suggest this treatment if there are signs that your lymphoma is changing (transforming) into a high grade NHL.

 

Chemotherapy for high grade lymphomas

Most high grade (faster growing) lymphomas are treated with a combination of several chemotherapy drugs. You have the treatment through a drip into a vein. Each treatment lasts a few days and you may need to stay in hospital during that time. Then you go home and have a break for 2 or 3 weeks to allow your body to recover from the effects of the drugs. The number of treatments you have depends on

  • Which drugs you are having
  • The type of lymphoma you have
  • How the lymphoma is responding to treatment
  • How your body is coping with the side effects

The treatment usually lasts for at least 6 months. But sometimes you have treatment once a week instead of once every few weeks. In this case the treatment lasts for 3 or 4 months.

There are lots of different drug combinations for high grade NHL. Most of the combinations have the chemotherapy drug doxorubicin in them, as this drug works well for many types of high grade lymphoma. The most common treatment is CHOP, which is made up of the drugs cyclophosphamide, doxorubicin, vincristine and prednisolone. CHOP is usually given with the biological therapy rituximab to make R-CHOP combination treatment

If the lymphoma comes back, you may need treatment with different combinations of drugs. Again, there are many to choose from. You may have treatment called

There is information about these drug combinations on another page in this section.

Your doctor might suggest that you have very intensive high dose chemotherapy treatment such as BEAM. After BEAM treatment you have a drip of your own or someone else's bone marrow or blood stem cells. You will need the bone marrow or stem cells because the chemotherapy will kill off your own bone marrow cells. 

You can read about high dose treatment on our page about NHL and transplants.

 

Chemotherapy to stop spread to the brain

Some types of lymphoma are more likely to spread to the central nervous system (the brain and spinal cord). In certain situations, your doctor may want you to have treatment to prevent this. The most common way of giving this treatment is to have injections of a drug called methotrexate into the fluid around your spinal cord. But your doctor may suggest treatment into a vein with high dose methotrexate instead. 

You may have this preventative treatment if you have

  • Lymphoma in the space behind your nose (paranasal sinuses)
  • Lymphoma in your testicles
  • Lymphoma in your bone marrow
  • Lymphoma in the breast

Chemotherapy into the fluid that circulates around the brain and spinal cord is called intrathecal chemotherapy (IT). It is very similar to having a lumbar puncture. 

After intrathecal treatment you will have to lie flat or with your head slightly lower than your feet for a few hours afterwards. You may have a bad headache or feel sick. To help avoid getting a headache, your doctor or nurse will ask you to stay lying down for a while. Tell them if you have a headache or feel sick and they will give you medicines to help.

 

Central lines

Central lines are often used to give lymphoma treatment. They are long, bendy plastic tubes that end in a large vein in your chest. There are different types of central lines. The tube stays in until your chemotherapy treatments have finished. Some are placed in your chest.

Diagram showing a central line

To have the tube put in you may be put to sleep for a short time with a general anaesthetic. Or you may be given an injection of local anaesthetic to numb the area where the tube is to go in.

The last six inches or so of the tube hangs out of the chest. It has a clamp and a screw cap on it to seal it off. Your nurse injects the chemotherapy drugs straight into the tube and it goes into your bloodstream. That means you don't have to have any injections with needles each time you have your treatment. You can have blood taken for blood tests through the central line. Usually the tube can stay in for as long as it is needed. 

Portacath

Another type of central line is a port or Portacath. This is a small chamber or box placed under the skin during a small operation. The chamber is attached to the central line tube inside. So there is no tube coming out of the chest. A special needle is pushed through the skin into the port to give the chemotherapy. 

You can read about Portacaths.

PICC lines

PICC stands for Peripherally Inserted Central Catheter. PICC lines start off by going into a vein in your arm. Then the tube runs through the vein and up to a larger blood vessel. Each time you need treatment, the chemotherapy drugs are injected into the line and go straight into your bloodstream. 

You can find out about PICC lines.

Looking after your central line

Your nurse will show you how to look after your central line and keep it clean. 

 

Dietary supplements and chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Also tell them if you are prescribed therapies by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having cancer treatment. We have information about the safety of herbal, vitamin and diet supplements.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking, or thinking of taking, these supplements talk to your doctor to find out whether they could affect your treatment.

 

More information about chemotherapy

Have a look at our chemotherapy section. It explains chemotherapy treatment in detail including

If you would like more information about anything to do with chemotherapy, you can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Or contact one of the non Hodgkin lymphoma organisations. They often have free factsheets and booklets which they can send to you.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 15 September 2014