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Chemotherapy and side effects for non Hodgkin lymphoma

Men and women discussing non Hodgkin's lymphoma

This page tells you about side effects of chemotherapy for non Hodgkin lymphoma. You can find the following information

 

A quick guide to what's on this page

Chemotherapy and side effects for non Hodgkin lymphoma (NHL)

Many different drugs are used to treat lymphoma. Your nurse or doctor will give you written information about the drugs you are having.

All chemotherapy drugs have side effects but they affect people in different ways. Some people may have very few side effects. They will depend on the drugs you have, the dose, and your own individual reaction to treatment. Common side effects of chemotherapy for NHL include

  • An increased risk of infection
  • Feeling or being sick
  • Diarrhoea
  • A sore mouth and mouth ulcers
  • Hair loss or thinning
  • Feeling tired and weak
  • Bruising or bleeding

Long term side effects

Chemotherapy can sometimes cause permanent side effects. These include an inability to father a child or become pregnant (infertility); an increased risk of heart problems, or a second cancer in the future. Your doctor or specialist nurse can tell you more about the risk of these effects in your case. 
 

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

 

 

What to remember about side effects

Many different drugs are used to treat non Hodgkin lymphoma. You may have a combination of drugs or a single drug. Your nurse or doctor will give you written information about the drugs you are having.

All chemotherapy drugs have side effects. But the drugs affect people in different ways. The same drug can give very different side effects in different people. Some people may have very few side effects. Your doctor or nurse can't tell how you will react until you have had a particular drug. The side effects you get will depend on

  • Which drugs you have
  • How much of each drug you have
  • Your own individual reaction to the treatment

Most of the side effects are temporary. They will gradually go when the treatment is finished. And there are lots of ways your doctor and nurse can help you manage any side effects you do have. A few side effects are possibly long term.

 

Common side effects of chemotherapy

Some side effects are common to many chemotherapy drugs. The main side effects for drugs used to treat NHL include  

The links take you to more information about how to deal with each side effect.

Not all the side effects happen with every drug. You can ask your doctor or nurse which side effects are most common with the chemotherapy drugs you will have. Or you can look up your cancer drugs in the cancer drugs side effects section.

 

Side effects of drugs used in NHL

There are many drugs and combinations of drugs used to treat NHL including those listed below.

Chlorambucil

Chlorambucil is a common chemotherapy drug used to treat low grade NHL in people who are not well enough to have combination treatment, or are very elderly. You take it as a tablet for up to 2 weeks at a time, then have 2 weeks off. Or you may have a larger dose for 7 or 10 days each month. 

Treatment usually lasts for about 8 to 10 months. Then you won't have any more treatment unless your lymphoma comes back. Chlorambucil doesn't have too many side effects. It may make you feel a bit sick or give you indigestion. You will have your white blood cell levels tested regularly throughout your 6 months of treatment.

You can read about chlorambucil and its side effects.

Fludarabine

Fludarabine is a treatment for low grade NHL. You can have it through a drip or as a tablet. It most often causes mild sickness, low resistance to infection, tiredness, and a risk of bleeding or bruising. Fludarabine is also sometimes used in combination with other chemotherapy drugs. 

We have detailed information about fludarabine and its side effects.

CHOP and R-CHOP

CHOP is a combination of 3 chemotherapy drugs and a steroid. The steroid is called prednisolone. The chemotherapy drugs are called cyclophosphamide, vincristine and doxorubicin. This is probably the most common combination for NHL. You usually have CHOP every 3 weeks as an outpatient. 

You have chemotherapy injections through a drip in your arm on the first day and take steroid tablets for 5 days. Then you have 2 weeks off before the cycle starts again. The most common side effects of CHOP are low resistance to infection, tiredness, a risk of bleeding or bruising, sickness, hair loss, a sore mouth, pins and needles, and tummy (abdominal) pain. R-CHOP is the same as CHOP but with the drug rituximab added. 

You can go to information about CHOP chemotherapy and R-CHOP treatment.

PMitCEBO and PMitCEBOM

PMitCEBO is a combination of 5 drugs and a steroid. You may have this treatment instead of CHOP. It includes mitoxantrone (mitozantrone), cyclophosphamide, etoposide, bleomycin, vincristine and the steroid prednisolone. You have PMitCEBO over a 2 week cycle. You have drug injections on the first and eighth day of each cycle, so you have some chemotherapy every week. PMitCEBOM is the same as PMitCEBO but with the drug methotrexate added.

We have information about PMitCEBO. And we have information about methotrexate.

CVP and R-CVP

CVP is chemotherapy used for low grade lymphoma. It is a combination of the chemotherapy drugs cyclophosphamide and vincristine, with the steroid prednisolone. You have CVP over a 3 or 4 week cycle. It may be given with the biological therapy rituximab as R-CVP.

We have information about CVP chemotherapy and R-CVP

FAD

FAD is chemotherapy used for follicular lymphoma and some other types of low grade lymphoma. It is a combination of 2 chemotherapy drugs, fludarabine and doxorubicin, and the steroid dexamethasone. You have FAD over a 4 week cycle. You have doxorubicin and fludarabine as injections into a vein on the first day. You then have a fludarabine injection into a vein on the next 2 days. You take dexamethasone tablets for the first 5 days of each cycle.

You can read about FAD treatment

FMD

Doctors use FMD to treat follicular lymphoma and some other types of low grade lymphoma. It is a combination of fludarabine, mitoxantrone and the steroid dexamethasone. You have FMD for a few days every 4 weeks. You have fludarabine on the first 3 days of each cycle either as injections into a vein or as tablets. You also have an injection of mitoxantrone into a vein on the first day. You take dexamethasone as tablets for the first 5 days of each cycle. You usually have 6 to 8 cycles.

Find out more about FMD treatment.

ICE and RICE

Doctors use ICE chemotherapy for some types of high grade lymphoma. You may have rituximab with this combination and then it is called RICE.

ICE is a combination of the chemotherapy drugs ifosfamide, carboplatin and etoposide. You have these through a drip into a vein. If you have rituximab, you also have that through your drip. You may need to stay in hospital for a few days to have this treatment. Ifosfamide can irritate the bladder lining and cause bleeding. So, to prevent this, you have a drug called mesna as a drip or as tablets. If you have the tablets you must take them exactly as your doctor prescribes.

You can find out more about ICE chemotherapy and RICE combination treatment.

DHAP and R-DHAP

DHAP is intensive chemotherapy used for high grade NHL that has come back. DHAP is high dose cytarabine (Ara-C), cisplatin and the steroid dexamethasone. You have DHAP in hospital over a couple of days, every 3 weeks. You may have eye drops for a week afterwards because the cytarabine can cause sore eyes. DHAP is sometimes combined with rituximab to make R-DHAP.

We have information about DHAP and its side effects and information about R-DHAP treatment.

ESHAP and R-ESHAP

ESHAP is chemotherapy that is used for high grade NHL that has come back. ESHAP is etoposide, the steroid methylprednisolone, high dose cytarabine (Ara-C) and cisplatin. You have ESHAP in hospital over 5 days, every 4 weeks. ESHAP can cause low resistance to infection, tiredness and weakness, and an increased risk of bruising or bleeding. It may also cause sickness, hair loss, diarrhoea, a sore mouth, taste changes, sore hands and feet, and pins and needles. R-ESHAP is ESHAP combined with the biological therapy rituximab. 

You can read about ESHAP treatment and R-ESHAP treatment and how to cope with the side effects.

 

Possible long term side effects

Chemotherapy can sometimes cause permanent side effects. Your doctors will try to choose drugs that cause as few permanent effects as possible. But they will balance this with the importance of successfully treating your NHL. The possible long term side effects of NHL chemotherapy treatment include infertility, second cancers and heart disease.

Infertility

Unfortunately some chemotherapy drugs doctors use to treat non Hodgkin lymphoma can stop you being able to get pregnant or father a child afterwards (infertility). It is difficult for doctors to say definitely whether this will happen to you. It depends on

  • The chemotherapy drugs you are having
  • The total dose of the drugs
  • Your age if you are a woman

Sometimes it is possible for men and teenage boys to store sperm before they start their chemotherapy. This is called sperm banking. Ask your doctor if you think you would like to do this. There is more information on the men's fertility and chemotherapy page.

For women, chemotherapy can cause an early menopause. Doctors can treat this with hormone replacement therapy. It may be possible to have embryos or eggs frozen so that you can try to have a baby in the future. If you want to look into this, you must speak to your doctor about it early on, because it will need to be done before you start your treatment. Researchers are looking into freezing ovarian tissue and having it put back later. There is more information about options for having a baby on the women's fertility and chemotherapy page.

Look at the page about sex and fertility and non Hodgkin lymphoma for ways of coping with these effects of chemotherapy.

Second cancers

There is a chance that your treatment can increase the risk of getting another type of cancer in the future. This is because both chemotherapy drugs and radiotherapy work by damaging cells. They damage, and so kill, the lymphoma cells. But they can damage healthy cells too.

Doctors don't know whether this increased risk of cancer in the future is only because of treatment. People who get lymphoma have a slightly increased risk of getting another cancer anyway. The lymphoma is an immediate risk to your health. So, your doctors have to balance the risks and benefits of your treatment. The main concern is your current lymphoma.

Your doctors will ask you to go back to the hospital for check ups for many years. They will check your health and watch out for any signs of a second cancer. Along with clinical trials this long term follow up helps to find the safest treatments for you and for people with NHL in the future.

Heart disease

Some drugs for lymphoma can cause heart problems. This is also true of radiotherapy to the heart area. You may have a slightly increased risk of getting heart problems in the future. As with the risk of second cancers, your doctors will be trying their best to treat your lymphoma while keeping down the long term risks as much as they can.

 

More about NHL chemotherapy

If you would like more information about any aspect of non Hodgkin lymphoma, 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.

Our non Hodgkin lymphoma organisations page gives details of other people who can provide information about NHL and its treatment. Some organisations can put you in touch with a cancer support group. They often have free factsheets and information which they can send to you. 

There are also books, booklets, CDs and other resources available about non Hodgkin lymphoma. Some of these are free. Look at our NHL reading list for details.

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

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Updated: 12 September 2014