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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

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. Side effects depend on the drugs you have, the dose and your own individual reaction to treatment. Common side effects include

  • A fall in the number of blood cells
  • Feeling or being sick
  • Diarrhoea
  • Sore mouth and mouth ulcers
  • Hair loss or thinning
  • Feeling tired and run down

Further down this page there is information about the different chemotherapy drugs and combinations used to treat NHL. It has links to information about their particular side effects.

Long term side effects

Chemotherapy can sometimes cause permanent side effects. These include infertility, and an increased risk of heart problems or a second cancer in the future. Your doctor or specialist nurse can tell you more about this. 
 

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 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

Remember that most side effects are temporary. They will 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. There is more information about possible long term side effects on this page.

 

Common side effects of chemotherapy

Some side effects are common to many chemotherapy drugs.  There is a list below of the most common side effects for drugs used to treat NHL.  The links will take you to more information about how to deal with them.

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. This is explained in more detail in the cancer drugs side effects section

 

Side effects of drugs used in NHL

There are many drugs and combinations of drugs that doctors use to treat NHL including

Chlorambucil

Chlorambucil is a common chemotherapy drug used to treat low grade NHL in people who are not fit enough to have combination treatment, such as the very elderly. You take it as a tablet for up to 2 weeks at a time, then have 2 weeks off. 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 count tested regularly throughout your 6 months of treatment. There is information about the side effects of chlorambucil in the chemotherapy section.

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 and a drop in blood cell counts. Fludarabine is also sometimes used in combination with other chemotherapy drugs. There is more detailed information about the side effects of fludarabine in the chemotherapy section.

CHOP and R-CHOP

CHOP is a combination of 3 chemotherapy drugs and a steroid. The steroid is called prednisolone. The chemo drugs are called cyclophosphamide, vincristine and doxorubicin. This is probably the most common chemo combination doctors use for NHL. You usually have CHOP every 3 weeks. You usually have this treatment 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 a drop in blood counts, sickness, hair loss, sore mouth and nerve symptoms (pins and needles or abdominal pain). R-CHOP is the same as CHOP but with the drug rituximab added. There is more about the side effects of CHOP and R-CHOP in the chemotherapy section.

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 chemotherapy drug methotrexate added.

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.

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.

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.

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 will 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.

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.

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 a drop in blood counts, sickness, hair loss, diarrhoea, a sore mouth and taste changes, sore hands and feet, and pins and needles. R-ESHAP is ESHAP combined with the biological therapy rituximab. 

 

Long term side effects

Chemotherapy can sometimes cause permanent side effects. These include infertility, second cancers and heart disease. 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

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 in the chemotherapy and fertility section.

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 have 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 on the women's fertility and chemotherapy page in the chemotherapy and fertility section.

Look in the section about sex and fertility, in our information on living with non Hodgkin lymphoma, for more about coping with these effects of chemotherapy.

Second cancers

There is a chance that your treatment can increase your 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 as well.

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, so that they can 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.

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Updated: 31 October 2012