Chemotherapy for non-Hodgkin lymphoma 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.
How you have it
You might have chemotherapy into a vein or as tablets. The best treatment for you depends on the type of low grade non-Hodgkin lymphoma you have and your general health.
Chemotherapy into a vein
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 might have the treatments as liquids given into a vein (intravenous treatment) or as a combination of intravenous treatment and tablets or capsules.
You usually have CVP chemotherapy (cyclophosphamide, vincristine and the steroid prednisolone) with the targeted cancer drug, rituximab (Mabthera).
If your lymphoma has come back since you were first treated or is at stages 3 or 4, you might have several different chemotherapy combinations, with rituximab or a similar drug. You might have more CVP and rituximab. Or you might have one of the following with rituximab:
- CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone)
For some types of low grade lymphoma you might have chemotherapy tablets to take at home.
Doctors often use the chemotherapy drug chlorambucil for people who are not fit enough to have the combination treatments mentioned above. 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.
In some situations, doctors might suggest very intensive chemotherapy along with a bone marrow or stem cell transplant.
You might have it 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. They might also suggest it if there are signs that your lymphoma is changing (transforming) into a high grade non-Hodgkin lymphoma.
Most high grade (faster growing) non-Hodgkin 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 might 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 side effects. The number of treatments you have depends on:
- which drugs you are having
- the type of lymphoma you have
- how your 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.
Chemotherapy drug combinations
Lots of different drug combinations are used. Most of them include the chemotherapy drug doxorubicin, as it works well for many types of high grade non-Hodgkin lymphoma.
The most common treatment is CHOP, which is made up of the drugs cyclophosphamide, doxorubicin, vincristine and prednisolone. You usually have CHOP with the targeted drug rituximab (Mabthera). This is called R-CHOP.
If the lymphoma comes back, you might need treatment with different combinations of drugs. Again, there are many to choose from. You might have:
- ICE (ifosfamide, carboplatin, and etoposide) – often given with rituximab (Mabthera) as RICE
- ESHAP (etoposide, methylprednisolone, cytarabine and cisplatin) – sometimes given with rituximab (Mabthera)
- DHAP (dexamethasone, cytarabine, cisplatin) – sometimes given with rituximab (Mabthera) as R-DHAP
Your doctor might suggest that you have a very intensive high dose chemotherapy treatment such as BEAM. After BEAM treatment you have a transplant of your own or someone else's bone marrow or blood stem cells. You need the bone marrow or stem cells because the chemotherapy kills off some of your own bone marrow cells.
Some types of lymphoma are more likely to spread to the central nervous system (the brain and spinal cord). In certain situations, your doctor might want you to have treatment to prevent this.
The most common treatment is to have injections of the chemotherapy drug methotrexate into the fluid around your spinal cord. But your doctor might suggest having a high dose of methotrexate injected into a vein instead.
You might have this preventative treatment if you have non-Hodgkin lymphoma in:
- the space behind your nose (paranasal sinuses)
- the testicles
- the bone marrow
- the breast
Chemotherapy into the fluid that circulates around the brain and spinal cord is called intrathecal chemotherapy. It is very similar to having a lumbar puncture.
After intrathecal treatment you have to lie flat or with your head slightly lower than your feet for a few hours. You might have a bad headache or feel sick.
To help you avoid getting a headache, your doctor or nurse asks 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.
Into your bloodstream
You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Taking your tablets or capsules
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
COVID swab test
Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.
To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.
At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.
This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.
Check with your team about when you’ll have the test as there are some differences between hospitals.
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- a lower resistance to infections
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.
Dietary or herbal supplements
We don't yet know much scientifically about how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
It is very important to tell your doctors if you take any supplements, or if you are prescribed them by alternative or complementary therapy practitioners.
Talk to your specialist about any other tablets or medicines you take while you are having active treatment.
Some studies seem to suggest that fish oil preparations might make some chemotherapy drugs work less well. If you take or are thinking of taking these supplements, talk to your doctor to find out whether they could affect your treatment.
When you go home
Chemotherapy for non-Hodgkin lymphoma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.