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Chemotherapy uses drugs to destroy cancer cells. The drugs enter the bloodstream and travel through the body. Chemotherapy primarily affects cancer cells but some healthy cells can also be damaged. The treatment plan and doses will be adjusted to provide the best effect against cancer with minimal side effects. Chemotherapy may be used on its own, but is more often used in combination with radiation therapy.

Chemotherapy may also be used in preparation for a bone marrow transplant, which may done for advanced or relapsed cases of non-Hodgkin lymphoma.

Chemotherapy Drugs and Delivery

There are a variety of chemotherapy drugs, but non-Hodgkin lymphoma is usually treated with specific regimens. The choice and combination of drugs is determined by the stage and type of lymphoma, as well as factors like your age and overall health. Examples of common chemotherapy drugs to treat non-Hodgkin lymphoma include:

  • CHOP—cyclophosphamide, doxorubicin, vincristine, prednisone
  • CVP—cyclophosphamide, vincristine, prednisone
  • Cisplatin, carboplatin, oxaliplatin
  • Fludarabine
  • Methotrexate
  • Dexamethasone

Chemotherapy for non-Hodgkin lymphoma is usually given through an IV, but some forms can be given by mouth or directly into the cerebrospinal fluid. It is delivered in cycles over a set period of time. A medical oncologist will determine how many cycles of chemotherapy are needed and what combination of drugs will work best

Side Effects and Management

Though the drugs are targeted to cancer cells, they can affect healthy cells as well. The death of cancer cells and impact on healthy cells can cause a range of side effects. A medical oncologist will work to find the best drug combination and dosage to have the most impact on the cancer cells and minimal side effects on healthy tissue. Side effects or complications from chemotherapy may include:

  • Nausea and vomiting
  • Fatigue
  • Hair loss
  • Reduced blood cell counts, which can lead to anemia or problems with blood clotting
  • Bone marrow suppression and/or reduced white blood cell counts, which increases the risk of infection
  • Inflammation and sores in the mouth, throat, or esophagus
  • Constipation
  • Diarrhea
  • Infertility, and/or reproductive and sexual problems—If you plan on having children, talk to your doctor about options to preserve fertility before starting treatment. This also applies to adolescents who have gone through puberty.

A variety of treatments are available to help manage side effects including medication, lifestyle changes, and alternative treatments. In some cases, the chemotherapy regimen may be adjusted to reduce severe side effects. The earlier the side effects are addressed, the more likely they will be controlled with a minimum of discomfort. Long-term side effects can include damage to the heart, peripheral nerves, kidneys, lungs, and some cognitive dysfunction.

References:

Non-Hodgkin lymphoma. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003126-pdf.pdf. Accessed April 7, 2016.

Non-Hodgkin lymphoma (NHL). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 25, 2016. Accessed April 7, 2016.

Non-Hodgkin lymphomas. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/hematology-and-oncology/lymphomas/non-hodgkin-lymphomas. Updated October 2012. Accessed April 7, 2016.

Treatment. Leukemia & Lymphoma Society website. Available at: http://www.lls.org/lymphoma/non-hodgkin-lymphoma/treatment. Accessed April 7, 2016.

Treatment option overview. National Cancer Institute website. Available at: http://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq#section/_190. Updated March 3, 2016. Accessed April 7, 2016.



Last reviewed March 2015 by Mohei Abouzied, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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