Chemotherapy is the use of anti-cancer drugs that are usually injected into a vein or taken by mouth. These drugs enter the bloodstream and reach almost all areas of the body, making this treatment very useful for lymphoma. In some cases where the lymphoma may have reached the brain or spinal cord, chemotherapy may also be given into the cerebrospinal fluid.

Depending on the type and the stage of the lymphoma, chemotherapy may be used alone or in combination with radiation therapy.

Doctors give chemotherapy in cycles, in which a period of treatment is followed by a rest period to allow the body time to recover. Each chemotherapy cycle generally lasts for several weeks. Most chemotherapy treatments are given on an outpatient basis (in the doctor's office or clinic or hospital outpatient department) but some may require a hospital stay.

Many drugs are useful in treating lymphoma patients. Often, several drugs are combined. The number of drugs, their doses, and the length of treatment depend on the type and stage of the lymphoma. Some of the drugs commonly used to treat lymphoma include:

• cyclophosphamide
• vincristine
• doxorubicin (Adriamycin)
• prednisone
• fludarabine
• cytarabine (ara-C)
• chlorambucil
• mitoxantrone
• methotrexate
• etoposide
• dexamethasone
• cisplatin
• carboplatin
• ifosfamide
• bleomycin
• bendamustine

One of the most common combinations of drugs is called CHOP. This includes the drugs cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone. Another common combination leaves out doxorubicin and is called CVP.

Sometimes a patient may take one chemotherapy combination for several cycles and later switch to a different one if the first combination doesn't seem to be working.

Possible side effects

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against lymphoma cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• increased chance of infections (due to low white blood cell counts)
• easy bruising or bleeding (due to low blood platelet counts)
• fatigue (due to low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. If serious side effects occur, the chemotherapy may have to be reduced or delayed.

There are often ways to lessen these side effects. For example, drugs are usually given to help prevent or reduce nausea and vomiting.

Drugs known as growth factors (G-CSF or GM-CSF, for example) are sometimes given to help the white blood cells recover from the effects of chemotherapy and thus reduce the chance of infection. Antibiotics may also be given at the earliest sign of an infection, such as a fever.

If your white blood cell counts are very low during treatment, you can help reduce your risk of infection by carefully avoiding exposure to germs. During this time, your doctor may advise you to:

• Wash your hands often.
• Avoid fresh, uncooked fruits and vegetables and other foods that might carry germs.
• Avoid fresh flowers and plants because they may carry mold.
• Make sure other people wash their hands before they come in contact with you.
• Avoid large crowds and people who are sick (wearing a surgical mask offers some protection in these situations).

Many of the side effects of chemotherapy are caused by low white blood cell counts. Some people find it helpful to keep track of their counts. If you are interested in doing this, ask your doctor or nurse about your blood cell counts and what these numbers mean.

If your platelet counts are very low, you may be given drugs or platelet transfusions to help protect against bleeding. Fatigue caused by anemia (very low red blood cell counts) can be treated with drugs or with red blood cell transfusions.

Some possible side effects are specific to certain drugs. For example, some drugs can damage the heart. Other drugs can sometimes cause damage to the kidneys or nerves. Your doctor or nurse can tell you about the possible side effects of specific drugs you may be getting.

Tumor lysis syndrome is another possible side effect of chemotherapy. It can be seen in patients who had large numbers of lymphoma cells in the body before treatment. When the cells are killed, they break open and release their contents into the bloodstream. This can overwhelm the kidneys, which cannot get rid of all of these substances at once. Excess amounts of certain minerals may also affect the heart and nervous system. This can be prevented by giving the patient extra fluids and certain drugs, such as sodium bicarbonate, allopurinol, and rasburicase.

Other organs that could be damaged by certain chemotherapy drugs include the kidneys, liver, testicles, ovaries, brain, heart, and lungs. If serious side effects occur, chemotherapy may have to be reduced or stopped, at least for a short time. Careful monitoring and adjustment of drug doses are important because some side effects to organs can be permanent. But if the patient is watched closely, these side effects rarely occur.

Chemotherapy can also cause side effects that might not occur until years after treatment. For example, in rare cases, people may develop leukemia several years after treatment.

Last Medical Review: 07/17/2009
Last Revised: 07/17/2009