Cancer therapy for non-Hodgkin lymphoma (NHL) can sometimes produce side effects. For most patients, treatment side effects are temporary and go away once therapy ends. For other patients, side effects can be more severe, sometimes requiring hospitalization. Some patients never have side effects.
Before you undergo treatment, talk with your doctor about potential side effects. Drugs and other therapies can prevent or manage many side effects.
Common Side Effects
Suppressed Blood Cell Formation. Decreases in blood cell counts may occur in patients treated with chemotherapy. Blood transfusions may be necessary for some patients with low blood cell counts. If decreases in white blood cell counts are severe and continue over extended periods of time, infection may develop and require antibiotic treatment. Sometimes, chemotherapy dosages or the time between chemotherapy cycles must be altered to allow the patient’s blood counts to recover from the effects of treatment. To stimulate the production of depleted white blood cells, a granulocyte-colony stimulating factor (G-CSF) such as Neupogen® or Neulasta® is sometimes used.
Infections. Chemotherapy and radiation therapy can make patients more susceptible to infections because these treatments weaken immune cell function and can lower the number of normal white blood cells.
Viral Reactivation. Hepatitis B virus reactivation has been reported in some patients treated with chemotherapy either with or without immunotherapy drugs. Carriers of the Hepatitis B virus, especially those treated with anti-CD20 monoclonal antibodies (rituximab [Rituxan®], ofatumumab [Arzerra®], obinutuzumab [Gazyva®]), have a high risk of virus reactivation and disease. Preventive antiviral therapy is recommended for patients who test positive for Hepatitis B virus.
Neuropathy. Some chemotherapy drugs such as vincristine (Oncovin®) or brentuximab vedotin (Adcetris®) can cause nerve damage called “neuropathy.” Initially, the patient experiences numbness and tingling in the fingertips and toes. The sensation might come and go, but if it continues, it may become permanent. If the neuropathy becomes severe, the dose of vincristine or brentuximab vedotin may need to be adjusted.
Tumor Lysis Syndrome. Patients with very high white blood cell counts before the beginning of treatment, may be at high risk for developing tumor lysis syndrome (TLS). TLS is caused by the sudden release of the cellular contents of dying cells into the bloodstream, a phenomenon induced by chemotherapy. If untreated, TLS can lead to heart arrhythmias, seizures, loss of muscle control, acute kidney failure and even death.
Other Side Effects. Chemotherapy drugs kill cancer cells, but they damage normal cells, too. The lining of the mouth, throat, stomach and intestines are particularly vulnerable to damage. Common side effects of chemotherapy include:
- Mouth Sores
- Nausea and vomiting
- Temporary hair loss
Side effects can range from mild to severe. They depend on the medications and dosages used and the individual patient’s susceptibility. Fortunately, there are drugs and other supportive measures to either prevent or manage many side effects. Click here to read more about managing side effects.
Long-Term and Late Effects
It is important to know about the potential for long-term and late effects of treatment so that any problems may be identified early and managed.
- Long-term effects of cancer therapy are medical problems that persist for months or years after treatment ends.
- Late effects are medical problems that do not develop or become apparent until years after treatment ends.
Many survivors of NHL do not develop significant long-term or late effects of treatment. However, it is important for all adult patients and for parents of children who will be treated for NHL to discuss possible long-term and late effects with members of the treatment team so that the proper planning, evaluation and follow-up care can take place.
Heart Disease. Radiation therapy to the chest and treatment with chemotherapy containing alkylating agents (eg, cyclophosphamide) or anthracyclines (eg, doxorubicin) have been linked to heart disease, including inflammation of the sac surrounding the heart (the pericardium), valve dysfunction or classic heart attack (myocardial infarction).
Secondary Cancers. For as long as three decades after diagnosis, patients are at a significantly elevated risk for second primary cancers, such as lung, brain and kidney cancers, melanoma, and Hodgkin lymphoma. Therapy with autologous bone marrow or peripheral blood stem cell transplantation and treatment with chemotherapy-containing alkylating agents are associated with an increased risk of developing myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).
Fertility. Patients may be less fertile after treatment for NHL. The risk of infertility varies according to the nature of the treatment, including the type and amount of chemotherapy, the location of radiation therapy and the patient’s age. It is important to discuss all your options and treatment concerns with your doctor. If possible, you may also want to discuss these options with a doctor who specializes in fertility and reproduction.
For some patients, side effects may last well after they finish treatment. To read more about lingering side effects, see The Leukemia & Lymphoma Society’s free information booklets:
- Long-Term and Late Effects of Treatment in Adults
- Long-Term and Late Effects of Treatment for Childhood Leukemia and Lymphoma Facts
- Managing Side Effects
- Integrative Medicine and Complementary and Alternative Therapies
- Download lists of suggested questions to ask your doctor
- FDA drug information webpage
- Download or order The Leukemia & Lymphoma Society’s free booklet, Understanding Side Effects of Drug Therapy