About chemotherapy for non Hodgkin's lymphoma

• A quick guide to what's on this page
• How chemotherapy works
• Chemotherapy for low grade lymphomas
• Chemotherapy for high grade lymphomas
• Chemotherapy to prevent spread to the brain
• Central lines
• Taking supplements with chemotherapy
• More information about chemotherapy

Chemotherapy uses anti-cancer or 'cytotoxic' drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. As they circulate in the blood, they can reach cancer cells wherever they are in your body.

For low grade lymphomas you may have chemotherapy tablets to take at home. Chlorambucil is a drug that doctors often use for low grade lymphoma. You take these 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. Some doctors give cyclophosphamide or fludarabine tablets instead. You may also have steroid tablets to take. Some people may have fludarabine into a vein, instead of as tablets.

If your lymphoma has come back since you were first treated, or is stage 3 or 4, there are several different combinations of chemotherapy drugs that may be used. You may have

• CVP (cyclophosphamide, vincristine and the steroid prednisolone) - often given with rituximab (Mabthera®)
• CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) - often given with rituximab (Mabthera®)
• FAD (fludarabine, doxorubicin, and the steroid dexamethasone)
• FMD ( fludarabine, mitoxantrone and dexamethasone)

You will probably have your chemotherapy treatment in the out patients clinic and go home the same day. With some drugs you may have to stay in hospital overnight.

In particular situations, doctors may suggest very intensive chemotherapy with a bone marrow or stem cell transplant. This might be suggested if your lymphoma is in remission but likely to come back. Or if your lymphoma has not responded to other treatment. It is still experimental for low grade lymphoma. Your doctor may also suggest this treatment if there is a sign that your lymphoma is ' transforming'.

There is more about all the drugs mentioned here on the next page of this section.

Most high grade lymphomas are treated with a combination of several chemotherapy drugs. For these faster growing high grade lymphomas, you have chemotherapy through a drip into a vein. Each treatment lasts a few days and you stay in hospital while you are having the drugs. Then you go home and have a break for 2 or 3 weeks to allow your body to recover from the effects of the drugs. The number of treatments you have depends on

• Which drugs you are having
• The type of lymphoma you have
• How the lymphoma is responding to treatment
• How your body is coping with the side effects

The treatment usually lasts for at least six months. But sometimes it is given once a week instead of once every few weeks. In this case the treatment lasts for three or four months.

There are lots of different combinations of drugs used. The most common is CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) and it is usually given with the biological therapy rituximab. Rituximab with CHOP is called RCHOP.Most of the combinations have the chemotherapy drug doxorubicin in them, as doctors know this drug works well for many types of high grade lymphoma.

The trouble with chemotherapy drugs is that cancers can become resistant to them. So if your lymphoma comes back, you may need treatment with different combinations of drugs. Again, there are many to choose from. You may have treatment called

• PMitCEBO (prednisolone, mitoxantrone, cyclophosphamide, etoposide, bleomycin and vincristine)
• DHAP (dexamethasone, cytarabine, cisplatin) - sometimes given with rituximab (Mabthera®)
• ESHAP (etoposide, methylprednisolone, cytarabine and cisplatin) - sometimes given with rituximab (Mabthera®)
• ICE (ifosfamide, carboplatin, and etoposide) - often given with rituximab (Mabthera).

There is information about these drug combinations on the next page of this section.

Your doctor might suggest you have very intensive high dose chemotherapy treatment, and a transfusion of your own or someone else's bone marrow or blood stem cells. You will need this because the chemotherapy will kill off your bone marrow cells. Look at the section on NHL and transplants for more information on this type of treatment.

Some types of lymphoma are more likely to spread to the central nervous system - the brain and spinal cord. In certain situations, your doctor may want you to have treatment to prevent this. The most common way of giving this treatment is to have injections of a drug called methotrexate into your spine. But your doctor may suggest treatment with high dose methotrexate instead. Or radiotherapy to your brain.

You may have this preventative treatment if you have

• Lymphoma in the space behind your nose (paranasal sinuses)
• Lymphoma in your testicles
• Lymphoma in your bone marrow

Chemotherapy into the fluid that circulates around the brain and spinal cord is called intrathecal chemotherapy (IT). It is much the same as having a lumbar puncture. You will have to lie flat or with your head slightly lower than your feet for a few hours afterwards. You may have a bad headache or feel sick.

Central lines are also sometimes called long lines or PICC lines. They are often used for lymphoma treatment. A central line is a long, bendy plastic tube that is threaded into a large vein in your chest.

To have the tube put in you may be put to sleep for a short time with a general anaesthetic. Or you may be given an injection of local anaesthetic to numb the area where the tube is to go in.

The last six inches or so of the tube hangs out of the chest. It has a clamp and a screw cap on it to seal it off. Your nurse injects the chemotherapy drugs straight into the tube and so straight into your bloodstream. That means you don't have to have any injections with needles when you have your treatment. You can even have blood taken for blood tests through the central line. The tube can stay in for as long as it is needed. Your nurse will show you how to look after it and keep it clean.

 PICC lines start off by going into a vein in your arm. They run through the vein and up to a larger blood vessel. The PICC line will stay in until your chemotherapy has finished. Each time you need treatment, the chemotherapy drugs are injected into the line and go straight into your bloodstream.

A type of central line that is not used so much these days is a port or Portacath. This is a small chamber or box which is placed under the skin during a small operation. The chamber is attached to the central line tube inside. So there is no tube coming out of the chest. A special needle is pushed through the skin into the port to give the chemotherapy. This is much easier and less painful than having to have a tube put into a vein every time you need chemotherapy.

There is increasing concern amongst doctors about dietary supplements and herbal medications. Some of these supplements or remedies may interact with chemotherapy drugs and can cause you harm.

You should talk to your specialist about any other tablets or medicines you take while you are having cancer treatment. It may not be a good idea to take anything that claims to boost your immune system, for instance. Doctors are already telling people with lymphomas or leukaemias that they should avoid these. We just don't know how supplements may interact with treatment for other types of cancer yet.

There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section of CancerHelp UK.

Have a look at the chemotherapy section in CancerHelp UK. It explains the treatment in more detail including

• What it involves
• How chemotherapy is planned and given
• General side effects
• Living with chemotherapy

If you would like more information about anything to do with chemotherapy, contact one of the non Hodgkin's lymphoma organisations. They will be happy to help. They often have free factsheets and booklets which they can send to you.