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Non-Hodgkin lymphoma

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Potential side effects of chemotherapy for non-Hodgkin lymphoma

Side effects can occur with any type of treatment for non-Hodgkin lymphoma (NHL), but not everyone has them or experiences them in the same way. Side effects of chemotherapy will depend mainly on:

  • the type of drug(s)
  • the dose
  • how the drug is given
    • Chemotherapy drugs to treat NHL can be given as a pill and taken by mouth, through a vein (intravenous) and, in some cases, into the space containing cerebrospinal fluid (intrathecal chemotherapy).
  • how long the drug needs to be taken
  • the person's overall health

Chemotherapy kills cancer cells, but it can also damage healthy cells. Different cells and tissues in the body tolerate chemotherapy differently.

Side effects can happen any time during chemotherapy. Some may happen during, immediately after, or a few days or weeks after chemotherapy. Most side effects go away after chemotherapy is over. However, some side effects may persist for a while because it takes time for healthy cells to recover from the effects of chemotherapy. Late side effects can occur months or years after chemotherapy. Some side effects may last a long time or be permanent.

If radiation therapy is given at the same time as chemotherapy, this can make the side effects of chemotherapy worse.

It is important to report side effects to the healthcare team. Doctors may also grade (measure) how severe certain side effects are. Sometimes chemotherapy doses or schedules may need to be adjusted if side effects are severe.

Bone marrow suppression

Chemotherapy used to treat non-Hodgkin lymphoma (NHL) commonly affects the bone marrow and can cause bone marrow suppression. This can lead to:

  • infection caused by low white blood cell count (neutropenia)
    • Infections are more likely to occur in people treated with intensive doses of chemotherapy. Bacterial infections are the most common type of infection after chemotherapy for NHL, although infections associated with fungi, viruses and other organisms can also occur.
  • bruising and bleeding caused by low platelet count (thrombocytopenia)
  • fatigue, paleness and malaisemalaiseA general feeling of discomfort or illness. caused by low red blood cell count (anemia)

Low blood cell counts occur because of chemotherapy's effect on the bone marrow, where blood cells are made. Blood cell counts often reach their lowest level about 7–14 days after chemotherapy. Bone marrow suppression is the most common and most serious side effect of chemotherapy. When it happens, the dose of chemotherapy drugs may need to be adjusted or chemotherapy may have to be stopped temporarily or postponed.

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Sore mouth

A sore mouth (also called stomatitis or oral mucositis) occurs because of chemotherapy's effect on fast-growing cells lining the inside of the mouth. Some of the chemotherapy drugs used to treat NHL can cause a sore mouth. It occurs more often when higher doses of drugs are used. A sore mouth occurs about a week (anywhere from 5–14 days) after chemotherapy is started. It often improves on its own a few weeks after treatment is finished.

Painful mouth sores, ulcers in the mouth and mouth infections can also develop. Thorough, regular mouth care can help prevent a sore mouth and reduce infection. The healthcare team will give instructions on how often to clean and rinse the mouth and what to use. Pain medications or special oral solutions may be needed to relieve pain.

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Fatigue is a common side effect of chemotherapy. It causes a person to feel more tired than usual and can interfere with daily activities and sleep. Fatigue may be caused by anemia, specific drugs, poor appetite, depression, or it may be related to toxic substances that are produced when cancer cells break down and die. Fatigue can occur days after a chemotherapy treatment cycle. It may get better as time goes by. Fatigue can continue long after the person has finished their treatment for NHL.

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Nausea and vomiting

Some of the chemotherapy drugs used to treat NHL may cause nausea and vomiting. Individual drugs vary in their effects, but nausea and vomiting are more likely when combinations of chemotherapy drugs are given, especially if they include the drug doxorubicin (Adriamycin).

Nausea and vomiting can occur within the first few hours after chemotherapy drugs are given and usually last about 24 hours. However, delayed nausea and vomiting may last for a few days after treatment. Some people may have anticipatory nausea after having a few treatments, where they feel nauseated even before treatment is given because they expect to be sick.

Corticosteroid drugs like prednisone (Deltasone) may be used as part of NHL treatment with chemotherapy. Although they don't usually cause nausea and vomiting, they can irritate the stomach and cause heartburn.

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Loss of appetite

Nausea and vomiting, fatigue or a buildup of waste products as cancer cells die can cause loss of appetite. Some chemotherapy drugs can cause temporary changes in taste and smell, which can also make foods seem less appetizing. Some people lose interest in food completely and don't eat, even though they know they need to. This can lead to weight loss and malnutrition. Maintaining good nutrition during and after chemotherapy is important to help a person recover from treatment.

Corticosteroid drugs like prednisone (Deltasone) may be used as part of NHL treatment with chemotherapy. Instead of loss of appetite, these drugs can cause an increased appetite and higher blood sugar levels.

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Diarrhea is an increase in the number and looseness of stools. It occurs because chemotherapy drugs often affect the cells that line the gastrointestinalgastrointestinalReferring to or having to do with the digestive organs, particularly the stomach, small intestine and large intestine. tract. Many factors increase the risk of diarrhea, including the type and dose of chemotherapy drug used. Diarrhea is often worse when combinations of drugs are given. Diarrhea occurs soon after chemotherapy starts and can continue for up to 2 weeks after treatment has ended.

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Constipation occurs when stools become hard, dry and difficult to pass. Many factors increase the risk of constipation, including the type of chemotherapy drug used, medications given with chemotherapy to relieve nausea and vomiting, and decreased fluid intake. Constipation usually occurs 3–7 days after chemotherapy is given. Vincristine (Oncovin) is one of the drugs used in the CHOP and CVP combination to treat some types of NHL that can cause constipation.

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Hair loss

Hair loss (alopecia) is a common side effect of many chemotherapy drugs, but not all. Hair follicles are vulnerable to chemotherapy drugs because they grow fast. The extent and duration of hair loss is unpredictable and depends on the type and dose of drugs used to treat NHL and personal factors. Hair loss can occur on all parts of the body, including the face and scalp. Hair loss can begin within a few days or 2–3 weeks after chemotherapy is started. Hair usually grows back once chemotherapy treatments are over.

It is often recommended that hair not be permed, straightened, dyed or coloured during treatment and to wait until new hair growth becomes established and hair returns to its original state. This may take as long as 6 months or more after treatment. Talk to the healthcare team about when it is okay to use these products again.

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Skin changes

The drugs used for NHL may also cause skin rashes or blisters. The skin may become darker. Nails may develop ridges or dark bands. Skin changes are more likely to occur when drugs like doxorubicin (Adriamycin) or cyclophosphamide (Cytoxan, Procytox) are used to treat NHL.

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Some of the chemotherapy drugs used to treat NHL, like cyclophosphamide (Cytoxan, Procytox) can irritate the bladder lining and cause inflammation or bleeding (cystitis). Cystitis is more likely to occur when high doses of cyclophosphamide are used. Drinking lots of fluids and emptying the bladder often can decrease the risk of cystitis.

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Tumour lysis syndrome

Tumour lysis syndrome (TLS) is a problem that can occur because of a rapid breakdown of cancer cells when chemotherapy is given. TLS is most likely to occur when chemotherapy is given for aggressive lymphomas. It usually occurs at the start of chemotherapy treatment when a large number of tumour cells are destroyed and can last for 5–7 days. When cancer cells are destroyed, they break down and release substances into the blood that can affect the kidneys, joints, heart and nervous system. Doctors may give extra fluids and a drug called allopurinol (Zyloprim) to prevent TLS.

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Organ damage

Certain chemotherapy drugs can cause organ damage. Steps are taken to limit the damage to healthy cells, but occasionally organ damage can occur. Whether or not organ damage occurs depends on many factors. Some of the organs that may be affected by chemotherapy drugs used to treat NHL include the:

  • heart
    • Heart problems are more likely to occur when drugs like doxorubicin (Adriamycin) are used.
  • reproductive organs
    • Some men may stop producing sperm and some women may have premature menopause (treatment-induced menopause) because of some of the chemotherapy drugs used to treat NHL. This can result in fertility problems (infertility). Whether or not a person will have fertility problems, depends on the type and dose of chemotherapy drugs given to treat NHL. Infertility is often a long-term or permanent side effect.
  • nervous system
    • Numbness or tingling in the toes or fingers, ringing in the ears or changes in hearing are possible signs of nerve damage, called peripheral neuropathyperipheral neuropathyA disorder of the peripheral nerves (nerves outside the brain and spinal cord) that causes pain, numbness, tingling, burning, swelling, muscle weakness and loss of reflexes in different parts of the body.. This is a possible side effect of some chemotherapy drugs used to treat NHL, like vincristine (Oncovin).

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Second cancers

There is a small risk that leukemia can occur years after chemotherapy treatment for NHL because of damage to the bone marrow. The risk of developing a second cancer depends on the type and dose of chemotherapy drugs given and the length of treatment. The benefit of treating the lymphoma usually far outweighs the risk of developing a second cancer from chemotherapy treatment.

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Note: Other side effects may occur.  For more detailed information on specific drugs, go to sources of drug information.


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