Chemotherapy for non-Hodgkin lymphoma
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout your body in the bloodstream.
Chemotherapy is a common treatment for non-Hodgkin lymphoma (NHL). You might have a combination of different chemotherapy drugs. You can have chemotherapy into a vein or as tablets, depending on the drug.
We have further information about the chemotherapy drugs on this page. You can select the name of your drug or treatment combination on our A-Z list of cancer drugs.
When you have chemotherapy
Your treatment plan depends on what type of NHL you have. You often have a combination of chemotherapy drugs as your first treatment. Or you might have a single chemotherapy drug on its own.
It is common to have chemotherapy together with a targeted drug such as rituximab. Doctors call this chemoimmunotherapy or immunochemotherapy.
You might also have chemotherapy:
- as a second treatment if your NHL doesn't go away or comes back
- before a stem cell transplant - this is called high dose chemotherapy, or intensive treatment
- to prevent your NHL spreading to your spine or brain
Types of chemotherapy for non-Hodgkin lymphoma
Doctors put NHL into groups depending on whether they tend to grow faster or slower. This is called the grade. NHL can be:
- low grade - these tend to grow slowly
- high grade - these tend to grow more quickly
The exact type of chemotherapy you have depends on your type of low grade or high grade NHL. And other factors such as:
- how far the NHL has grown - this is the stage
- your age and general health
On this page we provide an overview of the main types of chemotherapy for low grade NHL and high grade NHL.
Low grade NHL
It is common to combine chemotherapy with rituximab or obinutuzumab for low grade NHL. Chemotherapy options include:
- bendamustine
- CVP - cyclophosphamide, vincristine and prednisolone
- CHOP - cyclophosphamide, doxorubicin, vincristine and prednisolone
- chlorambucil tablets - this is rare
In some situations, you might have very intensive chemotherapy followed by a stem cell transplant. And in some other situations you might have 
after your chemotherapy.
High grade NHL
You usually have a combination of several chemotherapy drugs. The treatment usually lasts for 4 to 6 months.
There are lots of different drug combinations. Most of them include the chemotherapy drug doxorubicin. This drug works well for many types of high grade NHL.
You might have a targeted drug such as rituximab alongside the chemotherapy. You will see the letter 'R' added to the treatment name - for example R-CHOP.
Treatment combinations include:
- CHOP - cyclophosphamide, doxorubicin, vincristine and prednisolone
- Pola-R-CHP - cyclophosphamide, doxorubicin hydrochloride, prednisolone and the targeted drugs polatuzumab vedotin and rituximab
- CODOX-M - cyclophosphamide, vincristine, doxorubicin and methotrexate
- IVAC - ifosfamide, etoposide and cytarabine
- DA-EPOCH - dose adjusted etoposide, prednisolone, vincristine, cyclophosphamide and doxorubicin
- DHAP - dexamethasone, cytarabine and cisplatin
If your NHL comes back, you might need treatment with different combinations of drugs. Again, there are many to choose from. You might have one of the combinations above. Other options include:
- GDP – gemcitabine dexamethasone, cisplatin
- Gem-Ox – gemcitabine and oxaliplatin
- ICE - ifosfamide, carboplatin, and etoposide
- ESHAP - etoposide, methylprednisolone, cytarabine and cisplatin
You might have an intensive high dose chemotherapy treatment followed by a stem cell transplant. An example of intensive chemotherapy is BEAM. This is carmustine, etoposide, cytarabine and melphalan.
Or you might have CAR T-cell therapy.
Chemotherapy to stop NHL spreading to your spine or brain
Some types of lymphoma are more likely to spread to the central nervous system (CNS). The CNS is your brain and spinal cord. Your doctor might want you to have chemotherapy to prevent this.
There has been much research into this area. Lymphoma specialists continue to debate who needs additional treatment to prevent CNS relapse. And they are also debating the best way to deliver treatment. There is a lot of change in this area at the moment.
The most common treatment is the chemotherapy drug methotrexate. You might have this:
- as an injection into the fluid around your spinal cord - this is intrathecal chemotherapy
- as an infusion into your vein - this is intravenous chemotherapy
When do you have it
You might have treatment to prevent CNS spread if your lymphoma is:
- in certain parts of your body - for example the testicles
- likely to come back after treatment (high risk)
How you have chemotherapy
You usually take chemotherapy in treatment cycles. This means you have the drug for a set period, followed by a break. For example, you might take a drug every day for a week and then not take it for 2 weeks. This 3 week period in total is one cycle of treatment.
The break from treatment is important too. For many cancer drugs, it allows your body to recover.
Some chemotherapy treatments for high grade NHL are quite intense. You might need to stay in hospital for the chemotherapy. Then you might go home and have a break for 2 or 3 weeks. For other treatments, you can have them in the day unit. This means you don't need to stay in hospital.
You might have chemotherapy:
- by mouth as tablets or capsules
- into a vein - this is intravenous chemotherapy
- into your spine - this is intrathecal chemotherapy
Taking your capsules or tablets
You must take tablets according to the instructions your doctor or pharmacist gives you.
Speak to your pharmacist if you have problems swallowing the tablets.
Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more or less.
Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.
Into your bloodstream
You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.
Into your spine
For some lymphomas, you have chemotherapy injected into the fluid around your spine and brain. This is called intrathecal chemotherapy.
To have this you have an injection into your spine, in your lower back. It is similar to having a lumbar puncture.
After intrathecal treatment you have to lie flat or with your head slightly lower than your feet for a few hours. You might have a bad headache or feel sick.
To help you avoid getting a headache, your doctor or nurse asks you to stay lying down for a while. Tell them if you have a headache or feel sick and they will give you medicines to help.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied, such as books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.
Side effects
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- increased risk of getting an infection
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
When you go home
Chemotherapy for non-Hodgkin lymphoma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
