Non-Hodgkin's Lymphoma

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Questions to Ask Your Doctor about Non-Hodgkin’s Lymphoma
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Chemotherapy

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Chemotherapy is a systemic (whole-body) treatment that involves using drugs to destroy cancer cells. Chemotherapy can be administered intravenously (through a vein), orally (by mouth), subcutaneously (injected under the skin), intramuscularly (injected into a muscle), and intrathecally (injected into the cerebrospinal fluid [CSF]).

Chemotherapy for lymphoma varies because there are so many different forms of this disease. In some cases, treatment involves a single anticancer medication (called single agent chemotherapy) and in other cases, a number of anticancer drugs are used (called combination chemotherapy). These drugs destroy cancer cells by preventing them from growing and dividing.

Cancer cells divide rapidly. Unfortunately, a number of the body's normal, noncancerous cells also divide rapidly and these cells can be harmed by chemotherapy. Cells that often are affected include hair follicles, red and white blood cells, platelets (blood particles responsible for clotting), and cells that line the gastrointestinal system. Damage to these cells cause chemotherapy side effects. Side effects of chemotherapy depend on the type and dose of drugs taken, as well as the length of time that they are used.

Many NHL patients are diagnosed with widespread disease and chemotherapy often is the cornerstone of treatment. In some cases, drug resistance becomes a primary treatment obstacle because tumor cells can already be resistant to any single chemotherapeutic drug by the time treatment is started. Fortunately, there are a number of different approaches to the chemotherapeutic management of NHL, including a class of drugs known as nucleosides or antimetabolites. These compounds include fludarabine phosphate (FDA), cladribine (2-CDA; 2-chloro-2'-deoxyadenosine), and pentostatin (2-DCF; 2'-deoxycoformycin). They are very active as single agents, and lack cross-resistance with most other drugs.

Side Effects
Chemotherapy side effects include temporary hair loss, mouth sores, anemia (decreased red blood cell count; may cause fatigue, dizziness, and shortness of breath), leukopenia (decreased white blood cell count; may lower resistance to infection), thrombocytopenia (decreased platelet count; may cause bruising or excessive bleeding), and gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).

Tumor lysis syndrome, which is a specific side effect of therapy for some bulky lymphomas, occurs when chemotherapy causes a rapid breakdown of NHL cells. The cells split apart and release cell fragments, metabolic byproducts, and minerals into the bloodstream, which can damage the kidneys, heart, and nervous system. Lymphoma patients often are monitored for this syndrome and physicians may prescribe extra fluids, sodium bicarbonate, and allopurinol (drug used to reduce uric acid in the blood) to rid the body of unwanted chemicals and cell fragments.

Clinical Trials
Many advances are being made in the treatment of NHL. However, continued advances in this field often depend on patient participation in clinical trials. Improved treatment outcomes and the development of additional risk-appropriate strategies (e.g., chemotherapy drugs) often are secured through the use of clinical trials. NHL patients should speak with their physician about participating in a clinical trial.

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