Reviewed: Assoc. Prof. Jeff Szer, Head, Bone Marrow Transplant Service, Dept of Clinical Haematology & Medical Oncology, Royal Melbourne Hospital
On this page: Watchful waiting | Chemotherapy | Side effects of chemotherapy | Side effects of radiotherapy | Antibody therapy for non-Hodgkin lymphoma | Stem cell (or bone marrow) transplantation | Side effects of stem cell transplantation | Effects on fertility
Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what's likely to work for a particular type and stage of cancer. Your doctor will advise you on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and if it's spread, your age and general health, and what you want.
In some forms of indolent non-Hodgkin lymphoma, your doctor might recommend no active treatment when you are first diagnosed. You will have regular check-ups and be treated when the lymphoma progresses. This causes you no harm but is only suitable for some people with this sort of lymphoma.
This is the treatment of cancer by special anti-cancer drugs. The aim is to kill cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing.
Some people can have all their chemotherapy drugs as tablets. Other people need to have the drugs injected into a vein. This is called intravenous treatment.
Side effects of chemotherapy
Drugs used in chemotherapy can cause side effects. Depending on the drug used, side effects can include feeling sick (nausea), vomiting, feeling off-colour and tired, a sore mouth and some thinning or loss of hair from your body and head. These side effects are temporary, and steps can often be taken to prevent or reduce them.
Radiotherapy treats cancer by using radiation or x-rays to kill cancer cells. The radiation can be precisely targeted onto cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissues.
Side effects of radiotherapy
Radiotherapy can cause temporary side effects including feeling sick (nausea), which can be helped by medication, and tiredness. Mild headaches are also quite common.
Skin in the treatment area may become red and sore after two or three weeks of treatment. From the start of your treatment, you will need to take care washing and avoid shaving the area or wearing clothing that rubs. Check with your doctor or nurse before using any talcs and lotions. Ask a member of your radiotherapy treatment team for a cream to ease any burning sensation.
Antibody therapy for non-Hodgkin lymphoma
A newer form of treatment for some non-Hodgkin lymphomas uses antibodies able to recognise lymphoma cells. One such treatment is available in Australia as an intravenous injection. It is effective alone or with chemotherapy. It appears to have few serious side effects although some patients may develop allergic reactions to the antibody during the treatment.
Several more antibody treatments are being developed.
Stem cell (or bone marrow) transplantation
This treatment might be suggested if your disease comes back, does not respond to treatment or if it is felt that it has a high risk of coming back. It allows you to have higher doses of chemotherapy than usual and this may offer an increased chance of being cured.
Stem cells are early stage blood cells that develop in bone marrow (the soft tissue inside bones). They are very important cells, but high doses of chemotherapy can harm them. Stem cells, infused into you just like a blood transfusion, can rescue your bone marrow from the effects of the treatment.
There are two sources of stem cells: autologous, where you act as your own donor, and allogeneic, where someone else (usually a tissue-matched family member, but sometimes a matched unrelated individual) donates. If you act as your own donor, the cells will be collected before you receive high dose chemotherapy. This may happen when you are recovering from another course of treatment with chemotherapy plus growth factor injections, or after injections of a growth factor alone. The growth factor stimulates the bone marrow to produce large numbers of stem cells for collection.
Autologous stem cells are commonly collected from the bloodstream in a process called apheresis. Blood is taken from a vein (usually in your arm) or from a small tube going through a vein in the neck or chest. The blood is then passed through a machine that can separate the blood cells by spinning them at very high speed. A computer is used to separate the stem cells, which are placed in a collection bag, and the remaining blood cells are returned to your body. An anticoagulant is used in the process and this may cause a tingling in your fingers. Let the nurse know if this happens and adjustments can be made. Sometimes, stem cells are collected directly from the bone marrow in a procedure done in an operating theatre under general anaesthetic. This is most commonly done for allogeneic donations but, even in this situation, blood stem cells are increasingly being used.
Stem cells can be stored at very low temperatures for many years, until they are needed.
The transplantation of stem cells takes place after the completion of high dose chemotherapy. The cells find their way into the bone marrow spaces, eventually resulting in the restoration of normal blood cell numbers. The length of time this takes determines how long you will be in hospital. Your doctor or nurse should give you specific information about the type of transplant you will be having.
Side effects of stem cell transplantation
While you are having treatment you will be prone to infections, may bruise and bleed more easily, and may become weak, with little energy. Other side effects may include mouth infection and ulcers, feeling sick (nausea), vomiting, diarrhoea or bleeding from the bladder. Let your nurse and doctor know if you have any of these symptoms so that they can be treated.
Many adults with lymphoma have their disease cured by treatment or controlled for very long periods. With this remission, people usually have normal or near-normal good health. This may last for months or many years. The prognosis is also good for children, especially when the disease is found in its early stages.
If the disease flares up (relapses) more treatment will be needed. This may be with chemotherapy or radiotherapy.
You will need to discuss your prognosis with your own doctor. Your medical history is unique, so you will need to discuss with someone who knows your medical history what you can expect and the treatment options best for you.
Effects on fertility
Some chemotherapy for lymphoma can affect men's and women's fertility, meaning you may not be able to conceive children. Whether you will be affected in this way will depend on the sort of treatment you have and your age. Talk to your doctor about what options you have if you are having treatment that could affect your fertility.