Your treatment for lymphoma will depend on your individual condition, your general health and your wishes. Throughout your treatment, your medical team will always discuss your options, and what’s involved, with you. You’ll be able to give your opinions and preferences and ask questions.
- Blood cancer
- Childhood leukaemia
- Acute lymphoblastic leukaemia (ALL)
- Acute myeloid leukaemia (AML)
- Acute promyelocytic leukaemia (APL)
- Chronic lymphocytic leukaemia (CLL)
- Chronic myeloid leukaemia (CML)
- Chronic myelomonocytic leukaemia (CMML)
- Hairy cell leukaemia (HCL)
- Large granular lymphocytic leukaemia (LGLL)
- Plasma cell leukaemia (PCL)
- T-cell acute lymphoblastic leukaemia (T-ALL)
- Other conditions related to blood cancer
Lymphoma treatment and side effects
Types of treatment for lymphoma
You’ll have the treatment that’s right for you – the treatment will be different depending on which type of lymphoma you have and your individual needs. Even patients who have the same type of lymphoma won’t have the same treatment.
For many patients, their treatment is split into different phases. Each phase of your treatment will have a different aim – it might be to get rid of the lymphoma cells entirely, or it might be to consolidate any previous treatment, or it might be to maintain the low levels of lymphoma cells in your blood after initial treatment.
Your healthcare team will discuss this with you before you start your treatment, but you can always ask them any questions at any point in your treatment if you’re not sure about something.
Below are some of the types of treatment you might have if you have lymphoma.
Chemotherapy is used to kill cells and stop them dividing. Although this type of treatment is aimed at the cancer cells, the treatment also affects normal cells which divide quickly, like the hair and gut.
If you have chemotherapy, you will be given anti-cancer drugs. You might take a single drug or a combination of different drugs. Sometimes these will be given in your vein (intravenously) or sometimes you’ll need to take tablets. You’ll usually have several courses (sometimes called blocks or cycles) of chemotherapy during your treatment.
Radiotherapy uses high energy rays, usually X-rays, to kill cancer cells in a specific area. It can be an effective treatment for diseases which affect a particular part of the body, such as lymphoma.
Your treatment plan might include biological therapies. These drugs identify proteins on the surface of the affected cells and kill them.
Steroids are very effective in killing lymphoma cells and are sometimes included in treatment regimes alongside chemotherapy and biological therapies, Steroids can make some chemotherapy treatments more effective and reduce any sickness you may get, but can sometimes be used alone to shrink down the lymphoma.
Stem cell transplants
Sometimes, people with lymphoma have a stem cell transplant. This is where a patient receives chemotherapy to reduce the lymphoma in their bone marrow, then receives blood stem cells from another healthy individual (a donor).
As well as the active treatment you’ll receive to reduce the lymphoma, some patients also have a type of treatment called supportive care. Supportive care is treatment to reduce infections, provide blood and platelet transfusions, and, in some cases, medicines to reduce bruising and bleeding.
Some patients might also be put in touch with a palliative care team. They’re experts in managing your symptoms, improving your quality of life and helping you take care of your general health. They’re able to support both you and family members.
Your doctor will recommend a treatment plan and talk to you about what it will involve. Treatment plans are tailored to each individual, so if you meet someone else having treatment for lymphoma, even for the same type of lymphoma you have, they might be having different treatments. A big factor in the type of treatment you have will be the type of lymphoma you have.
If you have a lymphoma which develops quickly, you’ll usually need to have treatment straight away. If you have a lymphoma which develops slowly, you might not need treatment right away – it might be months, or even years before you need to have treatment for the cancer, and some people might never need treatment. In this case you’ll be on something called ‘watch and wait’: you’ll have regular check-ups, either at your GP surgery or in hospital, to monitor your condition and you’ll only have treatment when doctors think you really need it.
Throughout your treatment, your healthcare team will always discuss your treatment options with you. They’ll want to hear what you think, answer your questions, and explain anything you’re unsure about – your wishes are always taken into account.
Your treatment plan may need to change along the way. If this happens, your healthcare team will explain why, and talk to you about the different options available to you.
Watch Dr Robert Marcus, Consultant Haematologist, King's College Hospital, London, talk about monitoring whether treatment is working.
Watch Dr Robert Marcus, Consultant Haematologist, King's College Hospital, London, talk about second line treatment.
The treatment you have for lymphoma might have different side effects. These might be short term side effects, which just last for the duration of your treatment, or long term side effects, which might have an impact for weeks, months or years after your treatment.
Different people have different responses to their treatment. Even if two patients are having the same treatment, they may have a different experience. You might not get all, or even any, of these side effects – try to bear this in mind when you read about them. You may also like to talk about potential side effects with your healthcare team.
Potential side effects from chemotherapy
Specific types of chemotherapy drugs might have different side effects. It’s best to talk to your healthcare team about any potential side effects of any chemotherapy drugs you might be taking.
Short term side effects
You may experience some short term side effects from chemotherapy treatment. They could include:
- an achy flu-like feeling
- bruising and bleeding
- extreme tiredness (fatigue)
- hair loss
- a sore mouth or mouth ulcers
- nausea and vomiting
- abnormalities of liver function (this doesn’t usually cause symptoms, but sometimes people may become jaundiced).
Long term side effects
With any type of chemotherapy, there’s always at least a small risk of long term side effects. These could include problems with the thyroid, heart or lung. The risk of long term side effects will depend on how many cycles of treatment you’ve had, the treatment intensity and whether you’ve had a transplant or not. Every patient is different, so your healthcare team will talk to you about this in more detail.
Side effects from steroids can include:
- feeling agitated
- weight gain
- water retention (build-up) around your face and ankles
- increase in appetite
- raised blood sugar, particularly in patients with diabetes.
The side effects from radiotherapy will depend on the area of the body being treated but common side effects are fatigue and redness in the treated area. Your healthcare team will speak to you in more detail about this.
Potential impact on your fertility
You might be worried about the effect of your treatment on your fertility. It’s a common concern that many patients have, and one that also impacts on their partners and families too. If you’re having treatment for lymphoma at an age when you’re thinking about having children or you think you might like to have children in the future, then it’s a good idea to discuss the options for protecting your fertility with your doctor.
It’s natural to worry about the effects of treatment on any children you might have after your treatment. Lots of evidence from clinical studies has shown that a parent's cancer treatment doesn’t lead to an increased risk of cancer or other health problems in their children.
Relapse means the lymphoma has come back. The chance of this happening is different for different types of lymphoma, and for each different patient. If you do relapse, your healthcare team will talk to you about what will happen next.
Treatment in relapse
Some patients might have more treatment for the relapsed lymphoma. Types of treatment which might be involved include more chemotherapy, taking different drugs, or a stem cell transplant – but the type of treatment you have will be different depending on what type of lymphoma you have. You might also be offered the chance to take part in a clinical trial to have a new type of treatment alongside whatever your doctor recommends.
Palliative care in relapse
If the doctors feel that more treatment isn’t likely to succeed for the lymphoma that you have, you may be advised that palliative care is more appropriate than having more treatment. Your doctor will discuss the options with you in detail before you decide on a treatment plan.
Palliative care will lessen your symptoms and control the disease rather than looking for a cure. It’s really important to note that palliative care is not the same as terminal care. Palliative care aims to extend survival as well as controlling your symptoms.
If your treatment is a success, this is called remission. This means you’ve had a good initial response to treatment, and no lymphoma cells can be seen in your blood when looked at under a microscope (although this may not mean you’re completely cured).
The aim of follow-up is to look out for signs of relapse and treatment complications. These appointments are really important so do make sure you get to them.
For the first year after your treatment, you’ll normally have a check-up every one to two months. After one year, your check-ups will get less and less frequent, until they’re given every year at five years and onwards.
In these check-ups it's important to report any new signs or symptoms to your healthcare team, so that they can investigate these.
The outlook (prognosis) is different for each type of lymphoma, and for each patient. Lots of different factors might affect your outlook – like your age, general health, and the type of lymphoma you have.
The best person to talk to about your individual prognosis is your consultant, or someone on your healthcare team.
Remember that your outlook may change, for example if you respond well to treatment. If there’s a change in your condition, or if you’ve finished all or part of your treatment, you might want to consider asking if your prognosis is still the same.
Talking about your prognosis
You may find it hard to ask or talk about your prognosis. This might be more difficult at first, and you might feel more ready to do this later on, once you’ve had more time to think about it. Sometimes those close to you may want to know, even if you prefer not to.
However, your healthcare team aren’t allowed to give this or any other information to anyone – not even family members – without your permission. Try to decide early on who you want to know about your condition, then tell your healthcare team. You can change your mind at any time.