Chemotherapy for non-Hodgkin lymphoma

Chemotherapy is the main treatment for most types of NHL. It uses cytotoxic (cell killing) drugs to destroy cancer cells.

Chemotherapy is usually given into a vein (intravenously) or taken as tablets. The chemotherapy gets into the bloodstream and is carried to lymphoma cells, wherever they are in the body.

Most people have chemotherapy as an outpatient. Sometimes just one drug is given, but most treatments involve a combination. Chemotherapy may also be given with a monoclonal antibody. This is called chemoimmunotherapy.

Some types of lymphoma may spread to the brain. If there is lymphoma in the brain, or a high risk of it spreading there, you may be given chemotherapy into the fluid in the spine (intrathecal chemotherapy).

Chemotherapy is usually given for one or more days followed by a few weeks without chemotherapy. This allows your body to recover from any side effects before the next treatment.

A course of chemotherapy treatment usually lasts several months. During this time you’ll have regular check-ups at the hospital.

How chemotherapy is used

Chemotherapy is the main treatment for most types of NHL. It uses cytotoxic drugs to destroy cancer cells. Cytotoxic means toxic to cells.

Chemotherapy can be given into a vein (intravenously) or taken as tablets. With both these methods, the chemotherapy gets into the bloodstream and is carried to lymphoma cells wherever they are in the body.

Most people have chemotherapy as an outpatient. Sometimes just one chemotherapy drug is given, but most treatments involve having a combination of two or more chemotherapy drugs in a single day. This is then followed by a rest period of a few weeks without chemotherapy. The rest period allows your body to recover from any side effects before the next treatment.

The day(s) of treatment and the rest period make up a cycle of treatment. A full course of chemotherapy usually involves several cycles of treatment and lasts a few months. During this time, you will have regular check-ups at the hospital. About 2–3 months after starting chemotherapy, you will usually have a CT scan. This is to see how well the NHL is responding.


Chemotherapy drugs for non-Hodgkin lymphoma

There are several chemotherapy treatments that work well for NHL. The most commonly used treatments include the following:

  • CHOP – A combination of the chemotherapy drugs cyclophosphamide, doxorubicin (Adriamycin®) and vincristine, given into a vein, and steroid tablets called prednisolone.
  • CVP – A combination of the chemotherapy drugs cyclophosphamide and vincristine (Oncovin®) given into a vein, and steroid tablets called prednisolone.
  • Bendamustine – A chemotherapy drug that’s given into a vein.
  • Chlorambucil (Leukeran®) – A chemotherapy drug taken as tablets.
  • Fludarabine – A chemotherapy drug that’s often given in combination. It can be given into a vein or as tablets.
  • Chemoimmunotherapy – This is when chemotherapy is given in combination with a monoclonal antibody.

Chemoimmunotherapy – This is when chemotherapy is given in combination with a monoclonal antibody. Many lymphomas are treated with chemoimmunotherapy. The most commonly used monoclonal antibody is rituximab. When chemotherapy and rituximab are given together, the letter R is added to the treatment name, for example R-CHOP or R-CVP.


Chemotherapy to treat or prevent lymphoma spreading to the brain

With some types of aggressive NHL, or when NHL is found in certain areas of the body, there’s a higher risk of lymphoma cells getting into the brain. If you have a lymphoma like this, you will be given extra treatment to reduce your risk. This is called prophylactic treatment.

This may involve having chemotherapy into the spinal fluid. This is called intrathecal chemotherapy. It’s done in a similar way to a lumbar puncture but before removing the needle, the doctor puts a small amount of liquid chemotherapy into the spinal fluid. The chemotherapy drug most commonly used is methotrexate.

Intrathecal chemotherapy can also be used to treat lymphoma that has already spread to the brain. Most people have intrathecal treatment as an outpatient.

We can send you fact sheets about methotrexate and intrathecal chemotherapy.

High doses of methotrexate can also be given into a vein to treat or prevent lymphoma in the brain. In this situation, intrathecal chemotherapy may not be needed.

Back to Chemotherapy explained

Your feelings

You may experience difficult feelings while having chemotherapy treatment. Talking these over can be helpful.

Who might I meet?

A team of medical specialists will be involved throughout the course of your chemotherapy treatment.