Late effects of treatment for lymphoma
Sometimes a side effect might not go away after treatment for lymphoma, and some side effects may only develop months or years after treatment. These are called long-term or late effects.
What are late effects of lymphoma treatment?
Late effects are side effects of treatment that may not go away after treatment. And some side effects may only develop months or years after treatment has finished. They are also called long-term effects.
Not everyone has long-term or late effects after lymphoma treatment. And many side effects usually improve during or in the weeks and months after treatment.
Your cancer doctor or specialist nurse will explain if there is a risk that your treatment may cause this type of side effect. This can depend on different factors, such as the type of treatment and your age when you have it.
Your cancer doctor or specialist nurse can give you information about:
- what side effects are most likely for you
- how side effects can be treated or managed
- who to contact if you have ongoing or new side effects.
Related pages
Tiredness
Recovering from lymphoma treatment can take time. It is not unusual to feel tired for many months after treatment is over. Occasionally, tiredness may last for 1 or 2 years, depending on the type of treatment you had.
Physical activity can help improve your energy levels and help reduce tiredness. Short walks are a good way to start. Being active may also help you sleep better and can improve anxiety and depression.
Sometimes tiredness is a sign of:
- depression
- sleep problems
- pain
- changes in the thyroid gland.
These are problems that can be treated. If tiredness is not going away, talk to your lymphoma team or GP.
Emotional effects
Some people find they still have strong emotions months or even years after lymphoma treatment. It can take time to adjust to and deal with these feelings.
If these feelings do not improve or you are finding them hard to cope with, talk to your lymphoma team or GP. They may be able to refer you to see a counsellor or psychologist, or prescribe medicines to help.
Immune system effects
Your immune system protects you against infection. Lymphoma and lymphoma treatments can affect how your immune system works. Your body may be less able to fight infections.
It is important to tell your lymphoma team or GP if you have signs of an infection. Having it treated straight away can prevent serious complications.
Vaccines
Your cancer doctor may advise you to have vaccinations for flu, pneumonia and coronavirus (covid). If you are over 50, they may also suggest vaccination for shingles. These reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems. Ask your doctor for advice about when you should have them.
Some vaccines contain a very weak version of the illness they will protect you against. They are called live vaccines. You should not have live vaccines:
- If you have had Hodgkin lymphoma
- for 6 to 24 months after treatment for non-Hodgkin lymphoma, or until your immune system has recovered.
This is because the vaccine may make you unwell. Ask your cancer doctor or specialist nurse for advice before having vaccinations. They can explain what vaccines are right for you and when it is best to have these.
Preventing pneumonia
Pneumonia is a severe type of chest infection. After some types of lymphoma treatment, you may have a higher risk of a type of pneumonia called PJP or PCP.
If you are at risk, your cancer doctor will give you antibiotic tablets to help prevent infection. You may need to take them for several months until your immune system is stronger.
Preventing shingles
Shingles is a viral infection that can cause a painful rash. It is caused by the reactivation of the virus that causes chicken pox. This is more likely to happen when the immune system is weak.
If you are at risk of shingles, your cancer doctor will give you antiviral tablets called aciclovir to help prevent it. You may need to take them for several months until your immune system is stronger.
Peripheral neuropathy
Some drugs used to treat lymphoma can affect the nerves, causing numb, tingling or painful hands or feet. This is called peripheral neuropathy. Tell your cancer doctor or nurse if you notice any new symptoms or have symptoms that are getting worse.
Most people find that their symptoms gradually improve with time as the nerves slowly recover. This may take several months or more. For some people, nerve damage will be permanent. In this situation, however, many people find that their symptoms become less troublesome over time, as they adapt and find ways of coping.
Early menopause
Menopause usually begins between the ages of 45 and 55. But after treatment for lymphoma, you may have an earlier menopause. Your cancer doctor or specialist nurse can tell you if this is likely.
Tell your doctor or nurse if you have any menopausal symptoms. You may have blood tests to check for signs of the menopause. Hormone replacement therapy (HRT) can help reduce menopausal symptoms. Your doctor will explain the possible benefits and risks of HRT.
Thyroid and hormonal changes
The thyroid is a small gland in the front of your neck. It makes hormones that help to control and influence the way your body works.
Radiotherapy to the neck may affect the thyroid gland a few years after treatment. It may stop producing enough hormones. This is called an underactive thyroid or hypothyroidism. It can cause symptoms such as weight gain, tiredness and constipation.
Checkpoint inhibitors drugs for Hodgkin lymphoma such as nivolumab and pembrolizumab can affect hormone-producing glands.
Your cancer doctor will explain if your treatment could cause thyroid and hormone changes. You will have blood tests to check how your thyroid is working. You may need drugs to control your hormone levels.
Second cancer
Chemotherapy and radiotherapy can lead to a slightly increased risk of developing a second type of cancer later in life. This means a different cancer to lymphoma.
Treatments are designed to limit these risks as much as possible.
If your treatment involved radiotherapy to the chest area, your cancer doctor may give you information about the following:
- Signs and symptoms of skin cancer. If you notice any changes to the skin in the treated area, get them checked. Skin cancer can be treated very effectively at an early stage.
- Breast cancer symptoms and screening. Women, and other people assigned female at birth, who are under the age of 30 should have regular screening for breast cancer. Screening usually involves a physical check-up and an x-ray (mammogram) or MRI scan of each breast. Your doctor or nurse will explain what to expect.
- Signs and symptoms of anal cancer. If you have HIV, you may have an increased risk of anal cancer after lymphoma treatment. Your cancer doctor can give you information about signs and symptoms of anal cancer and possible check-ups.
Effects on the heart
Some lymphoma treatments may cause heart problems later in life. This includes some types of chemotherapy and, rarely, radiotherapy to the chest area.
Your cancer doctor will explain if there is a risk your treatment may cause heart problems. You may have heart tests before and during chemotherapy to check how well your heart is working. After treatment, you may have regular heart tests to check for signs of heart changes.
There are things you can do to improve your heart health and reduce your risk of heart problems after lymphoma treatment. These include being active, not smoking and a healthy diet.
Effects on the lungs
Some treatments used to treat lymphoma may sometimes cause changes to the lungs. Tell your cancer doctor, nurse or GP if you develop:
- breathlessness
- a cough that does not go away
- wheezing.
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs. If you smoke, stopping will improve your lung health and reduce your risk of breathing problems.
Bleomycin
The drug bleomycin can cause permanent damage to the lungs. This is more likely if:
- you smoke
- you also had radiotherapy to the chest area
- you are over 60
- you have other lung problems.
After treatment with bleomycin, breathing in high doses of oxygen can cause lung problems. If you need to have a general anaesthetic or oxygen therapy for any reason, always tell the doctor that you have had bleomycin. Some people choose to wear a medical alert identifier.
You should not scuba dive for a year after treatment with bleomycin. After this, you should have tests to check whether scuba diving is safe for you. Your cancer doctor can give you more information about this.
Irradiated blood products
Irradiated blood products are treated with x-rays to get rid of white blood cells called lymphocytes. Rarely, these lymphocytes can cause a serious reaction in people with Hodgkin lymphoma, or in people who have had certain treatments for non-Hodgkin lymphoma.
Your cancer doctor will tell you if you should have irradiated blood products and for how long. This includes if you need blood products called red cells, platelets or granulocytes.
If you have Hodgkin lymphoma, you should only ever have irradiated blood products.
If you have non-Hodgkin lymphoma, it depends on the treatments you have had. If you need a blood transfusion after the following treatments, you should only have irradiated blood products:
- some types of chemotherapy or targeted therapy drugs
- a stem cell transplant
- CAR T cell therapy.
This is important after your lymphoma treatment ends and for the rest of your life, even if the lymphoma is in remission.
Your cancer doctor will give you a medical alert card that explains this. You should show the card if you ever need treatment at hospital or need a blood transfusion. Some people also wear a medical ID bracelet or chain that carries this information. This is useful if you need emergency treatment and are not able to explain your medical history. Your pharmacist can give you more information.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our lymphoma information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Follows GA, Barrington SF, et al. Guideline for the first-line management of Classical Hodgkin Lymphoma — A British Society for Haematology guideline. Br J Haematol, 2022; 197, 558– 572. [accessed April 2024].
Fox CP, Chaganti S, McIlroy G, et al. The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline. Br J Haematol. 2024; 204(4):1178–92. [accessed April 2024].
McKay P, Fielding P, et al. Guidelines for the investigation and management of nodular lymphocyte predominant Hodgkin lymphoma. Br J Haematol, 2015; 172, 32-43. [accessed April 2024].
McNamara C, Montoto S, et al. The investigation and management of follicular lymphoma. Br J Haematol, 2020; 191, 363-381. [accessed April 2024].
National Institute for Health and Care Excellence. Non-Hodgkin’s lymphoma: diagnosis and management. NICE guideline [NG52]. Published: 20 July 2016. Last update Oct 2021. [accessed April 2024].
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