Late effects of treatment for lymphoma
Sometimes a side effect from lymphoma treatment may continue or develop months or years after treatment. This is called a late effect.
Some people have side effects during their lymphoma treatment and for a few weeks after. Usually, these effects reduce and eventually disappear.
But some people may have side effects that continue for months after treatment and that sometimes become long-term. Other people may have late side effects that develop months or years after treatment.
Not everyone has long-term or late effects. And many side effects get better over time. This can depend on different factors such as the type of treatment. Your lymphoma doctor or nurse can give you more information.
Recovering from chemotherapy can take time. You may feel tired for many months after treatment is over. Occasionally, tiredness may last for a year or two.
Physical activity can help improve energy levels and reduce tiredness. Short walks are a good way to start. Being active also helps you sleep better and can improve anxiety and depression.
Sometimes tiredness is a sign of depression, sleep problems, pain, or changes in the thyroid gland. These are problems that can be treated. If tiredness is not going away, talk to your doctor.
Your immune system protects you against infection. Lymphoma and treatment for it can affect how your immune system works. this can make you less able to fight infections.
Your lymphoma doctor may advise you to have vaccinations to protect you against infections such as flu or pneumonia. Ask them for advice about when you should have vaccinations.
Some vaccines have small amounts of a live virus or bacteria in them. They are called live vaccines. You should not have live vaccines:
- if you have had Hodgkin lymphoma
- for about 6 to 12 months after treatment for NHL.
Ask your doctor whether a vaccination is safe for you to have before having it.
Pneumonia is a severe type of chest infection. Certain treatments for NHL can lower the number of infection fighting lymphocytes in your blood for several months. This can make you more likely to develop a type of pneumonia called PJP or PCP.
If you are at risk your doctor will ask you to take tablets such as co-trimoxazole (Septrin®) to help prevent infection. You usually take them for about 3 months. They reduce your risk of infection until the number of lymphocytes in your blood returns to normal.
Some vaccines have small amounts of a live virus or bacteria in them. They are called live vaccines. You should not have live vaccines for 6 to 12 months after treatment, or until your immune system has recovered. Your doctor will tell you which vaccinations are safe for you to have and which you should avoid.
If the feeling in your hands or feet was affected by chemotherapy, you will usually find this slowly gets better after treatment ends. This may take up to 2 years. Sometimes nerves do not fully recover and you may continue to have difficulty with fiddly tasks, such as picking up very small objects or doing up small buttons. People generally find these kinds of changes become less noticeable over time as they adapt and find ways of coping with them.
We have more information about peripheral neuropathy.
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 functions.
Some people who have radiotherapy to the neck develop changes in their thyroid gland a few years after treatment. The thyroid stops producing enough hormones. This is called an underactive thyroid or hypothyroidism. It can cause symptoms such as weight gain, tiredness and constipation.
Your lymphoma doctor will explain if your treatment could cause thyroid changes. You will have a blood test once a year to check how your thyroid is working. You may need daily tablets if your thyroid is underactive.
Women under the age of 30 who have had radiotherapy to the chest area have a higher risk of breast cancer. They should have screening for breast cancer at an earlier age than usual.
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.
Some lymphoma treatments may cause heart problems later in life. This includes some types of chemotherapy and, rarely, radiotherapy to the chest area.
Your 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.
The chemotherapy drug bleomycin can cause changes to the lungs that may affect your breathing. These changes may happen during treatment and usually get better over several months or years after treatment ends. Sometimes bleomycin causes permanent damage to the lungs. Lung changes are more likely if:
- you also have radiotherapy to the chest area
- you are over the age of 60
- you have other lung problems.
If you smoke, quitting will improve your lung health and reduce the risk of breathing problems.
High doses of oxygen can make breathing problems worse in people who have had bleomycin. If you need oxygen treatment or an operation, always let your doctor or nurse know that you have had bleomycin.
If you need a blood transfusion at any time after:
- a diagnosis of Hodgkin lymphoma
- certain chemotherapy drugs or targeted therapy drugs
- a stem cell transplant
you should only have irradiated blood. Your doctor will tell you if this applies to you.
This includes if you need blood products called red cells, platelets or granulocytes. This is still important after your lymphoma treatment ends and for the rest of your life, even if the lymphoma is in remission.
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 who have had certain treatments for non-Hodgkin lymphoma.
Your lymphoma doctor will give you a 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 information about this. This is useful if you need emergency treatment and are not able to explain your medical history. Your pharmacist can give you more 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. It has been approved by Senior Medical Editors, Dr Anne Parker, Consultant Haematologist; and Professor Rajnish Gupta, Macmillan Consultant Medical Oncologist.
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