Chemotherapy for non-Hodgkin lymphoma

Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. It is usually used to treat non-Hodgkin lymphoma (NHL). Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is given for different reasons. You may have chemotherapy to:

  • destroy cancer cells in the body
  • destroy cancer cells in the bone marrow before a stem cell transplant
  • relieve pain or control the symptoms of advanced NHL (called palliative chemotherapy)

Depending on the type and stage of NHL, chemotherapy may be used alone or given with radiation therapy or with other drugs, such as in immunotherapy, targeted therapy and corticosteroids.

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy lymphoma cells all over the body. Chemotherapy may also be a regional therapy, which means that it is given to a specific area of the body. For central nervous system (CNS) prophylaxis, the drugs are given directly into the spaces containing cerebrospinal fluid (CSF).

Chemotherapy drugs used for NHL

The following chemotherapy drugs are often combined to treat NHL:

  • cyclophosphamide (Cytoxan, Procytox)
  • bendamustine (Treanda)
  • chlorambucil (Leukeran)
  • ifosfamide (Ifex)
  • fludarabine (Fludara)
  • cladribine (Leustatin)
  • vincristine (Oncovin)
  • cisplatin (Platinol AQ)
  • methotrexate
  • cytarabine (Cytosar, Ara-C)
  • doxorubicin (Adriamycin)
  • pentostatin (deoxycoformycin, Nipent)
  • gemcitabine (Gemzar)
  • mitoxantrone (Novantrone)
  • etoposide (Vepesid, VP-16)

Corticosteroid drugs are often given with chemotherapy to treat NHL. These drugs include prednisone, dexamethasone (Decadron, Dexasone) and methylprednisolone (Medrol).

The most common combinations of chemotherapy drugs used to treat NHL are:

  • CHOP – cyclophosphamide, doxorubicin, vincristine and prednisone
  • R-CHOP – CHOP with rituximab (Rituxan)
  • CVP – cyclophosphamide, vincristine and prednisone
  • R-CVP – CVP with rituximab

Other combinations of chemotherapy drugs that may be used to treat NHL are:

  • FND – fludarabine, mitoxantrone and dexamethasone
  • hyperCVAD – cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate and cytarabine
  • MACOP-B – methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone and bleomycin (Blenoxane)

If NHL does not respond to drugs used in earlier treatments or if it comes back (relapses, or recurs), the following chemotherapy combinations may be used:

  • GDP – gemcitabine, dexamethasone and cisplatin
  • DHAP – dexamethasone, cytarabine and cisplatin
  • EPOCH – etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin
  • ESHAP – etoposide, methylprednisolone, cytarabine and cisplatin
  • ICE – ifosfamide, carboplatin (Paraplatin, Paraplatin AQ) and etoposide
  • DICE – ICE with dexamethasone

Central nervous system prophylaxis or treatment

The central nervous system (CNS) is the brain and spinal cord. CNS prophylaxis means giving treatment to prevent lymphoma cells from spreading to the CNS. Treatments are also given if NHL has spread to the CNS.

To prevent NHL from spreading to the CNS or to treat NHL in the CNS, drugs are given directly into the spaces containing CSF. This is called intrathecal chemotherapy. The drugs are given by a lumbar puncture (also called a spinal tap) or an Ommaya reservoir.

The most common chemotherapy drugs used for CNS prophylaxis or to treat NHL in the CNS are:

  • methotrexate
  • cytarabine

Side effects

Side effects can happen with any type of treatment for NHL, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how the drug is given, how long the drug needs to be taken and your overall health. Some common side effects of chemotherapy drugs used for NHL are:

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Information about specific cancer drugs

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.

Questions to ask about chemotherapy

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

Expert review and references

  • American Cancer Society. Non-Hodgkin Lymphoma. 2014:
  • American Society of Clinical Oncology . Lymphoma Non-Hodgkin Overview . 2014 :
  • Cancer Care Ontario. Drug Formulary. Toronto, ON: Cancer Care Ontario;
  • Faber EA, Vose JM, Armitage JO, Bierman PJ . Diagnosis and treatment of non-Hodgkin's lymphoma of adults. Wiernik PH, Goldman JM, Dutcher JP, Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 47: 1027-1047.
  • Manson SD & Porter C . Lymphomas. Yarbro, CH, Wujcki D, & Holmes Gobel B (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 60: pp. 1458-1512.
  • Sanjay Vinjamaram. Non-Hodgkin Lymphoma. WebMD LLC; 2015: