Supportive therapy for non-Hodgkin lymphoma

Supportive therapy is an important part of treatment for non-Hodgkin lymphoma (NHL). It is given to treat complications from treatment and the lymphoma itself. Complications can include infection, bleeding and low blood cell counts.

Different types of drugs are used to prevent and treat infections. An infection is when bacteria, viruses or other harmful organisms enter the body and your immune system cannot destroy them. Your immune system is your body's natural defence against infection and disease.

You may receive antibiotics, antivirals and antifungals to prevent or treat bacterial, viral and fungal infections. These are given to help prevent an infection if your white blood cell (WBC) count is too low, the risk of infection is high or the healthcare team thinks that you have an infection. Antibiotic, antiviral or antifungal drugs can be taken by mouth as a pill (orally) or through a needle in a vein (intravenously).

An infection is a serious complication in people with lymphoma. Infections can be caused by NHL as well as treatments such as chemotherapy. Infections are common in people receiving cancer treatment because it lowers the number of WBCs. WBCs are an important part of your immune system and play a key role in defending your body against viruses and bacteria. When your WBC counts are low, your immune system is less able to fight an infection on its own (called immunosuppression). You will usually need to be treated in the hospital with infection-fighting drugs.

An infection can start in almost any part of your body. Common locations of an infection include the skin, mouth, respiratory tract (such as sinuses or lungs), mucous membranes, blood and urinary tract (such as the bladder and kidney) and rectum. Examples of infections include pneumonia, sepsis, shingles and influenza.

The most common symptom of an infection is a fever. Other symptoms include:

• chills or shivering
• mouth sores, red or white patches in the mouth
• sore throat
• cough
• shortness of breath or rapid breathing
• frequent, painful urination
• diarrhea
• pain, redness or swelling of the rectal area
• drainage, pus, redness or swelling from a cut, a sore, an incision, a venous access device or a drainage tube

Find out more about treating infections and managing low white blood cell counts.

Your healthcare team will check your blood cell counts during treatment. You will be given blood transfusions when needed to replace the blood cells you may have lost. The types of replacement transfusions used include:

• red blood cells
• platelets
• fresh frozen plasma
• cryoprecipitate (a product that replaces clotting factors)

Find out more about blood transfusions.

Growth factors (granulocyte colony-stimulating factors, or G-CSFs) may be used to stimulate the production of white blood cells. This shortens the length of time you will have a low white blood cell count and lowers the risk of infection.

Growth factors used in supportive therapy for NHL include filgrastim (Neupogen) and pegfilgrastim (Neulasta). These drugs may be given as an injection just under the skin (subcutaneous) or intravenously.

Immunoglobins are proteins in the blood that act like antibodies to fight infection. They are made by WBCs and are an important part of the immune system. Some people with lymphoma can have low levels of immunoglobins in their blood. You may receive intravenous immunoglobulins (IVIG) collected from donors to help prevent infections.

Tumour lysis syndrome (TLS) can be life-threatening and requires urgent treatment. It can happen with treatment of some aggressive types of NHL. It usually occurs at the start of chemotherapy when many tumour cells are destroyed rapidly. When the cells die, their contents are released into the bloodstream. This can create abnormally high levels of uric acid, potassium and phosphorus. TLS occurs when cancer cells break down so quickly that the kidneys can't remove these substances from the blood fast enough.

The following treatments are used to lower the levels of these substances in the blood. These treatments may be given orally as a tablet or intravenously.

• increased intravenous fluids
• allopurinol (Zyloprim)
• sodium bicarbonate
• rasburicase (Fasturtec)

Find out more about tumour lysis syndrome.

To make the decisions that are right for you, ask your healthcare team questions about treatment. For more detailed information on specific drugs, go to sources of drug information.