Non-Hodgkin’s lymphoma (NHL) is a type of cancer that affects white blood cells, known as lymphocytes. In NHL, cancer cells tend to spread to parts of the lymphatic system throughout the body, like the lymph nodes.

An estimated 4 percent of people in the United States who receive a cancer diagnosis have NHL. If a doctor diagnoses NHL in you or a loved one, they will likely recommend chemotherapy for treatment. Chemotherapy is the use of medications to treat rapidly dividing cells, such as cancer cells.

Choosing a chemotherapy regimen depends on several factors:

  • type of NHL
  • stage of the cancer
  • other health conditions
  • your overall health

Most people will receive a combination of chemotherapy drugs to treat NHL. There are many different types of NHL and many different drugs and combinations that doctors use to treat specific types. We’ll review some of the common drugs and how they work.

Many types of chemotherapy drugs are available to treat NHL. Each works slightly differently to target and ideally kill cancerous cells or keep them from multiplying.

But chemotherapy can affect healthy cells, too, causing side effects. Certain groups of chemotherapy drugs may have unique side effects. These are things a doctor will consider before coming up with an appropriate regimen.

Chemotherapy drugs used to treat NHL usually fall into one of the following groups:

Alkylating agents

Alkylating agents work by damaging the genetic material (DNA) that tells a cancerous cell to replicate.

Examples of alkylating agents doctors prescribe to treat NHL include:

While all chemotherapy drugs have side effects, alkylating agents may come with an increased risk of bone marrow damage. Research has also linked some alkylating agents to pulmonary fibrosis.

Platinum drugs

Platinum drugs are a form of alkylating agent. When inside the body, they form platinum “complexes” that keep cancer cells from replicating.

Examples of platinum drugs include:

  • carboplatin (Paraplatin)
  • cisplatin (Platinol)
  • oxaliplatin (Eloxatin)

Platinum drugs have some unique side effects.

Up to 40 specific side effects are known to occur with platinum drugs, but some are unique. Some platinum drugs, particularly oxaliplatin, have been observed to cause nerve damage.

Antimetabolites

Antimetabolites are medications that interfere with the typical parts of a cancerous cell’s genetic material. They scramble the “code” that helps DNA copy itself, so the cancerous cells cannot multiply.

Examples of antimetabolites used to treat NHL include:

One of the main side effects of antimetabolites is a low white blood cell count (leukopenia).

Purine analogs

Purine analogs are an antimetabolite drug category. They have a similar structure to purines, which can be a building block of certain genetic material.

Examples of purine analogs used to treat NHL include:

  • cladribine (Leustatin)
  • fludarabine (Fludara)
  • pentostatin (Nipent)

Anthracyclines

Anthracyclines are antitumor antibiotics. These are not the same as the antibiotics we use to treat infections. These drugs bind to DNA to keep it from copying itself.

The types of anthracyclines doctors prescribe to treat NHL include:

  • doxorubicin (Adriamycin)
  • liposomal doxorubicin (Caelyx)

Anthracyclines can cause heart damage in higher doses.

Others

Doctors may prescribe other medications to treat NHL that may not fall into a specific category. Examples of these medications include:

  • bleomycin (Blenoxane)
  • etoposide (VP-16)
  • mitoxantrone (Novantrone)
  • vincristine (Oncovin)

If your doctor prescribes these or other medications, you can ask how they work to help treat your cancer type and what combinations may be most effective.

R-CHOP

Doctors usually treat NHL with a combination of chemotherapy drugs. One such option for treating some of the most common types of NHL is R-CHOP. R-CHOP is an acronym for five drugs:

  • rituximab (Rituxan), an immunotherapy drug
  • cyclophosphamide
  • doxorubicin (hydroxydaunorubicin)
  • vincristine (Oncovin)
  • prednisone

Corticosteroids

Corticosteroids are not a chemotherapy drug, but they may be part of your treatment. For NHL, doctors prescribe them to reduce inflammation and boost the effectiveness of your chemotherapy drugs.

Examples of corticosteroids used to treat NHL include:

Doctors often prescribe chemotherapy drugs for NHL in cycles. This means a person may take a medication for a short time, followed by a rest period.

Most chemotherapy drugs are taken either by mouth or by an intravenous (IV) line.

Typically, a doctor may prescribe several doses of chemotherapy drugs to be given over several weeks. After this time, you may undergo imaging tests, such as a PET scan or CT scan, to see if the drugs are working well.

If the initial chemotherapy treatment was ineffective or not fully effective, a doctor might recommend another chemotherapy regimen or different therapies.

Intrathecal chemotherapy

If lymphomas have developed in the spinal area, doctors may give some chemotherapy drugs by intrathecal chemotherapy. This is when they insert a small, thin needle through the spinal column to get the medication directly to the spinal fluid.

Doctors may also use intrathecal chemotherapy to prevent lymphomas from developing in the spinal area.

The side effects of chemotherapy for NHL depend on what chemotherapy type a doctor prescribes. It’s important to understand the side effects of the specific chemotherapy drugs you may be taking.

Some side effects that may commonly occur related to chemotherapy drugs include:

  • appetite loss
  • bleeding
  • bruising
  • constipation
  • diarrhea
  • fatigue
  • hair loss
  • mouth sores
  • nausea
  • risks for increased infection
  • shortness of breath
  • vomiting

Some chemotherapy drugs are known to have specific effects. Examples of these known side effects include damage to the:

  • bladder (ifosfamide)
  • heart (doxorubicin)
  • lungs (bleomycin)
  • nerves (platinum drugs), which causes symptoms such as tingling or numbness in the hands and feet

A doctor will consider the impact of these side effects when deciding on dosage.

Sometimes, NHL will not respond to chemotherapy. When this is the case, a doctor may recommend alternative treatments. These will depend on exactly what NHL type you have and how advanced your cancer is.

Treatment examples include:

  • Monoclonal antibodies. These are special infection-fighting proteins that target specific portions of a lymphocyte, where lymphomas begin. Monoclonal antibodies are a subtype of immunotherapiy. Examples include rituximab, obinutuzumab, and ofatumumab.
  • Immunotherapy. Traditional immunotherapy treatments alter the immune system so they can better fight cancer cells. These include checkpoint inhibitors, like pembrolizumab (Keytruda), and immunomodulators, like thalidomide (Thalomid).
  • Radiation therapy. Radiation therapy involves exposing areas of lymphoma to radiation to kill the cancerous cells.
  • Stem cell transplant. Also known as a bone marrow transplant, this lymphoma treatment method involves transplanting bone marrow, which forms new blood cells.
  • Targeted therapy. Targeted therapies are medications that ultimately help to stop uncontrolled cell division, which commonly occurs in people with cancer. Doctors will usually only prescribe these treatments for very specific NHL types.
  • CAR-T treatments. This relatively new treatment creates chimeric antigen receptors from a person’s T cells. The modified T cells are then reinfused into the body to attack cancer cells.

Researchers are also studying new treatment types regularly to determine if there are other, more effective methods to treat NHL.

Advancements in chemotherapy drugs and how doctors can combine them have meant better outcomes for people with NHL. The earlier the NHL stage is detected, the better a person’s 5-year survival rate is.

If your doctor has prescribed a chemotherapy regimen for you, they should explain how the drugs work to help your body deal with cancer.