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. These are often called long-term effects. Other people may have side effects that develop months or years after treatment. These are often called late effects.
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 specialist doctor or nurse can give you more information.
We have more information on treating Hodgkin lymphoma (HL) and treating non-Hodgkin lymphoma (NHL).
Recovering from treatment can take time. You may feel tired for many months after treatment is over. Occasionally, tiredness may last for a 1 or 2 years, depending on the type of treatment you had.
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.
It is important to report any signs of an infection to your lymphoma team or GP. Having it treated straight away can prevent serious complications.
Your specialist doctor may advise you to have vaccinations to protect you against infections such as flu or pneumonia. They usually also recommend that you have a coronavirus vaccination.
These are inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations. 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 6 to 12 months after treatment for NHL, or until your immune system has recovered.
Ask your specialist doctor or nurse whether a vaccination is safe for you to have before having it.
Pneumonia is a severe type of chest infection. Certain treatments can lower the number of lymphocytes (white blood cells that fight infection). This can last for several months. It 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 to help prevent infection. These may be co-trimoxazole (Septrin®). You may need to take them for several months. They reduce your risk of infection until the number of lymphocytes in your blood returns to normal.
Treatment can affect the nerves, causing numb, tingling or painful hands or feet. This is called peripheral neuropathy. It usually slowly gets better after treatment ends.
Sometimes nerves do not fully recover. If this happens, you may continue to have difficulty with fiddly tasks. For example, it may be harder to pick up very small objects or do up buttons. Tell your doctor or nurse if this happens. People generally find the changes become less noticeable over time as they adapt and find ways of coping.
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.
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 specialist 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. They usually get better months or years after treatment ends. Sometimes bleomycin causes permanent damage to the lungs. This is more likely if:
- you also had radiotherapy to the chest area
- you are over 60
- you have other lung problems.
If you smoke, quitting will improve your lung health and reduce your 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 tell your doctor or nurse 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 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 in people who have had certain treatments for non-Hodgkin lymphoma.
Your specialist 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 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.
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 firstname.lastname@example.org
National Institute of Health and Care Excellence (NICE). Blood and bone marrow cancers. NICE Pathways. Last accessed 3 December 2020.
Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up; European Society for Medical Oncology (2018).
Non-Hodgkin’s lymphoma: diagnosis and management; NICE Guideline (July 2016).
Newly Diagnosed and Relapsed Follicular Lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up; European Society for Medical Oncology (2020).
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 Editor, Professor Rajnish Gupta, Macmillan Consultant Medical Oncologist.
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