Other drug therapies for lymphoma

Steroid therapy

Having steroids

Steroids (also known as corticosteroids) are substances made naturally in the body. They can also be produced artificially and used to reduce inflammation (redness, swelling and/or pain). The most commonly prescribed steroid for both Hodgkin and non-Hodgkin lymphomas is prednisolone.

You may be given steroids with chemotherapy to increase the effect of the chemotherapy, help destroy the lymphoma, and treat any nausea or vomiting caused by the chemotherapy. Steroids are usually taken as tablets, but can also be given into a vein (intravenously).

Side effects of steroid therapy

Steroid therapy can cause various side effects, which depend on the dose prescribed and how long you take steroids. Most side effects gradually go away after you stop taking the medicine.

When taken for a short period of time, steroids may increase your appetite, make you feel restless, make it harder to sleep or stay asleep (insomnia), and cause weight gain and mood changes. If you need to take steroids for several months, you may have a build-up of fluid in the body (known as fluid retention), high blood pressure and high blood glucose levels (which may lead to diabetes in some people). There is an increased risk of developing stomach ulcers, so your doctor may prescribe a drug to help prevent ulcers while you are on steroid therapy. You may also be more likely to get infections (see Taking care with infections).

Your treatment team can help you manage or reduce side effects, especially if they are causing you discomfort.

Targeted therapy

Immunotherapy

Immunotherapy uses the body’s own immune system to fight cancer. There are 2 main types of immunotherapies used to treat lymphoma – checkpoint inhibitors and CAR T-cell therapy. Your haematologist will discuss which is best for you.

Checkpoint inhibitors

Checkpoint inhibitors are drugs that help the immune system recognise and attack cancer cells. This type of immunotherapy can be used to treat Hodgkin lymphoma. At this stage, checkpoint inhibitors are not used to treat non-Hodgkin lymphoma.

To work out if checkpoint inhibitor therapy is an option for you, your cancer specialist will consider the type and stage of cancer, your treatment history, future treatment options and your overall health. 

Checkpoint inhibitors are given as a liquid through a drip inserted into a vein (intravenous infusion). They are usually given in repeating cycles, with rest periods of 2–6 weeks between cycles.

How often and how long you have the treatment depends on the type of cancer, the type of checkpoint inhibitor, how the cancer responds to the treatment, and what side effects you may experience. People can stay on checkpoint inhibitors for up to 2 years.

Checkpoint inhibitors can take weeks or months to start working. Sometimes they keep working long after treatment stops, but this varies from person to person.

Side effects

Because immunotherapy drugs act on the immune system, they can sometimes cause the immune system to attack healthy cells in any part of the body. This can lead to a variety of side effects such as skin rash, diarrhoea, breathing problems, inflammation of the liver, hormone changes and temporary arthritis. Your doctor will discuss possible side effects with you.

CAR T-cell therapy

Chimeric antigen receptor (CAR) T-cell therapy is a type of immunotherapy used to treat some types of non-Hodgkin lymphoma. This therapy works by boosting the ability of T-cells to fight cancer.

To make CAR T-cells, your own T-cells are removed from your blood and changed so they can better recognise cancer cells. A few weeks later, the changed T-cells are returned to the blood through an intravenous drip (IV infusion). You will stay in hospital for several weeks, and recovery will take time.

CAR T-cell therapy is available only for some types of B-cell lymphomas that have come back or have not responded to other treatment. If CAR T-cell therapy is an option, you may be referred to a specialist centre for treatment.

Side effects

CAR T-cell therapy can cause the immune system to react, causing cytokine release syndrome (CRS). Symptoms of CRS include a high temperature, fast heart rate, low blood pressure, changes to your blood cell count, and breathing difficulties.

CAR T-cell therapy can also affect the nervous system, causing side effects in the brain, such as headaches and confusion. Your doctor will discuss possible side effects with you and how long they may last. Most side effects can usually be managed, but it’s important to let your doctor know if you have them.