Chemotherapies consist of an association of medicines injected into the veins and taken orally, at defined intervals. Many associations of medicines (treatment protocols) are known, their use depends on the type of lymphoma and its extent.
Examples of chemotherapies in lymphoma treatments:
- CHOP (Adriamycin, Cyclophosphamide, Vincristine, Prednisone) is a very common chemotherapy association for treating lymphomas. In many countries, especially the United States, it is the standard treatment for aggressive lymphomas. This chemotherapy can be used for patients up to 80 years old.
- CHOP ACVBP (Adriamycin, Cyclophosphamide, Vindesine, Bleomycin, Prednisone) is a much more intensive chemotherapy association. It is usually reserved for certain patients under 60 years old and for aggressive lymphomas. This association has been the subject of several studies by the LYSA teams.
The treatment protocol os defined in advance by the treating doctor, but it can be modified according to the side-effects and the response of the disease.
The chemotherapy treatment is usually performed in the day hospital, but hospitalisations are sometimes necessary due to the type of treatment or the patient’s state of health. For certain lymphomas, there is a risk of relapse in the meninges (the envelopes of the brain and spinal cord). It is then necessary to inject the chemotherapy at regular intervals (between 4 and 12 doses) in the meninges, through lumbar punctures.
To make it possible to inject chemotherapy intravenously for several months in comfortable conditions, it is usual to attach a stent for the perfusions, which the patient keeps for the duration of the treatment. The port consists of a small box with a diameter of two centimetres, placed under the skin, linked to a tube (catheter) that is introduced into a large vein.
This port is usually placed under local anaesthetic, in the operating block, under the responsibility of an anaesthetist or a surgeon. A short incision uncovers a vein at the base of the neck, into which the catheter is slid, with the box being placed under the skin. This intervention lasts from thirty minutes to an hour. General anaesthesia is sometimes proposed.
In the first 48 hours after the stent is placed, the base of the neck may be tender or painful. Painkillers are prescribed for this. The dressing can be removed after four days, the stiches are usually absorbed automatically.
Chemotherapy side-effects depend on the type of chemotherapy, and vary from one person to the next. The doctor who prescribed the chemotherapy informs the patient of these side-effects and their frequency. Measures can be taken to reduce certain side-effects.
The most common and immediate side-effects are nausea and vomiting. Very significant progress has been made in the prevention and treatment of these side-effects. If nausea and vomiting occur despite this, other medicines can be prescribed.
A decrease of white blood cells is frequent in the days following the chemotherapy. The degree of this decrease depends on the type of chemotherapy. Growth factors (Neupogen, Granocyte) are sometimes used to reduce the severeness of this decrease, but they cannot prevent it entirely. The concentration of white blood cells in the blood is regularly monitored by the doctor if necessary. The occurrence of a fever over 38°, shivering, faintness or any other event in between the chemotherapy cycles should be reported without delay to the treating doctor or the hospital.
Chemotherapy can lead to hair loss (alopecia). This also depends on the type of chemotherapy. In the case of lymphomas, it is frequent for all hair to be lost. This starts three weeks after the first chemotherapy injections, and lasts for the duration of the treatment. At the end of the chemotherapy cycles, the hair grows back normally, and often quite quickly. A cold cap is sometimes used to reduce hair loss, but this method is contraindicated for many lymphomas.
Chemotherapy can also affect the patient’s fertility. Certain chemotherapies used against lymphomas may reduce fertility. This is particularly the case for therapeutic intensifications with autografts. For men, it is usually possible to take a sperm sample before the treatment and to keep it frozen for use several years later. For women, chemotherapy often leads to irregular menstrual cycles, or even the disappearance thereof, especially if the patient is close to natural menopause. It is however essential to have an effective contraception during the treatment, because most chemotherapies include a risk of deformities for the foetus. Oral contraception also has the advantage of letting the ovaries rest and thus protecting them, to a certain extent, against the harmful consequences of the chemotherapy. In rare cases, it may be proposed to sample and freeze an ovary fragment. However, this method is not always possible, as it requires a surgical intervention. Its effectiveness and innocuity in the long term are unknown, and it thus remains a field to be studied. The chances of recovering normal fertility depend on the patient’s age and on the type of chemotherapy used. The doctor who prescribes this chemotherapy should inform the patient about these issues, depending on the planned treatment.
In the long term, certain chemotherapies can favour the occurrence of cardiac illnesses or another cancer. This risk highlights the necessity of maintaining a healthy lifestyle and medical monitoring.