The Second Round of Chemotherapy
- Chemotherapy is part of the first treatment for non-Hodgkin lymphoma, as well as when the cancer returns
- A few different chemotherapy combinations treat relapsed lymphoma
- The goal is to put you into remission so that you can have a stem cell transplant
“When patients have relapsed after their R-CHOP therapy, there are some standard options,” Dr. Michael Jain, medical oncologist at Moffitt Cancer Center, tells SurvivorNet. “The chemotherapies that work typically include a platinum-based drug.”
Read MoreTypes of Salvage Chemotherapy
One of the chemotherapy regimens doctors use to treat relapsed large B-cell lymphoma is called RICE for short. It includes the monoclonal antibody drug rituximab (Rituxan), plus the chemotherapy drugs ifosfamide, carboplatin, and etoposide. Rituxan binds to a protein on the surface of the cancer cells, while the three chemotherapy drugs alter the cancer cells’ DNA. Another common combination is Rituxan plus gemcitabine and oxaliplatin, or gemcitabine plus dexamethasone (a steroid drug) and cisplatin, Dr. Jain says. Giving you different chemotherapy drugs than the ones you had the first time around attacks your cancer in new ways. “We think that these different chemotherapies may be able to work on patients who have had responses to chemotherapy before, or in patients who have failed other types of chemotherapy,” Dr. Jain says.As you probably already know if you’ve been through chemo before, these drugs are very strong. There’s a good possibility that you’ll have at least some side effects from them. The side effects of the new drug regimen should be pretty similar to what you experienced with the first round of treatment, including:
- An increased risk of infection
- Bruising and bleeding
- Hair loss
- Diarrhea or constipation
- Nausea
- Mouth sores
- Changes in taste
- Rash or other skin changes
- Tiredness
- Appetite loss
There may be a few subtle differences from R-CHOP in terms of side effects. Ask your oncologist about the possible side effects and how you can manage them before you start treatment, so you’ll know what to expect and you’ll be ready for them.
It will probably take a couple of months on chemotherapy treatment to get you into remission. Studies have shown that all three of these chemotherapy regimens are similarly effective at putting patients into remission, which is the ultimate goal, Dr. Jain adds.
Next Step: Stem Cell Transplant
Once you’re in remission, you’ll be healthy enough to undergo an autologous stem cell transplant. About half of people who have platinum-based salvage chemotherapy will get enough of a remission to qualify for this treatment, Dr. Jain tells SurvivorNet.
An autologous stem cell transplant involves first getting very high doses of chemotherapy to wipe out as many of your cancer cells as possible. But before you get the chemo, your medical team will remove some of your own stem cells — the young cells that eventually grow into new blood cells — and freeze them. Chemotherapy damages the stem cells in your bone marrow and blood. After you’ve undergone treatment, you’ll get an infusion of your own preserved stem cells to help you regrow healthy new blood cells.
Making it through salvage chemotherapy and a stem cell transplant is the first step toward a positive outcome. Patients who achieve a remission from platinum-based chemotherapy and then go on to have an autologous stem cell transplant may achieve a long-term remission or even be cured, Dr. Jain says.
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