Non-Hodgkin’s Lymphoma: Long-Term and Late Side Effects of Treatment

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Like any cancer, non-Hodgkin’s lymphoma (NHL) can result in physical and emotional challenges during treatment, particularly if chemotherapy and radiation—the treatments used most often—have immediate side effects. But even after your treatment is concluded, you may have other health problems related to your NHL.

“This type of lymphoma is exemplified by 30 different types of conditions,” says Jack Jacoub, M.D., medical oncologist and medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, California. He told HealthCentral by phone that each type can be unique in terms of how it’s managed, which means that long-term effects might differ, depending on the treatment you’ve had.

In general, though, there are some long-term effects that are most common across a range of NHL types:

Increased risk of developing other conditions

Chemotherapy and radiation may cause damage to healthy areas of the body, says Dr. Jacoub, and sometimes these effects aren’t seen for years. For example, he notes that for those with NHL, there’s a potential impact on bone marrow and stem cells, which can affect your immune response. That could make you more prone to infections after treatment.

If you’ve had radiation to the chest or neck, you may develop thyroid issues that require long-term medication, he adds. Similarly, if radiation has been used on the chest area, or you’ve had a certain chemo drug that affects the chest, you may experience respiratory problems like shortness of breath. Smoking can exacerbate the problem, and increase the likelihood that you’ll have negative effects.

Potentially higher risk of a secondary cancer

Those who’ve had NHL have a higher risk of developing a different type of cancer. Most common are cancers of the brain, lung, kidney, and bladder, as well as melanoma, sarcomas, leukemia, and Hodgkin’s lymphoma, according to Sean Fischer, M.D., medical oncologist and hematologist at Providence Saint John’s Health Center in Santa Monica, California.

He told HealthCentral by phone that this is not as much of a concern as it once was, since NHL treatment has improved over the past decade, with newer techniques that reduce the risk of secondary cancers. However, they’re still enough of a concern that those who’ve had NHL should be aware that it’s a possibility.

Persistent neuropathy in arms and legs

Several chemotherapy drugs can cause a condition called peripheral neuropathy, which begins as a tingling in the fingers and toes and then may extend to the arms and legs, says Dr. Fischer.

These sensations aren’t just annoying, they can feel debilitating. “This is not a trivial side effect,” he says. “For many people, it negatively impacts quality of life, including their mobility.”

In most cases, neuropathy regresses over time, he adds, but some might experience “flare-ups” of the condition where it seems to come and go, even years after chemo. He adds that neuropathy is more likely to persist if you have a secondary condition such as alcoholism or diabetes.

Increased risk of congestive heart failure

Use of radiation, especially to the chest area, could potentially weaken the heart muscle, says Dr. Jacoub, and that may happen with some chemo drugs as well. Sometimes, the damage isn’t seen for years, or even more than a decade, after your NHL treatment. That’s why it’s important for your physician to check heart function and blood pressure regularly, to catch any problems early.

Also crucial is avoiding habits that might further weaken the heart, Dr. Jacoub adds. That includes smoking, sedentary behavior, carrying excess weight, and poor diet choices.

“The best strategy is to talk with your doctor about all potential long-term effects based on the specific treatment you’ve had for your NHL,” he says. “Then, you can be better prepared to spot any early symptoms of problems like these, and make a plan for regular checkups.”