What are the potential side effects of NHL - Follicular treatments

Potential Side Effects of Follicular Lymphoma Treatments

Understanding what side effects might occur is important for preparing yourself and knowing what to discuss with your care team. Let me explain the common side effects associated with FL treatments.

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How to Think About Side Effects

According to the NCCN Guidelines for Patients: Follicular Lymphoma, side effects can vary depending on:

• Which treatment you receive (rituximab alone causes different effects than chemotherapy)
• Your individual health and age
• How your body responds to the specific drugs
• The dose and duration of treatment

Not everyone experiences all side effects, and some people have mild effects while others have more significant ones. Your care team will monitor you closely and help manage any side effects that occur.

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Common Side Effects by Treatment Type

Rituximab (CD20 Antibody) Side Effects

During or shortly after infusion:

• Fever and chills
• Headache
• Muscle aches
• Nausea
• Fatigue (tiredness)
• Low blood pressure
• Rash

Why this happens: Your immune system reacts to the drug being introduced. These reactions are often called "infusion reactions" and typically improve with subsequent doses.

Longer-term considerations:

• Increased infection risk (because the drug affects B cells, which help fight infection)
• Low blood cell counts

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Chemotherapy-Related Side Effects

When chemotherapy is combined with rituximab (like R-CHOP or bendamustine + rituximab), additional side effects may occur:

Blood-Related Effects

According to the NCCN Guidelines for Patients: Follicular Lymphoma, chemotherapy affects bone marrow (where blood cells are made):

• Low white blood cell count (neutropenia) — increases infection risk
• Low red blood cell count (anemia) — causes fatigue and shortness of breath
• Low platelet count (thrombocytopenia) — increases bleeding and bruising risk

Your care team will monitor your blood counts regularly with blood tests.

Hair Loss (Alopecia)

According to the NCCN Guidelines for Patients: Follicular Lymphoma:

• Some chemotherapy drugs are more likely than others to cause hair loss
• Hair loss typically occurs on the scalp but can affect hair all over your body
• Most hair loss from chemotherapy is temporary — hair often regrows 3 to 6 months after treatment ends
• Your hair may return with a different shade or texture

What helps: Talk to your care team about options like cooling caps or wigs.

Gastrointestinal (Digestive) Side Effects

Nausea and vomiting:

• Common during and after chemotherapy
• Usually manageable with anti-nausea medications

Diarrhea:

According to the NCCN Guidelines for Patients: Follicular Lymphoma, diarrhea is frequent and watery bowel movements that may occur. Your care team will tell you how to manage it. It is important to drink lots of fluids to prevent dehydration.

Fatigue

According to the NCCN Guidelines for Patients: Follicular Lymphoma:

Fatigue is a state of physical or mental tiredness that can be characterized by a lack of energy, motivation, or stamina. Fatigue may be caused by cancer or it may be a side effect of treatment.

What can help:

• Eating a balanced diet
• Exercise (as tolerated)
• Yoga
• Acupuncture
• Massage therapy
• You might be referred to a nutritionist or dietitian to help with fatigue

Hand-Foot Syndrome

According to the NCCN Guidelines for Patients: Follicular Lymphoma:

Hand-foot syndrome is a common side effect of certain chemotherapy drugs. Small amounts of chemotherapy leak out of very small blood vessels called capillaries in the palms of the hands and soles of the feet. It causes:

• Redness
• Swelling
• Pain
• Sometimes blisters

What helps: Protect your hands and feet by applying moisturizer or lotion regularly.

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Serious but Less Common Side Effects

Cytokine Release Syndrome (CRS)

According to the NCCN Guidelines for Patients: Follicular Lymphoma:

Cytokine release syndrome may occur after treatment with some types of immunotherapy, such as monoclonal antibodies and CAR T cells. It is caused by a large, rapid release of cytokines (immune signaling molecules) from immune cells affected by the immunotherapy.

Signs and symptoms include:

• Fever
• Muscle aches
• Nausea
• Headache
• Rash
• Fast heartbeat
• Low blood pressure
• Trouble breathing

Important: Report these symptoms immediately to your care team, as CRS requires prompt medical attention.

Blood Clots

According to the NCCN Guidelines for Patients: Follicular Lymphoma:

Cancer can cause blood clots to form. This can block blood flow and oxygen in the body. Blood clots can break loose and travel to other parts of the body causing breathing problems, stroke, or other problems.

Warning signs:

• Swelling in legs
• Chest pain
• Shortness of breath
• Seek immediate medical attention if you experience these

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Emotional and Mental Health Side Effects

According to the NCCN Guidelines for Patients: Follicular Lymphoma:

Depression, anxiety, and sleeping issues are common and are a normal part of cancer diagnosis.

What can help:

• Talk to your care team about how you're feeling
• Connect with those whom you feel most comfortable
• Support and counseling services are available
• There are medicines that can help

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Managing Side Effects: Questions to Ask Your Care Team

1. "Which side effects are most likely with my specific treatment plan?"

2. "What side effects should I report immediately versus manage at home?"

3. "What medications or strategies can help prevent or manage side effects?"

4. "When should I call you if I experience side effects, and what's the best time to reach you?"

5. "Are there support services (nutritionist, counselor, support groups) available to help me manage side effects?"

6. "How will my blood counts be monitored, and how often will I have blood tests?"

7. "What can I do to reduce my infection risk while my immune system is affected?"

8. "Are there clinical trials studying ways to reduce side effects from my treatment?"

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Important Reminders

• Side effects are individual — your experience may be different from others
• Most side effects are manageable — your care team has many strategies to help
• Report side effects early — don't wait; your team can often help prevent them from getting worse
• Your preferences matter — discuss your concerns about side effects with your oncologist, as this may influence treatment choices

Your oncologist will work with you to balance the benefits of treatment against potential side effects and will adjust your care plan as needed based on how you're tolerating treatment.

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.