At NYU Langone’s Perlmutter Cancer Center, doctors who specialize in lymphoma and other blood diseases—called hematologist–oncologists—recommend a variety of medications to people with primary central nervous system lymphoma. Your doctor may prescribe more than one therapy, depending on how aggressive the cancer is.
Treatment is tailored to each person’s needs. If a person has a weakened immune system—for instance, due to an organ transplant or because he or she has human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS)—he or she may experience more severe side effects from chemotherapy drugs.
Sometimes, doctors prescribe medications along with other treatments, such as radiation therapy.
Chemotherapy destroys cancer cells throughout the body. The blood–brain barrier, which protects the brain from infection and harmful substances, often prevents chemotherapy drugs from reaching tumors in the brain. As a result, your doctor may inject chemotherapy drugs directly into the cerebrospinal fluid, which protects the brain and spinal cord.
To determine which chemotherapy drugs to use—as well as the length and number of treatment cycles—our doctors consider a tumor’s genes, which are identified at the time of diagnosis. This is known as molecular, or genetic, testing.
Our oncologists usually administer treatments for several days once every two weeks. This treatment cycle may be repeated several times.
Chemotherapy for a person with central nervous system lymphoma is usually given through a vein with intravenous (IV) infusion. If lymphoma affects the eye, the doctor may inject the chemotherapy drug into the eye.
If you have AIDS, your doctor determines whether chemotherapy is right for you. AIDS weakens the immune system, so some people with the condition cannot tolerate chemotherapy or its side effects, which may include appetite changes, nausea and vomiting, diarrhea, extreme fatigue, anemia, and susceptibility to life-threatening infection. In addition, some AIDS medications can interact adversely with chemotherapy drugs.
If lymphoma returns after your first round of chemotherapy treatment, a doctor typically prescribes high-dose chemotherapy with an autologous stem cell transplant. During this procedure, cancerous immature bone marrow cells, called stem cells, are replaced with healthy stem cells from your own body.
For people who don’t have AIDS, doctors may prescribe an immunosuppressant medication called methotrexate, which is similar to the vitamin folic acid. It prevents cancer cells from using the nutrient folate to make genetic material, which stops their growth.
Methotrexate may be given alone or in combination with chemotherapy drugs, radiation therapy, or both. This medication is sometimes given during a clinical trial—which is when researchers test promising new cancer treatments—in combination with a stem cell transplant. Your doctor can help to determine if a clinical trial is right for you.
Although this drug destroys cancer cells, it also suppresses the immune system, increasing the risk of infection and blood clots. Given by mouth or injection, methotrexate can cause nausea, vomiting, mouth sores, diarrhea, or skin changes, such as increased sensitivity to the sun. These side effects are usually temporary and improve after treatment is completed.
Managing Side Effects
Side effects of chemotherapy may include hair loss, mouth sores, nausea, vomiting, and diarrhea. Hematologist–oncologists, nurses, and pain management specialists at NYU Langone’s Perlmutter Cancer Center are available seven days a week to help manage any side effects. They can also refer you to support services that can help you address any long-term issues after treatment is finished.
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