Diffuse large B-cell lymphoma (DLBCL) treatment and side effects

If you have lymphoma in parts of the body outside the lymphatic system – for example, in a breast, testicle, kidney or adrenal gland – you are more likely to develop lymphoma in your central nervous system. Extra treatment may be directed at the central nervous system to reduce the risk of the lymphoma appearing there.

Doctors use two different terms to refer to high-grade NHL in your central nervous system:

• primary CNS lymphoma – the lymphoma is only in your central nervous system
• lymphoma with CNS involvement – the lymphoma is in your central nervous system as well as other parts of your body

Your brain has a natural protection to stop harmful chemicals (toxins) such as chemotherapy drugs from entering your central nervous system. This is called the blood-brain barrier. But if you have a high risk of the lymphoma affecting your central nervous system, or you already have lymphoma cells in your central nervous system, the chemotherapy drugs need to break through this barrier.

Certain drugs, like cytarabine or methotrexate, are able to do this. These can be given into a vein (intravenously) or directly into the spinal fluid (intrathecally). You’ll usually take these drugs in high doses and will need to stay in hospital while you have your treatment.

During intrathecal therapy, you’ll have a lumbar puncture to inject a small amount of the chemotherapy drugs into your spinal cord. You may be advised to lie down for an hour or so after the treatment to try to reduce the chance of developing a headache.

Find out more about lumbar punctures.