Is Fever a Common Side Effect of Lymphoma Treatment? How It’s Managed

Fever can happen during lymphoma treatment, and there are a few important reasons why. Most commonly, fever signals an infection during chemotherapy when white blood cells are low, which is treated as a medical emergency. ^[1] Fever may also be part of treatment side effects such as bone marrow suppression leading to febrile neutropenia (fever with low neutrophils) or, with some immunotherapies like CAR‑T, a reaction called cytokine release syndrome. ^[2] [PM20]

Why Fever Happens

• Infection during chemotherapy: Chemotherapy can lower white blood cell counts (neutropenia), making infections more likely; fever can be the only warning sign and needs urgent evaluation. ^[1] Because the immune system is suppressed, even minor infections can become serious quickly. ^[3]

• Bone marrow suppression: Many lymphoma regimens can suppress bone marrow, reducing blood cells and increasing infection risk, which can present with fever. ^[2] This effect raises the risk of febrile neutropenia, a well‑recognized complication in lymphoma care. ^[4]

• Febrile neutropenia (FN): FN means fever with low neutrophils; it’s considered serious and requires prompt antibiotics and risk assessment for outpatient vs inpatient care. [PM17] Validated tools (like the MASCC risk index) help identify who may be safely managed as an outpatient after initial assessment. ^[5]

• Immunotherapy reactions (CAR‑T and bispecifics): These therapies can cause cytokine release syndrome (CRS), often starting with fever and potentially progressing to low blood pressure or breathing problems. [PM20] CRS is managed with supportive care and, if severe, medications like tocilizumab and/or corticosteroids. [PM20]

When to Seek Immediate Care

• Call your oncology team right away or go to the emergency department if your temperature is 100.4°F (38°C) or higher during treatment. ^[3] Tell staff you are receiving chemotherapy; fever may indicate a life‑threatening infection and you should be seen quickly. ^[6]

• Seek urgent help for chills, shaking, sweats, shortness of breath, a fast heartbeat, feeling suddenly very unwell, or signs of infection like a new cough or burning with urination. ^[7] These can be red flags for bloodstream infection, severe FN, or CRS. ^[7] [PM20]

Immediate Steps You Can Take

• Check your temperature any time you feel warm, flushed, chilled, or unwell, and have a working thermometer at home. ^[1] Keep your doctor’s daytime and after‑hours contact numbers readily available. ^[3]

• If fever is present, do not delay contact your care team and be prepared to go for urgent evaluation within an hour for antibiotics if advised. [PM17] Early treatment dramatically lowers complication risks. ^[8]

How Clinicians Manage Fever in Lymphoma Treatment

Suspected Infection or Febrile Neutropenia

• Rapid triage and early antibiotics: Initial empirical antibacterial therapy is recommended within 1 hour of arrival (within 30 minutes if there are signs of severe illness). ^[8] Patients are monitored closely for at least several hours before considering outpatient management. [PM17]

• Risk assessment: Clinicians may use tools such as the MASCC risk index to decide outpatient vs inpatient care after the first dose and observation. ^[5] Low‑risk patients may continue oral antibiotics at home with close follow‑up, while higher‑risk patients are admitted for IV therapy. [PM17]

• Antibiotic choices: For appropriate low‑risk cases, an oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin if allergic) is commonly used unless prior fluoroquinolone prophylaxis was given. [PM17] Therapy is reassessed daily and adjusted based on cultures, clinical course, and local resistance patterns. ^[9]

• Growth factor support (G‑CSF): To prevent FN or maintain chemotherapy dose intensity, clinicians may use G‑CSF prophylaxis when FN risk is ≥20% or regimens are potentially curative. [PM16] Applying guideline‑based G‑CSF can reduce FN rates, especially in older adults receiving R‑CHOP. [PM15]

Cytokine Release Syndrome (CRS) from Immunotherapies

• Recognition: CRS often starts with fever and can progress to low blood pressure, low oxygen, and organ stress. [PM20] CRS can mimic infection initially, so teams evaluate for both and treat promptly. [PM21]

• Management: Supportive care (fluids, oxygen) and, for moderate to severe CRS, tocilizumab (IL‑6 receptor blocker) and sometimes corticosteroids are used. [PM20] Centers follow standardized grading and response algorithms to ensure safety while preserving anti‑cancer effect. [PM22]

Practical Prevention Tips at Home

• Hygiene: Wash hands often and encourage family and visitors to do the same to reduce infection risk. ^[10] Clean high‑touch surfaces and follow catheter or port care instructions carefully. ^[11]

• Monitor symptoms: Track temperature, cough, sore throat, urinary symptoms, and wound changes (redness, warmth, pus). ^[12] Report new or worsening symptoms promptly rather than waiting. ^[3]

• Know your plan: Keep an action plan from your team that lists where to go, whom to call after hours, and your recent treatment dates; bring your medication list to urgent visits. ^[3] Let emergency staff know you are on chemotherapy so they can fast‑track evaluation. ^[6]

Comparison: Infection‑Related Fever vs CRS‑Related Fever

Feature	Infection/FN Fever	CRS Fever
Typical timing	During nadir (low counts) days after chemo	Hours to days after immunotherapy infusion
Cause	Bacterial/viral/fungal infection with neutropenia	Immune activation and cytokine surge
Key risks	Sepsis, organ dysfunction	Hypotension, hypoxia, organ dysfunction
First‑line actions	Rapid triage; empirical antibiotics within 1 hour	Rapid triage; supportive care; consider tocilizumab if moderate/severe
Additional steps	Risk stratification (MASCC), cultures, possible admission	CRS grading; rule out infection; may add steroids if indicated

Both scenarios start with fever and require urgent evaluation; clinicians often treat for infection while assessing for CRS when relevant. [PM17] [PM20]

Bottom Line

• Fever during lymphoma treatment is not unusual, but it should be taken seriously because it may signal infection or treatment‑related reactions. ^[2] A temperature of 100.4°F (38°C) or higher during chemotherapy warrants immediate contact with your care team or emergency evaluation. ^[1]

• Early antibiotics for suspected febrile neutropenia and structured management for CRS have strong evidence and save lives. [PM17] [PM20] Preventive steps like hand hygiene and, when appropriate, G‑CSF can reduce the chance of dangerous fevers. ^[10] [PM16]