Non-Hodgkin Lymphoma

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Treating Non-Hodgkin Lymphoma TOPICS

Immunotherapy for non-Hodgkin lymphoma

Immunotherapy is treatment that either boosts the patient’s own immune system or uses man-made versions of the normal parts of the immune system. These treatments may kill lymphoma cells or slow their growth.

Monoclonal antibodies

Antibodies are proteins made by the body’s immune system to help fight infections. Man-made versions, called monoclonal antibodies, can be designed to attack a specific target, such as a substance on the surface of lymphocytes (the cells in which lymphomas start).

Several monoclonal antibodies are now being used to treat lymphoma.

Rituximab (Rituxan®): This is an antibody that attaches to a substance called CD20 found on some types of lymphoma cells. This attachment seems to cause the lymphoma cell to die. The treatments are given as intravenous (IV) infusions in the doctor’s office or clinic.

When used by itself to treat lymphoma, it’s given weekly for 4 to 8 weeks. When combined with chemotherapy, it is most often given on the first day of each chemo cycle. For some lymphomas, it may be given after chemo as maintenance therapy. In that case it’s given weekly for 4 weeks in a row, every 6 months for up to 2 years.

Common side effects are usually mild but may include chills, fever, nausea, rashes, fatigue, and headaches. Rarely, more severe side effects occur during infusions, such as trouble breathing and low blood pressure. Even if these symptoms occur during the first rituximab infusion, it is very unusual for them to recur with later doses. This drug may also increase a person’s risk of certain infections for up to 6 months after the drug is stopped.

Rituximab can cause hepatitis B infections that were dormant (inactive) to become active again, sometimes leading to severe liver problems or even death. For that reason, your doctor may check your blood for signs of an old hepatitis infection before starting this drug.

Tositumomab (Bexxar®): This drugs is a monoclonal antibody aimed at CD20 (like rituximab) that has a radioactive molecule attached to it. The antibody brings radiation directly to the lymphoma cells. This drugs is given as an intravenous (IV) infusion. Side effects are similar to those seen with rituximab, although low blood cell counts are seen more often with these drugs.

This drug is not used as often as rituximab, in part because it is somewhat harder for doctors to give (because of the radiation dosing involved). Tositumomab cannot be used with chemotherapy because it also lower blood counts, which may raise the risk of infections, bleeding, or other problems. At this time this drug is most often used if chemotherapy and/or rituximab are no longer working.

Alemtuzumab (Campath®): This antibody is directed at the CD52 antigen. It is useful in some cases of chronic lymphocytic leukemia (CLL) and also some types of peripheral T-cell lymphomas. It is given by infusion into a vein (IV), usually 3 times a week for up to 12 weeks. The most common side effects are fever, chills, nausea, and rashes. It can also cause very low white blood cell counts, which increases the risk for serious infections. Antibiotic and antiviral medicines are given to help protect against them, but severe and even life-threatening infections can still occur.

Ofatumumab (Arzerra®): Ofatumumab is another antibody that targets the CD20 antigen. It is approved to treat chronic lymphocytic leukemia and is used mainly when other treatments such as chemotherapy, rituximab, and alemtuzumab are no longer working. It is being studied for use in treating other lymphomas. Side effects are similar to those that are seen with rituximab.

Brentuximab vedotin (Adcetris®): This drug is an anti-CD30 antibody attached to a chemotherapy drug. Some lymphoma cells have the CD30 molecule on their surface. The antibody acts like a homing signal, bringing the chemo drug to the lymphoma cells, where it enters the cells and causes them to die when they try to divide into new cells.

Brentuximab can be used to treat anaplastic large cell lymphoma (ALCL) that has come back after other treatments. It is given as an infusion into a vein (IV) every 3 weeks. Common side effects include nerve damage (neuropathy), low blood counts, fatigue, fever, nausea and vomiting, infections, diarrhea, and cough.

Interferon

Interferon is a hormone-like protein made by white blood cells to help the immune system fight infections. Some studies have suggested that giving man-made interferon can make some types of lymphomas shrink or stop growing.

Common side effects of this treatment include fatigue, fever, chills, headaches, muscle and joint aches, and mood changes. Because of these side effects, interferon is not used very often. It may be given to some patients in addition to chemotherapy.

Immunomodulating agents

These drugs are thought to work against certain cancers by affecting parts of a person’s immune system, although exactly how they work isn’t clear. They are sometimes used to help treat certain types of lymphoma, usually after other treatments have been tried.

Thalidomide (Thalomid®): The main use of this drug is to treat another cancer of the lymphocytes known as multiple myeloma, but it may also be used to treat some types of lymphoma.

Side effects of thalidomide include drowsiness, fatigue, severe constipation, low white blood cell counts (with an increased risk of infection), and neuropathy (painful nerve damage). The neuropathy can be severe, and may not go away after the drug is stopped. There is also an increased risk of serious blood clots (that start in the leg and can travel to the lungs). Because thalidomide causes severe birth defects if taken during pregnancy, this drug should not be used by women who are or may become pregnant.

Lenalidomide (Revlimid®): This is a newer drug that is similar to thalidomide. It may be used to treat some types of lymphoma.

The most common side effects of lenalidomide are low platelet counts (with an increased risk of bleeding) and low white blood cell counts (with an increased risk of infection). It can also cause painful nerve damage. The risk of blood clots isn’t as high as with thalidomide, but it is still increased. Like thalidomide, access to lenalidomide is tightly controlled out of concern about possible serious birth defects.

More information on immunotherapy can be found in our document Immunotherapy.


Last Medical Review: 03/27/2013
Last Revised: 07/30/2014