- How is non-Hodgkin lymphoma treated?
- Chemotherapy for non-Hodgkin lymphoma
- Radiation therapy for non-Hodgkin lymphoma
- Immunotherapy for non-Hodgkin lymphoma
- High-dose chemotherapy and stem cell transplant for non-Hodgkin lymphoma
- Surgery for non-Hodgkin lymphoma
- Clinical trials for non-Hodgkin lymphoma
- Complementary and alternative therapies for non-Hodgkin lymphoma
- Treating specific types of non-Hodgkin lymphoma
- Palliative care for non-Hodgkin lymphoma
- More treatment information for non-Hodgkin lymphoma
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.
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.
Ibritumomab (Zevalin®) and tositumomab (Bexxar®): These drugs are monoclonal antibodies aimed at CD20 (like rituximab) that have radioactive molecules attached to them. The antibodies bring radiation directly to the lymphoma cells, which may help them work better. These drugs are given as intravenous (IV) infusions. Side effects are similar to those seen with rituximab, although low blood cell counts are seen more often with these drugs.
These drugs are not used as often as rituximab, in part because they are somewhat harder for doctors to give (because of the radiation dosing involved). They cannot be used with chemotherapy because they also lower blood counts, which may raise the risk of infections, bleeding, or other problems. At this time these drugs are 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 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.
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.
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: 11/14/2013