Monoclonal antibodies for non-Hodgkin lymphoma in children

Antibodies are proteins normally 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 lymphoma cells.

Several monoclonal antibodies are now being used to treat lymphoma in adults. Some of these are now being studied for use in children as well.

Rituximab (Rituxan) is an antibody that attaches to a substance called CD20 that is found on the surface of some types of lymphoma cells. This attachment seems to cause the lymphoma cell to die. Rituximab is being studied for use along with chemotherapy. The treatments are given as intravenous (IV) infusions in the doctor’s office or clinic. Common side effects are usually mild but may include chills, fever, nausea, rashes, fatigue, and headaches during or after the infusion. Even if these symptoms occur with the first rituximab infusion, it is unusual for them to recur with later doses. Rituximab may also increase a person’s risk of infections.

Other monoclonal antibodies, such as ibritumomab (Zevalin) and tositumomab (Bexxar), are similar to rituximab but have radioactive molecules attached to them. The antibodies bring radiation directly to the lymphoma cells, which may help them work better. These drugs are somewhat harder for doctors to give because of the radiation dosing involved. They are sometimes used to treat adults with certain lymphomas, but their usefulness in children is just beginning to be studied.

Brentuximab vedotin (Adcetris) 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. So far it has been used mainly in adults, but it is now being studied in children as well. 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.