Immunotherapy for Acute Lymphocytic Leukemia (ALL)

Rituximab is a monoclonal antibody that attaches to a protein called CD20 on B lymphocytes (B cells). It can be used along with chemotherapy to treat some people with B-cell ALL whose leukemia cells have the CD20 antigen.

How this drug is given

Rituximab is given as an infusion into a vein (IV) or as an injection under the skin (subcutaneously). When it's given along with chemotherapy, this is most often done on the first day of each chemo cycle.

Side effects

Common side effects of rituximab are usually mild but can include:

• Chills
• Fever
• Nausea
• Rashes
• Fatigue
• Headaches

More severe side effects: Rarely, more severe side effects happen while getting rituximab, such as trouble breathing and low blood pressure. You’ll get medicines before each treatment to help prevent this. Even if these symptoms do happen during the first infusion, it's unusual for them to happen again with later doses.

Hepatitis B reactivation: Rituximab can cause prior hepatitis B infections to become active again, sometimes leading to severe liver problems or even death. Your cancer care team will probably check your blood for signs of hepatitis before starting this drug.

Increased risk of infections: Rituximab can also increase your risk of infection during treatment and for several months after the drug is stopped.

Blinatumomab is a special kind of monoclonal antibody known as a T-cell engager (TCE). It attaches to 2 different proteins at the same time.

One part of blinatumomab attaches to the CD19 protein. This protein is found on B cells, including some leukemia and lymphoma cells. Another part attaches to CD3, a protein on immune cells called T cells.

By binding to both proteins, this drug brings the leukemia cells and immune cells together, helping your immune system attack the leukemia cells.

This drug is used to treat some types of B-cell ALL. For example, it might be used:

• As part of the second (consolidation) phase of treatment in some people.
• To treat ALL that comes back or is no longer responding to other treatments.
• As part of the first (induction) phase of treatment for some people with Philadelphia chromosome-positive (Ph+) ALL.

How this drug is given

Blinatumomab is given into a vein (IV) as a continuous infusion over 28 days. It may be repeated again for more cycles with 2 weeks off in between.

Because of certain serious side effects that happen more often during the first few times it’s given, most people are treated in a hospital or clinic for the beginning of at least the first 2 cycles.

Side effects

The most common side effects of blinatumomab include:

• Fever
• Headache
• Swelling of feet and hands
• Nausea
• Tremor
• Rash
• Constipation
• Low blood potassium levels
• Low white blood cell counts, increasing the risk of serious infection

Nervous system problems: This drug can also cause nervous system problems, such as seizures, trouble speaking or slurred speech, passing out, confusion, and loss of balance.

Infusion reactions: Some people have serious infusion reactions while getting this drug. Symptoms include feeling lightheaded or dizzy (due to low blood pressure), headache, nausea, fever or chills, shortness of breath, and/or wheezing.

This reaction can be life-threatening. Let your cancer care team know if you develop any of these symptoms. If you do have a reaction, the drug will be stopped while the reaction is treated.

This is an antibody-drug conjugate (ADC), made up of an anti-CD22 antibody linked to a chemotherapy drug. It is used to treat some types of B-cell ALL.

B cells (including some leukemia cells) usually have the CD22 protein on their surface. The antibody acts like a homing device, bringing the chemo drug to the leukemia cells, where it enters the cells and kills them when they try to divide into new cells.

For some types of B-cell ALL, this drug might be an option as part of the initial (induction) or the second (consolidation) phase of treatment. Or, it might be used after chemotherapy has been tried.

How this drug is given

It is given as an infusion into a vein (IV), once a week for 3 or 4 weeks in a row. This may be repeated for more cycles.

Side effects

The most common side effects include:

• Low levels of blood cells (with increased risks of infection, bleeding, and fatigue)
• Fever
• Nausea
• Headache
• Abdominal (belly) pain
• High blood levels of bilirubin (a substance in bile)

Less common but more serious side effects include:

• Severe liver damage, including veno-occlusive disease (blockage of veins in the liver)
• Reactions during the infusion (similar to an allergic reaction). You will likely be given medicines before each infusion to help prevent this.
• Serious or life-threatening infections, especially in people who’ve already had a stem cell transplant
• Heart rhythm changes

This is approved to treat adults with B-cell ALL that has come back or is no longer responding to other treatments.

This is approved for use in children and young adults up to age 25 to treat B-cell ALL that has come back or is no longer responding to treatment.

This is approved to treat adults with B-cell ALL that has come back or is no longer responding to other treatments.