Immunotherapy for Hodgkin Lymphoma

Immunotherapy is the use of medicines to help someone’s immune system better recognize and destroy cancer cells. Immunotherapy can be used to treat some people with Hodgkin lymphoma (HL).

Monoclonal antibodies

Antibodies are proteins made by your immune system to help fight infections. Man-made versions, called monoclonal antibodies (mAbs), can be designed to attack a specific target, such as a substance on the surface of lymphocytes (the cells in which HL starts). This means these treatments attack cancers cells, but ignore normal cells that don't have the target substance. This reduces damage to normal, healthy cells. Some mAbs are now being used to treat HL.

Brentuximab vedotin (Adcetris®)

Classic Hodgkin lymphoma (cHL) cells usually have the CD30 molecule on their surface. Brentuximab vedotin is an anti-CD30 antibody attached to a chemo drug. The antibody part of brentuximab acts like a homing signal, bringing the chemo drug to the lymphoma cells with CD30 on them. The drug enters the cells and kills them when they try to divide into new cells.

Brentuximab may be used along with chemo as the first treatment for stage III or IV. It has also been shown to help many people with cHL that has come back after other treatments, including a stem cell transplant. It's helped people are not well enough to have a transplant, as well as those with cHL that's not responding to other treatments. (This is called refractory disease.) It can be given alone or along with chemotherapy.

Brentuximab may also be used alone for 1 year after transplant for people at high-risk of recurrence (cancer coming back after treatment).

Brentuximab is infused into a vein (IV), usually every 3 weeks. Common side effects include:

  • Nerve damage (neuropathy)
  • Low blood cell counts
  • Fatigue
  • Fever
  • Nausea and vomiting
  • Infections
  • Diarrhea

Rarely, serious side effects occur during IV infusions, such as trouble breathing and low blood pressure

Rituximab (Rituxan®)

Rituximab may be used to treat nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). This mAb attaches to a substance called CD20 found on some types of lymphoma cells and kills the lymphoma cell. It's often given along with chemotherapy and/or radiation therapy.

Rituximab is given as an IV infusion in the doctor’s office or clinic. When it's used by itself, it's usually given once a week for 4 weeks, which may then be repeated several months later. When it's given along with chemotherapy, it's most often given on the first day of each chemo cycle.

Common side effects are usually mild but can include:

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

Rarely, more severe side effects occur during infusions, such as trouble breathing and low blood pressure. You will be given medicines before each treatment to help keep this from happening. But even if these symptoms do occur during the first infusion, it's unusual for them to happen again with later doses.

Rituximab can cause prior hepatitis B infections to become active again, which sometimes leads to severe liver problems or even death. Your doctor will probably check your blood for signs of hepatitis before starting this drug.

Rituximab can also increase your risk of infection for several months after the drug is stopped.

Immune checkpoint inhibitors

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints” – molecules on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Drugs that target these checkpoints hold a lot of promise as cancer treatments.

Nivolumab (Opdivo®) and pembrolizumab (Keytruda®) are checkpoint inhibitors that can be used in people with classic Hodgkin lymphoma whose cancer has grown during treatment (called refractory cancer) or returned after other treatments have been tried (called recurrent cancer).

These drugs target PD-1, a protein found on immune system cells called T cells. PDL-1 is a protein found on healthy cells. When PD-1 "sees" PDL-1 it's like an "off switch" that keeps the T cells from attacking healthy cells in the body. Lymphoma cells also can have a lot of PDL-1 protein on them. This helps them "turn off" the immune system. By blocking this PD-1 and PDL-1 pathway, these drugs allow the immune system to find and kill the lymphoma cells. This can shrink some tumors or slow their growth.

These drugs are given as an intravenous (IV) infusion, typically every 2 or 3 weeks.

Possible side effects

Side effects of these drugs can include:

  • Fatigue
  • Fever
  • Cough
  • Nausea
  • Itching
  • Skin rash
  • Loss of appetite
  • Joint pain
  • Constipation
  • Diarrhea

Other, more serious side effects occur less often. These drugs work by basically removing the brakes on the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.

If you notice any problems, you should tell your health care team about it right away. If serious side effects do occur, treatment may need to be stopped and you may get high doses of steroids to suppress your immune system.

More information about immunotherapy

To learn more about how drugs that work on the immune system are used to treat cancer, see Cancer Immunotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: May 1, 2018 Last Revised: May 1, 2018

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