Immunotherapy for Hodgkin Lymphoma

Immunotherapy is the use of medicines to help your immune system better recognize and destroy cancer cells. It is used to treat some people with Hodgkin lymphoma.

Monoclonal antibodies

Antibodies are proteins made by your immune system to help fight infections. Man-made versions of these proteins are called monoclonal antibodies (mAbs). They can be designed to attack a specific target, such as a substance on the surface of lymphocytes. Lymphocytes are the cells in which Hodgkin lymphoma starts.

Brentuximab vedotin (Adcetris)

Brentuximab vedotin may be used to treat classic Hodgkin lymphoma (cHL).

Classic Hodgkin lymphoma (cHL) cells usually have the CD30 protein on their surface. Brentuximab vedotin is an anti-CD30 antibody attached to a chemo drug. The antibody acts like a homing device, 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.

How this drug is used for Hodgkin lymphoma

Brentuximab vedotin is infused into a vein (IV), usually every 2 or 3 weeks.

It can be used:

• As part of the first treatment in children 2 years of age or older with high-risk cHL, along with chemotherapy
• As part of the first treatment for adults with stage III or IV cHL, along with chemotherapy
• In adults with cHL that comes back after other treatments, including after a stem cell transplant, or in people who can't have a transplant for some reason. It can be given alone or along with chemo.
• After a stem cell transplant for adults at high risk of the lymphoma coming back after treatment. In this situation, it is usually given by itself for a year.

Side effects

Common side effects can include nerve damage (neuropathy), low blood cell counts, fatigue, fever, nausea and vomiting, infections, diarrhea, or constipation.

During IV infusions, serious side effects such as trouble breathing and low blood pressure can happen, but this is rare.

Rituximab (Rituxan)

Rituximab may be used to treat nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). This mAb attaches to a substance called CD20 on some types of lymphoma cells.

It's often given along with chemotherapy and/or radiation therapy.

How this drug is used for NLPHL Hodgkin lymphoma

Rituximab is given as an IV infusion in the doctor’s office or clinic.

When used by itself, it's usually given once a week for 4 weeks. It may then be repeated several months later. When given along with chemotherapy, it's most often given on the first day of each chemo cycle.

Side effects

Common side effects are usually mild but can include:

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

Rare but severe side effects: Rarely, more severe side effects happen during infusions, such as trouble breathing and low blood pressure. You will be given medicines before each treatment to help keep this from happening. If these symptoms do occur 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. This can lead to severe liver problems or even death, although this is rare. Your cancer care team will check your blood for signs of hepatitis before starting this drug.

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

Immune checkpoint inhibitors

An important part of your immune system is its ability to keep itself from attacking normal cells in your body. To do this, it uses “checkpoint” proteins. These proteins act like switches 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.

The immune checkpoint inhibitors used to treat Hodgkin lymphoma are:

• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)

These drugs target PD-1, a protein on certain immune system cells called T cells. PD-1 normally helps keep T cells from attacking other cells in your body. By blocking PD-1, these drugs boost the immune response against cancer cells. This can shrink some tumors or slow their growth.

These drugs are given as an intravenous (IV) infusion, typically every 2, 3, or 6 weeks.

Nivolumab may be used with chemotherapy as part of the first treatment for people with advanced Hodgkin lymphoma, stage III or IV.

Possible side effects

Side effects of these drugs can include:

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

Other, more serious side effects occur less often.

Infusion reactions: Some people have an infusion reaction while getting one of these drugs. This is like an allergic reaction. It can include fever, chills, flushing of the face, rash, itchy skin, dizziness, wheezing, and trouble breathing. Tell your cancer care team right away if you have any of these symptoms while getting one of these drugs.

Autoimmune reactions: These drugs essentially remove one of the safeguards on your body’s immune system. Sometimes, this causes the immune system to attack other parts of the body. This can lead to serious or even life-threatening problems in your lungs, intestines, liver, hormone-making glands, kidneys, or other organs.

If you notice any problems, tell your cancer care team right away. If serious side effects happen, your treatment may be stopped and you may get high doses of steroids to suppress your immune system.