If Your Immunotherapy for NHL Stops Working

When immunotherapy works for non-Hodgkin's lymphoma (NHL), it keeps all signs of the cancer away or stops it from growing further. But this kind of treatment doesn't work for everyone, and it can stop working.

You may be able to tell because you have some of the same symptoms as when you were first diagnosed: fever, weakness, fatigue, weight loss, or swollen lymph nodes in your neck, armpits, or groin. Doctors can also tell that your NHL has come back or is getting worse from test results.

Even when immunotherapy doesn't work for your NHL, you probably still have choices about treatments to try next.

Why Immunotherapy Might Not Work

Your non-Hodgkin's lymphoma may have become a faster-growing type. Scientists aren't sure why, but the cancer cells can change on their own over time. A tumor biopsy can figure out if that has happened.

Sometimes immunotherapy works to control the cancer, but its side effects are severe and too hard to handle. So your doctor may decide to stop that type of treatment.

And sometimes immunotherapy doesn't work or stops working because your immune system doesn't respond the way it's supposed to:

  • Not enough T-cells in your immune system react to the immunotherapy drug.
  • Something stops the T-cells from working.
  • The cancer cells don't attract enough immune cells to attack it.
  • The cancer becomes resistant to that immunotherapy because genes within the cells have changed.

What's Next?

The treatments you could try, and which one you ultimately choose, will depend on several things, including:

  • Your overall health
  • Your age
  • Other treatments you've tried
  • Where the cancer is now
  • Side effects other treatments caused
  • The type of non-Hodgkin's lymphoma you have now, and if that's changed

Your doctor's recommendation may also take into account how long it's been since you were first diagnosed and how slowly or quickly your cancer is growing.

Sometimes doctors suggest treatments you've already had, either before or at the same time as your immunotherapy. You may undergo chemotherapy, radiation, or targeted therapy again.

Stem Cell Transplant

Stem cells, which can become immune cells and blood cells, grow in your bone marrow. Healthy ones from your own bone marrow or blood supply or those donated by someone else whose tissue is a good match for yours are put into your blood to replace the unhealthy ones.

Continued

Other Immunotherapies

Just because one type of immunotherapy doesn't work for your non-Hodgkin's lymphoma doesn't mean another won't, too.

CAR T-cell therapy is used when at least two kinds of treatment have failed. It's made from your own white blood cells, which are sent to a lab and altered to recognize and attack your specific lymphoma cells.

Clinical Trials

Research studies test new drugs and ways to treat diseases. You may be able to try a treatment that isn't otherwise available. It might work better than standard treatments or help other treatments work better.

What to Consider

Ask your doctor or care team why a certain treatment is a good idea now. It's also OK to get a second opinion to help you weigh the pros and cons of your options.

You could also talk with a social worker, counselor, or other people dealing with non-Hodgkin's lymphoma through a support group to get some perspective.

You should look into the cost of any additional treatment and how much your medical insurance, Medicare, or Medicaid will pay toward your bills. Your out-of-pocket costs may be lower now, or you may have paid the maximum for the year. Find out if the clinic or hospital where you would get treatment is in your insurance network.

Palliative Care

There is one more option. You don't have to continue treatment after immunotherapy doesn't work.

Palliative care can help you manage pain or other symptoms to help you live comfortably without trying to cure your cancer. You can choose hospice care -- either at home, in a hospice center, or in a hospital -- if it seems that recovering from your non-Hodgkin's lymphoma isn't possible.

Tell your doctor and health care team about your feelings and concerns. But only you can make this decision.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on May 30, 2018

Sources

SOURCES:

Cancer.Net: "Lymphoma - Non-Hodgkin: Treatment Options."

American Society of Hematology: "For Patients: Lymphoma," "For Patients: Clinical Trials."

Best Practice & Research Clinical Haematology: "Transformation of Follicular Lymphoma."

American Cancer Society: "Types of Non-Hodgkin Lymphoma," "Immunotherapy for Non-Hodgkin Lymphoma," "Coping with Cancer Recurrence."

American Society of Clinical Oncology: "Lymphoma – Non-Hodgkin: Treatment Options."

Frontiers in Oncology: "OX40 Agonists and Combination Immunotherapy: Putting the Pedal to the Metal."

Science: "Clonal Neoantigens Elicit T Cell Immunoreactivity and Sensitivity to Immune Checkpoint Blockade."

Cell: "Loss of IFN-y Pathway Genes in Tumor Cells as a Mechanism of Resistance to Anti-CTLA-4 Therapy."

Leukemia & Lymphoma Society: "Stem Cell Transplantation."

Singleterry, J. "The Costs of Cancer: Addressing Patient Costs," American Cancer Society Cancer Action Network, 2017.

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