Types of Immunotherapy for Non-Hodgkin's Lymphoma

Immunotherapy is a treatment that uses your own immune system to fight cancer. It can boost your whole immune system, or it can make it easier for your immune cells to find and destroy cancer.

Since it works with your own immune system, immunotherapy sounds "natural." But some forms of it are quite high-tech, and some side effects can be serious or life-threatening.

After successful immunotherapy, your cancer's not as likely to return because your immune system has learned to recognize and target that type of tumor cell if they come back.

Monoclonal Antibodies

Normally, your immune system makes antibodies to help fight infection. The antibodies stick to proteins called antigens on the surfaces of cells. Different kinds of cells have different antigens. That's why your body can find things that can make you sick, like viruses and bacteria. Only one kind of antibody fits each antigen, like a key in a lock. The antibodies mark the "bad" cells so your immune system can go after and destroy them.

One type of immunotherapy works the same way, except it uses antibodies made in a lab, called monoclonal antibodies. They find and stick to specific antigens on the surface of cancer cells.

Obinutuzumab (Gazyva), ofatumumab (Arzerra), and rituximab (Rituxan) are some of the most common monoclonal antibodies. They target an antigen called CD20 that's found on a type of white blood cell called a B cell. They'll go after all B cells, not just the ones that have cancer. But your body will grow healthy new ones when you finish your treatment.

You usually get CD20 monoclonal antibodies through an IV (intravenous) line in your arm, what doctors call an infusion. This can take up to 6 hours, especially at first. How often you get an infusion depends on the type of cancer you have and how your body reacts to the medicine.

Rituximab also comes as a shot you get under your skin. It takes just a few minutes. The shot may work as well as an infusion for some types of non-Hodgkin's lymphoma.

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CD20 monoclonal antibodies rev up your immune system, so you might feel like you have the flu during or after the infusion. You're also more likely to get a serious infection later on.

If you've had hepatitis B, the drugs that target the CD20 antigen can make it act up again, so your doctor may check for signs of an old infection before your treatment.

Alemtuzumab (Campath) is an antibody that targets a different antigen called CD52. Doctors mainly use it to treat T-cell lymphoma.

You get alemtuzumab as infusion about three times a week for up to 3 months. It can cause fever, chills, nausea, and other symptoms, so your doctor may start with a low dose and work up.

Alemtuzumab can give you very low blood cell counts, and there's a greater chance you'll get a serious infection.

Immunomodulators

Your doctor might try a medication like thalidomide (Thalomid) or lenalidomide (Revlimid) when chemo hasn't worked or you're too sick to have it. These immunomodulators are pills you take every day.

They can cause painful side effects that might not go away after treatment. And they can cause severe birth defects, so you should never take them if you're pregnant or planning to have a baby.

CAR T-Cell Therapy

This is one of the newest types of immunotherapy. It uses some of your own white blood cells, called T cells, that help your body fight infections.

A special machine removes all the T cells from your blood. They're sent to a lab, where they're genetically changed just a bit to make them better at finding and killing cancer cells. The lab grows hundreds of millions more of these new cells (now called CAR T cells) to put back into your body with a process that’s like a blood transfusion. The hope is that they'll start attacking cancer cells right away.

The FDA has approved two CAR T-cell therapies for people with non-Hodgkin’s lymphoma. Axicabtagene ciloleucel (Yescarta) is for certain types of large B-cell lymphoma that haven't responded to or have come back after at least two other kinds of treatment. Tisagenlecleucel (Kymriah) is for relapsed/refractory diffuse large B-cell lymphoma (RR DLBCL), high-grade B-cell lymphoma, and DLBCL that started as follicular lymphoma.

CAR T can have severe side effects, so you can only get it in special cancer centers. It also costs more than almost any other medical treatment, and your insurance may not pay for it.

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

Sources

SOURCES:

American Cancer Society: "What Is Cancer Immunotherapy?" "Immunotherapy for Non-Hodgkin Lymphoma."

National Cancer Institute: "CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers."

Frontiers in Immunology: "Lymphoma Immunotherapy: Current Status."

Lymphoma Action: "Antibody therapy (including rituximab)."

Dana-Farber Cancer Institute Insight: "How is Immunotherapy Used to Treat Lymphoma?" "How Treatment Works for CAR T-Cell Therapy Patients."

Chemocare: "Rituxan," "Campath."

City of Hope: "FDA-approved CAR T Cell Therapy for Non-Hodgkin Lymphoma."

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