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Non-Hodgkin Lymphoma: Immunotherapy

What is immunotherapy?

Immunotherapy is a treatment that works with your immune system. It is also called biological therapy. Your immune system helps fight infections by killing germs. In the same way, it can also kill cancer cells. This treatment can boost your immune system. Or it can use lab-made versions of normal immune system proteins to fight cancer.

Types of immunotherapy used to treat non-Hodgkin lymphoma

The types used to treat non-Hodgkin lymphoma include:

  • Monoclonal antibody therapy

  • Immunomodulator therapy

  • Immune checkpoint inhibitors

  • CAR T-cell therapy

Monoclonal antibody therapy

Monoclonal antibodies are lab-made versions of immune system proteins. These proteins can attach to some substances on cancer cells. This can help the immune system attack the cancer. These medicines are most often given by an IV (intravenous line) right into the blood. But some can also be given as a shot under the skin. Treatment is often done at a healthcare provider's office. Or it may be done at a treatment center.

The most common monoclonal antibody used to treat non-Hodgkin lymphoma is rituximab. This medicine attaches to a substance found on B-cells. It's often given with chemotherapy. Other medicines that work in the same way include obinutuzumab and ofatumumab.

Alemtuzumab is another monoclonal antibody. Brentuximab vedotin and polatuzumab vedotin-piiq are monoclonal antibodies joined with chemotherapy. These all attach to different proteins on lymphoma cells to destroy them.

Some monoclonal antibodies are attached to small radioactive particles. The antibodies then attach the radiation to the cancer cells. This kills the cancer cells. An example of this type of medicine is ibritumomab tiuxetan.

Other types of antibodies are attached to chemo medicines. The antibodies then attach the chemo right to the cancer cells. An example of this type of medicine is brentuximab vedotin. 

Possible side effects

Side effects of these medicines are often mild. They most often occur during or right after the treatment. They may include:

  • Feeling tired

  • Fever

  • Chills

  • Upset stomach (nausea)

  • Headache

  • Rash or hives

  • Swelling in the throat

  • Chest tightness

In rare cases, people may have more severe reactions during the treatment. This is a higher risk during the first treatment. This can lead to low blood pressure and trouble breathing.

Some of these medicines can increase your risk of infection in the months after treatment. If you have had the hepatitis B virus in the past, the virus may flare up. You will have a blood test for hepatitis B before you start this medicine.

Monoclonal antibodies may affect the bone marrow. This is more likely if they have radioactive molecules or chemo medicines attached to them. This can lead to low red and white blood cell counts. And it can lead to low platelet counts. Low red blood cell counts (anemia) can cause fatigue. Low white blood cell counts can raise your risk of infection. Low platelet counts can raise your risk of bleeding and bruising. Some monoclonal antibodies attached to chemotherapy can also affect nerve endings. This can cause tingling, numbness, or pain in the hands and feet.

Immunomodulating therapy

Immunomodulating medicines can stimulate your immune system. They can help slow down the growth of cancer cells. They may be used for some types of non-Hodgkin lymphoma. They're most often used if other treatments are no longer working. Lenalidomide is an example of this kind of medicine. It's taken as a pill.

Possible side effects

Side effects of these medicines can include:

  • Low platelet counts, which raises your risk of bleeding

  • Low white blood cell counts, which raises your risk of infection

  • Nerve damage, which can cause pain in the hands or feet

  • Blood clots

  • Tiredness

  • Constipation

  • Birth defects if taken during pregnancy

Immune checkpoint inhibitors

The immune system uses certain proteins to see healthy cells and not attack them. Cancer cells sometimes use these checkpoints to keep the immune system from attacking them.

Medicines called immune checkpoint inhibitors block these checkpoints. Then the immune system can kill the cancer cells. Pembrolizumab is 1 of these medicines. It might be used to treat certain B-cell lymphomas that start in the chest and don't respond to other treatments.

Possible side effects

Side effects of these medicines can include:

  • Tiredness

  • Rash and itching

  • Muscle aches

  • Constipation

  • Diarrhea

  • Nausea and vomiting

  • Decreased appetite

  • Low platelet counts, which increases the risk of bleeding

  • Low white blood cell counts, which increases the risk of infection

  • Low red blood cell counts, called anemia, which can cause fatigue, paleness, and shortness of breath

  • Pneumonia (rare)

  • Heart problems (rare)

Your blood counts will be tested regularly to watch for changes.

CAR T-cell therapy

For this type of treatment, a type of your white blood cells (WBCs) called T-cells, are removed from the blood. This is done with a process called apheresis. The rest of the blood goes right back into you. Only the WBCs are removed. The genes of the WBCs called T-cells are then changed in a lab. They are made to have receptors called chimeric antigen receptors (CARs) on their surface. This causes the T cells to target and kill cancer cells. The CAR T-cells are grown in a lab. They are then put back in your blood after chemotherapy. They stay in the body for many months. This is done to help keep the cancer cells from coming back.

This is still a new treatment. It's mostly available in clinical trials. It might be an option if other lymphoma treatments stop working.

Possible side effects

This treatment can cause things like

  • Nausea

  • Headache

  • Fever

  • Tiredness

  • Breathing problems

  • Infection

  • Swelling

It can also cause serious side effects like heart problems. It may lead to nerve damage. This can cause seizures, confusion, twitching, and hallucinations. Other organs that can be affected include the lungs, liver, and kidneys.

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Lu Cunningham RN BSN
Online Medical Reviewer: Richard LoCicero MD
Date Last Reviewed: 3/1/2020
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