Non-Hodgkin Lymphoma: Immunotherapy
What is immunotherapy?
Immunotherapy is a treatment that works with your immune system. It's also called
biological therapy. Your immune system helps fight infections by killing germs. In
the same way, it can also kill cancer cells.
Immunotherapy treatments can boost your natural immune system. Or they can be lab-made
versions of normal immune system proteins that kill or slow the growth of lymphoma
cells.
Types of immunotherapy used to treat non-Hodgkin lymphoma
The types used to treat non-Hodgkin lymphoma include:
Monoclonal antibody therapy
Monoclonal antibodies are lab-made versions of immune system proteins. Each type of
antibody attaches to a certain type of CD protein that is on the cancer cells. (CD
stands for cluster of differentiation.) This helps the immune system find and kill
the cancer cells. Because of this focused attack, there's less damage to healthy cells.
These medicines are most often given over several hours through an IV (intravenous
line). This means they're put right into the blood through a vein. 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 antibody attaches to a substance called CD20, which is found on B cells. It's
often given with chemotherapy. There are other medicines that also attach to CD20.
Other monoclonal antibodies attach to different proteins on lymphoma cells to destroy
them. Some of the proteins these medicines target include CD19, CD52, CD79b, and CD30.
Your lymphoma cells are tested to see which CD proteins are on them. This helps find
the monoclonal antibody treatment that's best for you.
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 is brentuximab vedotin. It
attaches the chemo to lymphoma cells with the CD30 protein.
Possible side effects
Side effects of these medicines are not the same as chemo side effects. They most
often happen during or right after the treatment.
Side effects depend on the type of monoclonal antibody medicine you get and may include:
Some people may have more severe reactions during treatment. This can lead to low
blood pressure and trouble breathing. The risk of this tends to be higher with the
first treatment. Because of this, medicines are often given before each treatment
to help reduce the risk of bad reactions.
Some of these medicines can increase your risk of infection in the months after treatment.
If you've had the hepatitis B virus in the past, the virus may flare up. A blood test
for hepatitis B will be done before you start this treatment.
Some monoclonal antibodies can 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 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 (called peripheral neuropathy).
Immunomodulating therapy
Immunomodulating medicines work with your immune system to help slow down the growth
of cancer cells. They may be used for some types of non-Hodgkin lymphoma if other
treatments are no longer working. Lenalidomide is an example of this kind of medicine.
It's taken every day as a pill.
Possible side effects
Side effects of these medicines can include:
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Low platelet counts, which raises your risk of bleeding
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Low white blood cell counts, which raises your risk of infection
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Nerve damage, which can cause pain in the hands or feet
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Blood clots
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Tiredness
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Constipation
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Birth defects if taken during pregnancy
Immune checkpoint inhibitors
The immune system uses certain proteins to know a cell is healthy and not attack it.
These proteins are called checkpoints. 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 an immune checkpoint inhibitor
that blocks the PD-1/PD-L1 checkpoint. It might be used to treat certain B-cell lymphomas
that start in the chest and don't respond to other treatments or come back after treatment.
It's given as an IV infusion.
Possible side effects
Because these medicines block checkpoints, the immune system can attack your healthy
cells as well as the cancer cells. This causes side effects such as:
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Skin problems, like rashes and itching
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Muscle and joint swelling and pain
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Diarrhea
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Low platelet counts, which increases the risk of bleeding
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Low white blood cell counts, which increases the risk of infection
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Low red blood cell counts, called anemia, which can cause fatigue, paleness, and shortness
of breath
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Lung inflammation, called pneumonitis (rare)
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Heart problems (rare)
CAR T-cell therapy
For this treatment, a certain type of white blood cells (WBCs), called T cells, are
removed from your blood. This is done during a process called apheresis. The rest
of your blood goes right back into your body. Only the T cells are removed.
The genes of the T cells are then changed in a lab. They're made to have receptors
called chimeric antigen receptors (CARs) on their surface. CARs make the T cells target
and kill your lymphoma cells. The CAR T cells are then grown and multiplied in a lab.
You're given chemotherapy, and then the CAR T cells are put back into your blood.
They stay in your body for many months and find and kill lymphoma cells. This helps
keep the lymphoma from coming back.
This might be an option if other lymphoma treatments aren't working. CAR T-cell treatment
takes many weeks. It's only done in treatment centers with special training for this
kind of cancer therapy.
Possible side effects
This treatment can cause things like:
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Nausea
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Headache
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Fever
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Tiredness
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Breathing problems
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Low blood pressure
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Infection
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Swelling
It can also cause very serious side effects, like heart problems, bleeding, or blood
clots. It may lead to nerve damage. This can cause seizures, confusion, twitching,
and hallucinations. Other organs that can be affected include the bone marrow, lungs,
liver, spleen, and kidneys.
Working with your healthcare provider
Talk with your healthcare providers about what you should expect immunotherapy to
be like and the side effects you should watch for. Be sure you know when to call them.
For instance, if your blood counts drop, it can make you more likely to get infections.
You may be told to check your temperature and stay away from people who are sick.
You may need to call if you have a fever or chills. Make sure you know what number
to call with problems or questions. Ask how to get help after hours and on weekends
and holidays.