Non-Hodgkin Lymphoma: Immunotherapy

What is immunotherapy?

Immunotherapy is a treatment that affects the immune system. It can boost your body's immune system. Or it uses synthetic versions of normal parts of the immune system to fight cancer. It’s also called biological therapy. The immune system fights infection by killing germs. And in the same way, it can also destroy cancer cells.

What types of immunotherapy are used to treat non-Hodgkin lymphoma?

The types used to treat non-Hodgkin lymphoma include:

  • Monoclonal antibody therapy

  • Interferon therapy

  • Immunomodulator therapy

Monoclonal antibody therapy

Monoclonal antibodies are synthetic versions of immune system proteins. These proteins can be designed to attach to substances on cancer cells. This can help the immune system attack the cancer. These medicines are given by an IV or intravenous line that is put in a vein. The treatment is often done at a doctor's office or treatment center.

The most common monoclonal antibody used to treat non-Hodgkin lymphoma is rituximab. This attaches to a substance found on B-cells. It is often given along with chemotherapy, also called chemo. Other medicines that work in a similar way include obinutuzumab and ofatumumab.

Some monoclonal antibodies are attached to small radioactive particles. The antibodies bring the radiation directly to the cancer cells to kill them. An example of this type of medicine is ibritumomab tiuxetan.

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

Interferon therapy

Interferons are proteins that your body makes in response to infections or cancer. Interferons made in a lab are used as cancer medicines for some types of non-Hodgkin lymphoma. They may attack cancer cells directly. And they may also boost your immune system.

A type of interferon called interferon-alpha may be used to treat the non-Hodgkin lymphoma called follicular lymphoma. It’s also being studied for other types of lymphoma. It’s most often given by injecting it under the skin. You may be taught to do this at home.

Immunomodulating therapy

Immunomodulating medicines can stimulate your immune system. And they can slow down the growth of cancer cells. They are sometimes used for certain types of non-Hodgkin lymphoma. They are usually used if other treatments are no longer working. Lenalidomide is an example of this kind of medicine for treating non-Hodgkin lymphoma. You may take this medicine as a daily pill for 3 weeks. This is then followed by a week off. This cycle is then repeated.

Possible side effects of monoclonal antibodies

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

  • Fatigue or feeling tired

  • Flu-like symptoms, such as fever, chills, and upset stomach or nausea

  • Headache

  • Rash or hives

  • Swelling in the throat or chest tightness

In rare cases, people may have more serious 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 the risk of infection in the months after treatment. If you have been infected with the hepatitis B virus in the past, the virus may become active again. Your doctor may test your blood for hepatitis B before you start this medicine.

Monoclonal antibodies that have radioactive molecules or chemo medicines attached to them are more likely to affect the bone marrow. This can lead to low counts of white blood cells. This can increase the risk of infection. It may also cause low levels of platelets. This can lead to bruising and bleeding. These medicines may have other side effects as well, such as an increased risk of nerve damage. 

Possible side effects of interferons

These medicines often cause serious flu-like symptoms, such as:

  • Fever

  • Chills

  • Headaches

  • Muscle and joint aches

  • Feeling weak or tired

  • Mood changes

These side effects often limit their use against lymphoma.

Possible side effects of immunomodulating medicines

Side effects of these medicines can include:

  • Low platelets, which increase the risk of bleeding

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

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

  • Blood clots

  • Drowsiness

  • Constipation

  • Birth defects if taken by pregnant women