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Non-Hodgkin lymphoma

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Biological therapy for non-Hodgkin lymphoma

Biological therapy may be used to treat certain types of non-Hodgkin lymphoma (NHL). It is also called biotherapy or biological response modifiers (BRMs).

Biological therapy uses natural or manufactured substances to kill, control or change the behaviour of cancer cells. Different types of biological therapies work in different ways.

Biological therapy may be used:

  • to treat advanced indolent NHL or aggressive NHL
  • to treat recurrent or relapsed NHL
  • in certain cases when chemotherapy no longer seems to be working

Drugs, doses and schedules vary from person to person. They are also based on other factors, such as the type and grade of NHL being treated and the reason the drug is being given.

Types of biological therapy

The most common biological therapy drugs used to treat non-Hodgkin lymphoma are:

  • rituximab (Rituxan)
  • ibritumomab (Zevalin)
  • alemtuzumab (Campath)
  • interferon alfa (Intron A, Wellferon)

Rituximab, ibritumomab, and alemtuzumab are also considered targeted therapies. These drugs target specific substances or proteins involved in lymphoma cell growth and are designed to attach to and destroy NHL cells. These drugs are monoclonal antibodies, which have been designed in the laboratory to recognize and lock onto particular protein markers on the surface of some cancer cells. One of the most common of these markers on NHL cells is CD20. CD20 is found on normal and abnormal B cells (B lymphocytes). Abnormal B lymphocytes are associated with the most common types of NHL.


The most common biological therapy drug used for NHL is rituximab (Rituxan). Rituximab is a monoclonal antibody designed to attach to CD20. It works by stimulating the body's immune system to attack and destroy the lymphocytes it attaches to. Rituximab is used to treat certain types of B-cell NHL that are considered to be CD20 positive (CD20+). CD20 is found on over 90% of B-cell NHLs.

Rituximab is given into a vein (intravenously). It can be used in different ways, either on its own or in combination with chemotherapy.

  • When rituximab is used by itself, it is often given once a week for 4 weeks.
  • When rituximab is used with chemotherapy, it is often given at the beginning of each cycle of chemotherapy. Adding rituximab to chemotherapy improves the results.

Sometimes rituximab is used on its own as maintenance therapy for some indolent lymphomas that have responded to initial chemotherapy or treatment with rituximab. It may be continued for up to 2 years, unless the lymphoma relapses. In this situation, it is given much less frequently than once a week, such as every 3 months. The schedule for giving maintenance rituximab varies and it is not clear which schedules, dosing, length of treatment or other combinations are the most effective. Studies are looking at the potential role of rituximab as maintenance therapy to improve the outcome in lymphoma.

Radioimmunoconjugate drugs

Ibritumomab (Zevalin) is a newer form of biological therapy that may be used to treat some types of B-cell NHL. This drug is a monoclonal antibody that also targets CD20, but has a radioactive substance (radioisotope) attached to it. The antibody portion finds the B lymphocytes and attaches to their surface, which allows the radioactive substance to destroy the cancer cells. This type of treatment is also called radioimmunotherapy (RIT).

  • ibritumomab – The radioactive substance attached is yttrium-90 (Y-90).

Ibritumomab is given into a vein (intravenously). Generally, this drug is not used with chemotherapy because it also lowers blood cell counts.

Ibritumomab is usually only given to people with:

  • recurrent (relapsed) indolent lymphoma like follicular lymphoma, if chemotherapy and rituximab no longer seem to be working (are refractory to treatment)
  • transformed NHL


Because ibritumomab contains a radioactive substance, the person receiving it may need to take special precautions for about 1–2 weeks after treatment to protect others from being exposed to radiation. The healthcare team will provide instructions on any special precautions that need to be taken, such as:

  • Wash hands with soap and water often, especially after handling body fluids and urinating or having a bowel movement.
  • Men should sit on the toilet to urinate to prevent splashing of urine.
  • Flush the toilet 2–3 times with the lid down after urinating or having a bowel movement.


Alemtuzumab (Campath) is an antibody that finds the CD52 antigenantigenA foreign substance that stimulates the immune system to produce antibodies against it. on the surface of B cells and T cells.

Alemtuzumab is usually given into a vein (intravenously). It may also be given as an injection into tissue just under the skin (subcutaneously).

Alemtuzumab is used to treat some chronic lymphocytic leukemias and small lymphocytic lymphomas. It may also be used to treat some types of peripheral T-cell lymphomas. This drug may be offered to some people with these types of lymphoma if other treatments, like chemotherapy, no longer seem to be working.


Another type of biological therapy that may be used to treat NHL is interferon therapy. Interferons are proteins that the body produces to help fight infection or cancer. The type of interferon used to treat NHL is called interferon alfa (Intron A, Wellferon). It is used to treat a few types of NHL, such as cutaneous T-cell lymphoma (CTCL) and adult T-cell leukemia/lymphoma (ATL/L).

Interferon is usually given as an injection into tissue just under the skin (subcutaneously).

For more detailed information on specific drugs, go to sources of drug information.

See a list of questions to ask your doctor about biological therapy.


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