Immunotherapy for non-Hodgkin lymphoma
Immunotherapy is sometimes used to treat non-Hodgkin lymphoma (NHL). Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy is sometimes called biological therapy.
You may have immunotherapy to:
- kill or slow the growth of lymphoma cells
- strengthen your immune system
- lower the risk that the cancer will come back (recur)
Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of immunotherapy. You may also receive other treatments.
Immunotherapy drugs commonly used for NHL
The following types of immunotherapy drugs may be used to treat certain types of NHL.
Cytokines are proteins made by certain cells of the immune system. They can also be made in a lab and given as a drug. Cytokines act as chemical messengers so the immune system cells communicate with each other and help control the immune response.
Interferon alfa (Intron A, Wellferon) is a cytokine used to treat some types of NHL. It may be used alone or combined with chemotherapy. Interferon alfa is usually injected into tissue just under the skin (called subcutaneous injection). Sometimes it is injected into a muscle (called intramuscular injection).
Immune checkpoint inhibitors
The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints, which are made by some immune system cells. Lymphoma cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors are drugs that work by blocking the checkpoint proteins so immune system cells, such as T cells, can attack and kill the cancer cells.
Immune checkpoint inhibitors are monoclonal antibodies, which are substances that find and attach to a specific antigen on a cancer cell.
Pembrolizumab (Keytruda) is an immune checkpoint inhibitor that may be used to treat primary mediastinal large B-cell lymphoma that is refractory (has not responded to treatment) or relapsed (has come back after treatment).
Immunomodulatory drugs work by blocking the growth and division of cancer cells.
Thalidomide (Thalomid) is a drug that stops a tumour from developing new blood vessels (called an anti-angiogenesis drug). It is a capsule taken by mouth. It may be used alone or combined with other drugs to treat some types of NHL.
Lenalidomide (Revlimid) is a newer drug similar to thalidomide that may be used to treat some types of NHL. It is a capsule taken by mouth. The side effects of lenalidomide tend to be different and more severe than thalidomide.
CAR T-cell therapy
CAR T-cell therapy takes millions of T cells from a person with cancer. In the lab, they are changed so they have chimeric antigen receptors (CARs) on their surface. These receptors recognize a specific antigen (protein) found on the type of cancer being treated. The T cells are then given back to the person where they multiply, attack and destroy the cancer cells.
CAR T-cell therapy with either tisagenlecleucel (Kymriah) or axicabtagene ciloleucel (Yescarta) is approved to treat people with large B-cell lymphoma that has relapsed (come back after treatment) or is refractory (not responded to treatment) after at least 2 other treatments. This includes diffuse large B-cell lymphoma (DLBCL) not otherwise specified, primary mediastinal large B-cell lymphoma, high grade B-cell lymphoma and DLBCL arising from follicular lymphoma.
Side effects can happen with any type of treatment for NHL, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.
Side effects of immunotherapy will depend mainly on the type of immunotherapy drug or drug combination, the dose, how it’s given and your overall health. Some common side effects of immunotherapy for NHL are:
- drowsiness and fatigue
- flu-like symptoms, such as fever, chills, muscle and joint aches or pains, headache, nausea and vomiting or loss of appetite
- skin rash
- nerve pain, including peripheral neuropathy
- blood clots
- low blood cell counts
Pregnant women or women planning to become pregnant should not take thalidomide or lenalidomide. These drugs may cause severe birth defects.
Report side effects
Be sure to report side effects to the healthcare team. Side effects can happen any time during, immediately after or a few days or weeks after immunotherapy. Sometimes late side effects develop months or years later. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Your healthcare team is there to help. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
Information about specific cancer drugs
Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.
Questions to ask about immunotherapy
The immune system’s reaction to the presence of foreign substances in the body.
A type of lymphocyte (white blood cell) that helps control immune response (the immune system’s reaction to the presence of foreign substances in the body), fight infection and destroy abnormal cells, including cancer cells.
Also called T lymphocyte.
A foreign substance that stimulates the immune system to produce antibodies against it.
A disorder of the peripheral nerves (nerves outside the brain and spinal cord) that causes pain, numbness, tingling, burning, swelling, muscle weakness and loss of reflexes in different parts of the body.
Peripheral neuropathy may be caused by physical injury, infection, toxic substances or disease (such as cancer, diabetes, kidney failure or malnutrition). It can also be a side effect of some cancer treatments, including chemotherapy and radiation therapy.
What’s the lifetime risk of getting cancer?
The latest Canadian Cancer Statistics report shows about half of Canadians are expected to be diagnosed with cancer in their lifetime.