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Understanding Immunotherapy for Lymphoma

Medically reviewed by Todd Gersten, M.D.
Written by Jennifer Shuman
Posted on July 14, 2021

Cancer immunotherapies help direct and strengthen the immune system’s response to cancer. Some types of immunotherapy have been approved to treat lymphoma, a cancer of the lymphatic system. The two main types of lymphoma are Hodgkin lymphoma (about 10 percent of cases) and non-Hodgkin lymphoma (about 90 percent of cases).

Optimal immunotherapies for lymphoma depend on many factors, such as the type of lymphoma diagnosed, stage of disease, and a person’s age and overall health. Immunotherapies that are effective at treating one type of lymphoma may not treat others as well.

How Immunotherapy Works

Immunotherapy works by teaching the natural immune system to fight cancer cells better. Immunotherapy can help the immune system by:

  • Teaching the immune system to recognize lymphoma cells
  • Helping the immune system to attack and kill lymphoma cells
  • Boosting the overall immune response

This type of treatment has many benefits. First, by harnessing the immune system, these treatments — unlike others — can tell the difference between healthy cells and lymphoma cells. Second, immune cells can adapt to continually attack cancer cells even after many medications stop working. Finally, the immune system remembers what cancer cells look like, so it can target and kill cancer cells more effectively if they try to return later.

Classes of Immunotherapy

A combination of chemotherapy and radiation therapy is typically used to treat lymphoma, but the use of immunotherapy drugs is on the rise. Immunotherapy has improved the quality of life and overall survival for adults and children living with lymphoma. There are several immunotherapy treatments approved by the U.S. Food and Drug Administration for lymphoma.

Targeted Antibodies

Targeted antibodies are designed to affect one or more specific immune pathways. The immune system naturally produces trillions of different types of antibodies to fight infections and cancer. Scientists have learned how to manufacture some of the antibodies that are most effective at fighting cancer.

Targeted antibodies include monoclonal antibodies (which target one specific pathway, such as the cells’ ability to grow) and antibody-drug conjugates (an anticancer drug combined with an antibody to deliver the drug specifically to cancer cells).

Antibody-drug conjugates include:

  • Adcetris (brentuximab vedotin) — Approved for people with Hodgkin or non-Hodgkin lymphoma
  • Zevalin (ibritumomab tiuxetan) — Approved to treat some cases of non-Hodgkin lymphoma
  • Polivy (polatuzumab vedotin) — Used to treat some cases of non-Hodgkin lymphoma
  • Zynlonta (loncastuximab tesirine) — Used to treat some people who have relapsed or refractory (treatment-resistant) large B-cell lymphoma

Monoclonal antibodies include:

  • Poteligeo (mogamulizumab-kpkc) — Used to treat two rare forms of non-Hodgkin lymphoma: Sezary syndrome and mycosis fungoides
  • Monjuvi (tafasitamab-cxix) — Used to treat diffuse large B-cell lymphoma
  • Gazyva (obinutuzumab) — Approved for some people with non-Hodgkin lymphoma
  • Rituxan (rituximab) — Approved for CD20-positive non-Hodgkin lymphoma

Immunomodulators

Immunomodulators work to stimulate or suppress the immune system. Examples of immunomodulators include vaccines, checkpoint inhibitors, and cytokines. Checkpoint inhibitors help T cells (a type of white blood cell in the immune system that protects against infection and cancer) kill cancerous cells. Cells of the immune system use cytokines to communicate and interact with other cells.

Immunomodulators include:

  • Opdivo (nivolumab) — A checkpoint inhibitor approved for some people with Hodgkin lymphoma
  • Keytruda (pembrolizumab) — A checkpoint inhibitor used to treat some cases of Hodgkin lymphoma
  • Intron A (interferon alfa-2b) — A cytokine used to treat follicular lymphoma

Adoptive Cell Therapy

Adoptive cell therapies involve removing T cells from a person’s blood, growing them in a laboratory, and then giving the T cells back to the person so the extra cells can fight cancer. Chimeric antigen receptor (CAR) T-cell therapy is a type of adoptive cell therapy. In CAR T-cell therapy, the T cells are taught how to better attack and kill cancer cells in the laboratory before they’re given back to the person with lymphoma.

Adoptive cell therapies include:

  • Yescarta (axicabtagene ciloleucel) — A type of CAR T-cell therapy used for non-Hodgkin lymphoma or follicular lymphoma treatment
  • Tecartus (brexucabtagene autoleucel) — A CAR T-cell therapy used to treat mantle cell lymphoma
  • Breyanzi (liscocabtagene maraleucel) — A CAR T-cell therapy approved for large B-cell lymphoma treatment
  • Kymriah (tisagenlecleucel) — A CAR T-cell therapy used to treat some people with relapsed or treatment-resistant large B-cell lymphoma

See what Dr. Matt Kalaycio says about the uses of CAR-T therapies.

Side Effects of Immunotherapy

Like many cancer treatments, immunotherapy may work better for some people than for others. Side effects of immunotherapy tend to be different from typical cancer treatment side effects. They are usually caused by stimulation of the immune system. Common side effects are usually minor, such as:

  • Fever
  • Fatigue
  • Skin reactions
  • Nausea
  • Headaches
  • Body aches
  • Chills
  • Changes in blood pressure
  • Other flu-like symptoms

However, life-threatening side effects have also been reported. Oncologists and researchers are working to better understand the risk factors for severe immunotherapy side effects.

Clinical Trials for Lymphoma Immunotherapies

There are ongoing clinical trials to test new types of immunotherapy. Many immunotherapies that haven’t been approved specifically to fight lymphoma are still available through these trials. Several immunotherapies currently in clinical trials for lymphoma treatment in adults or children look promising.

Talk With Others Who Understand

MyLymphomaTeam is the social network for people living with lymphoma and their loved ones. More than 8,500 members come together to ask questions, give advice, and share their stories with others who understand life with lymphoma.

Have you used immunotherapy to treat your lymphoma? Share your experience in the comments below, or start a conversation by posting on MyLymphomaTeam.

Posted on July 14, 2021
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Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Jennifer Shuman is a graduate student at Vanderbilt University pursuing her Ph.D. in pathology, microbiology, and immunology. Learn more about her here.

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