Immunotherapy

Lymphoma

Lymphoma occurs when cells of the immune system called lymphocytes, a type of white blood cell, grow and multiply uncontrollably. These cancerous lymphocytes can travel to many parts of the body and form a mass called a tumor. Two main types of lymphocytes develop into lymphomas: B-lymphocytes (B-cells) and T-lymphocytes (T-cells).

Non-Hodgkin Lymphoma (NHL)

Non-Hodgkin lymphoma (NHL) is the most common cancer of the lymphatic system. NHL occurs when T-cells, B-cells and natural killer (NK) cells grow uncontrollably, sometimes forming a tumor. It may be found in any of the lymphoid tissues, and it spreads in a less orderly way than Hodgkin lymphoma. More than 60 subtypes of NHL exist. These subtypes vary in microscopic appearance, molecular features, how they grow and spread, how they affect the body and how they are treated. Slow-growing types are called indolent lymphomas, and fast-growing types are called aggressive lymphomas.

Treatment options for NHL include chemotherapy, immunotherapy, targeted therapy, radiation therapy and stem cell transplantation. Factors that will guide your treatment include the stage of the disease as well as your age, overall health and symptoms. The first successful immunotherapy introduced for lymphoma is a monoclonal antibody that is available for all B-cell lymphomas. Monoclonal antibodies are laboratory-made versions of immune system proteins designed to attack cancer cells. NHL is usually treated with an immunotherapy drug combined with chemotherapy.

Many clinical trials are evaluating possible immunotherapy drugs or combinations (see Clinical Trials). Researchers have been focused on checkpoint inhibitors, such as anti-PD-1, anti-PD-L1 and anti-CTLA-4 antibodies, alone and in combination. Cancer treatment vaccines and chimeric antigen receptor (CAR) T-cell therapy are also being researched in clinical trials. Ask your doctor if a clinical trial is right for you.

B-Cell Lymphoma

B-cell lymphoma is the most common type of NHL. T-cell lymphoma is less common, and NK-cell lymphoma is relatively rare. NHL can start nearly anywhere and can spread to almost any organ. It most often begins in the lymph nodes, liver, spleen or bone marrow, but it can also involve the stomach, intestines, skin, thyroid, brain or any other part of the body where lymphatic tissue is found. In 2017, the FDA approved a chimeric antigen receptor (CAR) T-cell therapy to treat certain types of large B-cell lymphoma. This CAR T-cell therapy involves using a patient’s genetically engineered immune cells, or T-cells, that are re-designed to recognize and kill lymphoma cells.

Follicular Lymphoma

Follicular lymphoma is a B-cell lymphoma and is the most common slow-growing form of non-Hodgkin lymphoma. It usually begins in the lymph nodes and can spread into the blood and bone marrow (soft, spongy tissue in the center of some bones) or other organs. Common treatment options for follicular lymphoma include chemotherapy, immunotherapy, targeted therapy and radiation therapy. The main type of immunotherapy used to treat follicular lymphoma involves monoclonal antibodies, which are laboratory-made versions of immune system proteins designed to attack cancer cells. One type of monoclonal antibody attaches to a specific protein found on B-cells (the type of cell that follicular lymphoma is made of) that makes the B-cells more visible to the immune system and helps it attack cancer cells more efficiently.

A somewhat similar treatment option involves the use of a radioactive monoclonal antibody. This is an immunotherapy drug that combines a radioactive particle with a monoclonal antibody, allowing it to deliver radiation directly to the cancer cells. This approach, known as radioimmunotherapy, leaves most of the surrounding healthy cells undamaged.

Follicular lymphoma commonly comes back after treatment. When this occurs, it is called relapsed disease. Relapse can happen weeks, months or even years after initial treatment has ended. Treatment options for relapsed follicular lymphoma include chemotherapy, immunotherapy, targeted therapy or a combination of treatments. Radioimmunotherapy may also be used alone or in combination with chemotherapy to treat this condition.

Immunotherapy combined with chemotherapy is the most common treatment for more advanced Stage II, Stage III and Stage IV disease. One of the first immunotherapies approved for follicular lymphoma was a type of interferon, which is a cytokine. Cytokines are proteins made naturally in the body or made in a laboratory, and act primarily by helping the various cells of the body’s immune system communicate. They are capable of stimulating the immune system or slowing it down to help it fight cancer.

Follicular lymphoma clinical trials are designed to investigate treatment strategies to increase the remission rate or cure the disease. The use of personalized vaccines is one strategy being evaluated. Personalized vaccines may be used to treat cancer by stimulating the immune system to recognize cancer cells as a threat to the body and destroy them. Ask your doctor if you are a candidate for clinical trials (see Clinical Trials).

Mantle Cell Lymphoma (MCL)

Mantle cell lymphoma (MCL) forms when B-cells in the outer edge of a lymph node mutate and grow uncontrollably. The uncontrollable growth of mutated B-cells causes them to accumulate in the lymph nodes, and the lymph nodes become enlarged. The MCL cells can enter the lymphatic channels and the blood and can spread to other lymph nodes or tissues, such as the bone marrow, liver and gastrointestinal tract.

Treatment options for MCL include chemotherapy, targeted therapy, stem cell transplantation and immunotherapy. Although chemotherapy is the most commonly used treatment for MCL, immunotherapy may be combined with a chemotherapy drug to treat MCL in people who have disease that relapsed or progressed after two prior therapies. For this group of people, the use of immunotherapy with chemotherapy has led to better results than the use of immunotherapy alone. As a result, this is offering hope as an additional treatment option.

New drugs and treatment types are also being evaluated in clinical trials, including immunomodulators, which are substances that regulate the function of the immune system and can slow the rate at which cancer cells grow and multiply. Another type, radioimmunotherapy, combines the cancer-killing ability of radiation therapy with the targeting capability of immunotherapy to deliver lethal doses of radiation directly to cancer cells.

Researchers are exploring ways to extend the length of remission between relapse, and the use of vaccines to treat MCL is also being assessed. Cancer-treating vaccines work by stimulating the immune system to recognize cancer cells as a threat to the body, and to destroy them. This type of immunotherapy treatment may be customized to work against your specific cancer by using the genetic makeup of your tumor cells to create the vaccine.

Participating in a clinical trial may offer you the best chance of receiving the most leading-edge treatments available (see Clinical Trials).

Hodgkin Lymphoma (HL)

Hodgkin lymphoma (HL), formerly known as Hodgkin disease, is a cancer that starts in the part of the body’s immune system known as the lymphatic system. The lymphatic system is made up of lymphoid tissue, lymph and lymphatic vessels. Lymphoid tissue is found in many parts of the body, including the lymph nodes, spleen, bone marrow, thymus, adenoids and tonsils, and digestive tract (see Immune System). These tissues are primarily made of white blood cells called lymphocytes. HL typically starts in the lymph nodes in the chest, neck or underarm and may spread to other lymph nodes or to other organs, such as the liver or lungs.

Treatment options for HL include chemotherapy, radiation therapy and immunotherapy, and advances in the diagnosis and treatment of this disease have contributed to a cure rate that is generally high. Until recently, if the disease progressed, returned after treatment or stopped responding to treatment, the primary option was high doses of chemotherapy followed by stem cell transplantation and additional drug therapy. Today, people with hard-to-treat HL have a new treatment option in immunotherapy.

In 2016, the U.S. Food and Drug Administration (FDA) approved an immunotherapy drug for classical HL that has returned or progressed after a specific type of stem cell transplantation and post-transplantation drug therapy. This type of immunotherapy is referred to as an immune checkpoint inhibitor, a drug that blocks specific proteins and receptors from triggering a slowdown of the immune system.

In 2017, the FDA approved another immune checkpoint inhibitor for children and adults with classical HL that has stopped responding to treatment or that has returned after three or more therapies.

Immunotherapy brings new hope for people with relapsed HL and HL that was previously difficult to manage. Researchers are exploring the use of immunotherapy in combination with other therapies to treat all stages of HL in clinical trials (see Clinical Trials). Before making any treatment decisions, ask your doctor if immunotherapy is right for you or if you may be a candidate for a clinical trial.

 

FDA-Approved Immunotherapies for Lymphoma*
As of 12/5/17
Adult T-cell Lymphoma
interferon alfa
Anaplastic Large Cell Lymphoma
brentuximab vedotin (Adcetris)
Diffuse Large B-cell Lymphoma
axicabtagene ciloleucel (Yescarta)
rituximab (Rituxan)
rituximab and hyaluronase human (Rituxan Hycela)
Follicular Lymphoma
ibritumomab tiuxetan (Zevalin)
interferon alfa-2b (Intron A)
obinutuzumab (Gazyva)
rituximab (Rituxan)
rituximab and hyaluronase human (Rituxan Hycela)
Hodgkin Lymphoma
brentuximab vedotin (Adcetris)
nivolumab (Opdivo)
pembrolizumab (Keytruda)
rituximab (Rituxan)
Intravascular Large B-cell Lymphoma
rituximab (Rituxan)
Lymphoplasmacytic Lymphoma
rituximab (Rituxan)
Mantle Cell Lymphoma
lenalidomide (Revlimid)
rituximab (Rituxan)
Marginal Zone B-cell Lymphoma
rituximab (Rituxan)
Non-Hodgkin Lymphoma
rituximab (Rituxan)
Primary Central Nervous System Lymphoma
rituximab (Rituxan)
Primary Mediastinal B-cell Lymphoma
rituximab (Rituxan)

*Each therapy is prescribed based on specific criteria. Discuss your options
with your doctor.

Additional Resources

Follicular Lymphoma

Hodgkin Lymphoma

Mantle Cell Lymphoma

Non-Hodgkin Lymphoma

 

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