Immunotherapy for childhood non-Hodgkin lymphoma

Immunotherapy is sometimes used to treat certain types of childhood non-Hodgkin lymphoma (NHL) that doesn’t respond to other treatments or comes back after treatment. Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy is sometimes called biological therapy.

Your child may have immunotherapy to:

• kill or slow the growth of lymphoma cells
• strengthen their immune system
• lower the risk that the cancer will come back (recur)

The healthcare team will consider your child’s personal needs to plan the drugs, doses and schedules of immunotherapy. Your child may also receive other treatments.

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 that immune system cells ( T cells) attack and kill the cancer cells. Immune checkpoint inhibitors are monoclonal antibodies 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 childhood primary mediastinal B-cell lymphoma that is refractory (has not responded to treatment) or recurrent (has come back after treatment).

CAR T-cell therapy is a type of immunotherapy that may be used to treat certain types of childhood NHL. It takes millions of T cells from a child with cancer. In the lab, the cells are changed so that they have chimeric antigen receptors (CARs) on their surface. These receptors recognize a specific antigen (protein) found on the lymphoma cells. The T cells are then given back to the child where they multiply, attack and destroy the lymphoma cells. CD19 CAR T-cell therapy may be used to treat recurrent diffuse large B-cell lymphoma or recurrent Burkitt lymphoma as part of a clinical trial.

Side effects can happen with any type of treatment for childhood NHL, but every child’s experience is different. Some children have many side effects. Other children have few or none at all.

Side effects of immunotherapy will depend mainly on the type of drug or drug combination, the dose, how it’s given and your child’s overall health. Pembrolizumab may cause these side effects:

• fatigue
• pain in muscles, bone or joints
• stomach pain
• loss of appetite
• skin problems, including rash or itching
• diarrhea
• nausea and vomiting
• fever
• cough
• shortness of breath
• constipation
• low blood pressure
• low blood cell counts

Tell your child’s healthcare team if your child has these side effects or others you think might be from immunotherapy. Side effects with immunotherapy can happen any time during, immediately after or a few days or weeks after immunotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

The healthcare team is there to help. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.

Other side effects can develop months or years after treatment for childhood NHL. Find out more about late effects for childhood NHL.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about immunotherapy. To make the decisions that are right for your child, ask the healthcare team questions about immunotherapy.