Immunotherapy for non-Hodgkin lymphoma

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. This works to kill cancer cells and stop cancer cells from growing and spreading.

Immunotherapy is sometimes used to treat non-Hodgkin lymphoma (NHL). If you have immunotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

Immunotherapy may be the only treatment you have or it may be used along with other treatments. You may have immunotherapy to:

• treat NHL that expresses certain proteins
• treat NHL that comes back or doesn't respond to other treatments
• control symptoms of NHL

Different types of immunotherapy are used for NHL. These include:

• immune checkpoint inhibitors
• CAR T-cell therapy
• bispecific antibodies

Side effects of immunotherapy will depend mainly on the type of drug or combination of drugs, the dose, how it's given and your overall health. Tell your healthcare team if you have side effects that you think are from immunotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

The immunotherapy drugs used to treat NHL may not be covered by all provincial or territorial health plans.

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 block the checkpoint proteins so immune system cells, such as T cells, can attack and kill the lymphoma cells.

These drugs are monoclonal antibodies, which means that they 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 (PMBCL) that doesn't respond to treatment (called refractory disease) or comes back (relapses) after 2 different types of chemotherapy or targeted therapy.

Pembrolizumab may cause these side effects:

• fatigue
• diarrhea
• nausea and vomiting
• skin problems, such as a rash
• joint pain
• loss of appetite
• lung problems, such as cough and shortness of breath
• thyroid problems, which may cause changes in weight, body temperature, heart rate and blood pressure

CAR T-cell therapy is a very complex treatment. It involves removing some T cells from your blood, making small changes to them in the lab and then giving them back to you.

T cells move around the body to find and destroy abnormal cells, including cancer cells. But sometimes they find it difficult to find cancer cells. In the lab, T cells can be changed to have chimeric antigen receptors (CARs) on their surface. This helps them recognize and target a specific antigen (protein) found on cancer cells. These changed T cells can be grown and multiplied in the lab and then put back into your bloodstream. When these changed T cells are returned to your body, they recognize and attack cancer cells.

The following CAR T-cell therapies may be used to treat NHL.

Axicabtagene ciloleucel (Yescarta) may be used to treat large B-cell lymphoma that relapses early (comes back within one year of treatment) or that doesn't respond (is refractory) to chemotherapy, targeted therapy or other immunotherapy treatments. This includes diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), primary mediastinal large B-cell lymphoma (PMBCL), high-grade B-cell lymphoma, follicular lymphoma and follicular lymphoma that develops into DLBCL.

Tisagenlecleucel (Kymriah) may be used to treat large B-cell lymphoma that relapses early (comes back within one year of treatment) or that doesn't respond (is refractory) to at least 2 other types of chemotherapy or targeted therapy. This includes DLBCL, not otherwise specified (DLBCL, NOS), high-grade B-cell lymphoma and follicular lymphoma that develops into DLBCL.

Lisocabtagene maraleucel (Breyanzi) may be used to treat DLBCL, primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma (double-hit or triple-hit lymphoma) and grade 3B follicular lymphoma that is refractory after at least 2 other types of chemotherapy or targeted therapy.

Brexucabtagene autoleucel (Tecartus) may be used to treat relapsed or refractory mantle cell lymphoma if you have already received treatment with 2 or more types of drug therapy, including a kinase inhibitor (a type of targeted therapy).

CAR T-cell therapy may cause these side effects:

• cytokine release syndrome
• severe infection
• nerve damage
• flu-like symptoms, such as fever and chills
• fatigue
• muscle and bone pain
• nausea and vomiting
• diarrhea
• constipation
• lung problems, such as cough and shortness of breath
• low blood pressure

Bispecific antibodies are a new type of immunotherapy designed to attach to 2 different targets – an immune cell and a cancer cell. Bispecific antibodies bring the 2 cells together to help the body's immune system attack the lymphoma cells.

Bispecific T-cell engagers (BiTEs) are a type of bispecific antibody to treat NHL. They work by attaching to the CD3 protein on immune cells (called T cells) and to a specific protein on lymphoma cells, such as the CD20 protein.

The following BiTEs are used to treat NHL.

Epcoritamab (Epkinly) can be used to treat relapsed or refractory diffuse large B-cell lymphoma (DLBCL), an indolent (slow-growing) lymphoma that transformed into DLBCL, high-grade B-cell lymphoma, primary mediastinal B-cell lymphoma or grade 3B follicular lymphoma. It may be offered after you have received 2 or more lines of systemic therapy and if you previously had CAR T-cell therapy or if you can't have CAR T-cell therapy.

Glofitamab (Columvi) can be used to treat relapsed or refractory DLBCL, DLBCL that develops from follicular lymphoma or DLBCL that develops from primary mediastinal B-cell lymphoma. It may be offered after you have received 2 or more lines of systemic therapy and if you previously had CAR T-cell therapy or if you can't have CAR T-cell therapy.

Epcoritamab and glofitamab may cause these side effects:

• cytokine release syndrome
• nerve damage
• severe infection
• low blood cell counts
• fever
• fatigue
• diarrhea
• nausea and vomiting
• pain at the injection site
• swelling

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

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