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Biological therapy for non Hodgkin lymphoma

Men and women discussing non Hodgkin's lymphoma

This page tells you about biological therapy drugs for non Hodgkin lymphoma. There is information about

 

A quick guide to what's on this page

Biological therapies

There are several different types of biological therapy. The types used most often in lymphoma are monoclonal antibodies. Monoclonal antibodies (MABs) are proteins made in the laboratory that target the cells of particular types of cancer. A MAB called rituximab is now commonly used to treat some types of lymphoma. It is also called Mabthera. One called ibritumomab (Zevalin) is more rarely used.

Rituximab (Mabthera)

Rituximab is part of standard treatment for high grade diffuse large B cell lymphoma. Rituximab is also part of standard treatment for low grade follicular NHL that needs treatment. 

Ibritumomab (Zevalin)

Ibritumomab (Zevalin) is an anti CD20 antibody connected to a molecule of radioactive yttrium (Y-90). It is for people with follicular B cell NHL who have had rituximab and either it hasn't worked or their NHL has come back since their treatment. It is also a maintenance treatment for follicular lymphoma in remission after the first course of treatment. Maintenance treatment is ongoing therapy aimed at keeping the lymphoma in remission. 

Having treatment

You have rituximab or ibritumomab through a drip (infusion). You may have to stay in hospital overnight for your first treatment. The number of doses and how often you have it depend on your type of lymphoma and whether you are having it with other drugs.

Side effects

During the infusion, you may have a high temperature (fever), chills and shivering, sickness, an itchy rash, or a headache. A small number of people also have wheezing and a drop in blood pressure. But the nurse looking after you will monitor you closely while you have the treatment.

 

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Biological therapy and NHL

Biological therapies are treatments that act on cell processes and stop cells from growing and dividing. They can help to treat some types of lymphoma. Monoclonal antibodies (MABs) are the most common type of biological therapy used in lymphoma. They are proteins made in the laboratory from a single copy of a humanised antibody.

 

Rituximab (Mabthera)

The monoclonal antibody rituximab is also called Mabthera. It is commonly used to treat some types of lymphoma. 

How rituximab works

Monoclonal antibodies target particular proteins found on the surface of cells. Rituximab targets a protein called CD20. All mature B cells have the CD20 protein on the outside of the cell. The most common types of non Hodgkin’s lymphoma develop when some of the B cells become cancerous. The cancerous B cells also carry the CD20 protein. The antibody sticks to all the B cells it finds with the CD20 protein. The cells of the immune system then pick out these B cells and kill them.

B cells develop from cells in the bone marrow called stem cells. B cell stem cells do not have the CD20 protein. So they are not killed by rituximab and they make normal healthy B cells to replace the ones that have been killed. Normal B cell levels in the blood are restored within a few months of having the treatment in most people. 

Who has rituximab

Rituximab is used to treat different types of NHL, including high grade diffuse large B cell lymphoma (DLBCL) and low grade follicular lymphoma. These are the most common types of NHL.

For DLBCL, you usually have rituximab in combination with chemotherapy such as CHOP. This is called R-CHOP.

We have detailed information about R-CHOP.

Rituximab is also standard treatment for follicular lymphoma. You may have it with chemotherapy to get rid of all signs of the lymphoma (in other words, to induce remission). Once in remission you may have rituximab regularly for up to 2 years as maintenance treatment. This aims to delay the lymphoma from coming back.

If your lymphoma comes back, you may have more chemotherapy with rituximab or rituximab on its own.

Having the treatment

You have rituximab through a drip (infusion). You may have to stay in overnight for your first treatment, but after that it is often given as an outpatient and you can go home after your treatment is over. Some people have a reaction to rituximab and need some extra drugs. The number of doses of rituximab and how often you have it depend on

  • Your type of lymphoma
  • Whether you are having it with other drugs.

Side effects of rituximab

You are most likely to have side effects when you first have the drug. During the infusion, you may have

  • A high temperature (fever)
  • Chills and shivering (rigors)
  • Feeling sick
  • An itchy rash
  • A headache

About half of the people treated with rituximab have a reaction to it. About 1 in every 20 people treated will also have

  • Wheezing
  • A drop in blood pressure

These side effects are most likely to come on in the first 2 hours of your first dose. The reaction can usually be prevented by having paracetamol and an anti histamine drug before the drip starts. If you do get side effects, they can usually be controlled by slowing down the drip or stopping it for a while. If you have a severe reaction, you may have to stay in hospital the first time you have rituximab.

 

Ibritumomab (Zevalin)

Ibritumomab (Zevalin) is another monoclonal antibody that is licensed for NHL. Zevalin is an anti CD20 antibody connected to a molecule of radioactive yttrium (Y-90). It is licensed for use in the UK in people with CD20 positive follicular B cell NHL who have had rituximab and either it hasn't worked or their NHL has come back since their treatment. 

Zevalin is also licensed as a maintenance treatment for follicular lymphoma in remission after the first course of treatment. Maintenance treatment is ongoing therapy aimed at keeping the lymphoma in remission. 

Zevalin is not widely available in the UK. The Scottish Medicines Consortium (SMC) has not recommended the use of Zevalin. And the National Institute of Health and Care Excellence (NICE) has not assessed it yet.

You have the treatment as a drip into your bloodstream. The side effects are similar to Rituximab.

 

Other monoclonal antibodies used in NHL

Other MABs being developed and tested for NHL include

Bexxar is an anti CD20 antibody connected to a molecule of radioactive iodine (I-131). Epratuzumab is a monoclonal antibody that seeks out the CD22 protein. This is also found on the outside of B cells.

Low blood counts seem to be the main side effect with this type of treatment. Low blood counts can cause

  • An increased risk of infection
  • An increased risk of bruising or abnormal bleeding
  • Tiredness and breathlessness from anaemia (a shortage of red blood cells)

The blood count usually recovers on its own over about 2 weeks but it may take several weeks. 

Alemtuzumab (MabCampath) is a monoclonal antibody that seeks out the CD52 protein. This protein is on the outside of B and T cells. It is licensed as a treatment for chronic lymphocytic leukaemia. This drug has been tested to treat NHL in combination with chemotherapy before a transplant. And it is also being looked at for T cell lymphoma of the skin.

You can read about research trials using biological therapy for non Hodgkin lymphoma on our clinical trials database.

 

More about non Hodgkin lymphoma treatments

We have detailed information about non Hodgkin lymphoma treatments in this section.

If you would like more information about any aspect of non Hodgkin lymphoma, you can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Our non Hodgkin lymphoma organisations page gives details of other people who can provide information about NHL and its treatment. Some organisations can put you in touch with a cancer support group. They often have free factsheets and information which they can send to you.

 There are also books, booklets, CDs and other resources available about non Hodgkin lymphoma. Some of these are free. Look at our NHL reading list for details.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 26 September 2014