Immunotherapy for Non-Hodgkin Lymphoma

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Immunotherapy uses the power of your immune system to fight your cancer. There are several types of immunotherapies. They include antibody therapies and CAR T-cell therapy. Immunotherapies are among the latest advances in non-Hodgkin lymphoma (NHL) care.

Your hematologist-oncologist prescribes your immunotherapy and other medicine-based treatments, like chemotherapy. They also set your treatment schedule. 

Non-Hodgkin Lymphoma Care Tailored to You

You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services. 

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How Immunotherapy Can Treat Non-Hodgkin Lymphoma 

There are many antibody therapies that physicians may use to treat NHL. Rituximab is one monoclonal antibody that’s often used. It can target cancer directly to kill tumor cells, making it both an immunotherapy and a targeted therapy.

Sometimes monoclonal antibodies are used alone. Antibody-drug conjugates use antibodies to ferry a chemotherapy drug to cancer cells. Bispecific antibodies have two different targets. One variety, called Bispecific T-cell engagers, or BiTEs, are bispecific antibodies that can aid NHL treatment by bringing T cells in closer contact with cancer cells. Blinatumomab is an example of a BiTE used to treat NHL.

Immune checkpoint inhibitors are monoclonal antibodies that help your immune system see your cancer cells and destroy them. Pembrolizumab is an example of an immune checkpoint inhibitor used for some NHLs.

Cellular immunotherapies are another important option. These involve taking immune cells from your body. In a lab, scientists multiply the cells. Sometimes they also re-engineer the cells to recognize and fight cancer. Then they return the cells to your body. Chimeric antigen receptor T cell therapy, or CAR T-cell therapy, is an example of a reengineered cellular immunotherapy. CAR T-cell therapies include:

  • Axicabtagene ciloleucel (axi-cel), known by the brand name Yescarta. It’s used for adults with relapsed or refractory large B-cell lymphoma, as well as relapsed or refractory follicular lymphoma.
  • Brexucabtagene autoleucel (brexu-cel), known by the brand name Tecartus. It’s available for adults with relapsed or refractory mantle cell lymphoma and adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia.
  • Lisocabtagene maraleucel (liso-cel), known by the brand name Breyanzi. It’s approved to treat adults with relapsed or refractory large B-cell lymphoma.
  • Tisagenlecleucel (tisa-cel), known by the brand name Kymriah. It’s available for adults with relapsed or refractory large B-cell lymphoma and relapsed or refractory follicular lymphoma. It is also available for young adults with relapsed or refractory acute lymphoblastic leukemia. 
Patient in an immunotherapy room
Bezos Immunotherapy Clinic at Fred Hutch Cancer Center

Why Choose Fred Hutch for Immunotherapy for Non-Hodgkin Lymphoma

At Fred Hutch, our hematologist-oncologists are leaders in medicine-based treatments for NHL, including immunotherapies. Fred Hutch was one of the first cancer centers to offer cellular immunotherapies approved for NHL by the U.S. Food and Drug Administration. Only certified treatment centers, like Fred Hutch, can give these CAR T-cell therapies. Along with approved therapies, we also offer many cellular immunotherapy clinical trials for people with NHL.

Your hematologist-oncologist, radiation oncologist and pathologist partner to design a personalized treatment plan for you. Our goal is to target your disease and have the least impact on healthy tissue. Your hematologist-oncologist also works closely with you to manage any immunotherapy side effects. Your whole team helps you take the best possible care of yourself.

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Immunotherapy for Non-Hodgkin Lymphoma FAQ

Monoclonal antibodies, like rituximab and pembrolizumab, are given in cycles by infusion. For an infusion, liquid medicine is put into a vein through an intravenous (IV) line. This can be a line in your arm (peripheral venous catheter) or a port in your chest (central venous catheter). Cancer nurses who are experts in infusions give you these treatments. They will also watch over you during the treatment. They will help with any medical issues that come up and will keep you comfortable.

For CAR T-cell therapy, we first collect your white blood cells by a process called leukapheresis. A small tube goes into a vein in your arm. Your blood flows through this tube to a machine that removes white blood cells. The rest of the blood goes back into your body through another tube. Then we send your blood cells to a manufacturing center to make the treatment. Before getting CAR T-cell therapy, you will likely have several days of chemotherapy to make room for the engineered T cells. When your CAR T-cell therapy is ready, your care team will infuse the cells into your body through an IV line. The infusion usually takes less than 30 minutes.

The side effects and risks depend on the type of immunotherapy you are getting. Your Fred Hutch care team will talk with you about what to expect. We’ll also help you weigh the benefits and risks of all your treatment options.

Side effects of rituximab may include:

  • Fever, chills or night sweats
  • Back or joint pain
  • Tiredness
  • Headache
  • Nausea or diarrhea
  • Mouth sores
  • Flushing
  • Feeling more anxious or worried than usual

Side effects of pembrolizumab may include:

  • Muscle, joint or bone pain
  • Skin changes, like dryness or change in color
  • Tiredness
  • Nausea, vomiting or constipation
  • Sleep trouble
  • Hair loss
  • Changes in taste
  • Dry eyes

CAR T-cell therapy may cause a condition called cytokine release syndrome. This can lead to a range of side effects like:

  • Fever
  • Trouble breathing
  • Nausea
  • Dizziness
  • Headaches
  • Fatigue
  • Joint or muscle pain

CAR T-cell therapy sometimes causes problems with the nervous system. Your care team will explain the possible side effects and how we can treat them.

Your care team at Fred Hutch is here to help you prevent or prepare for side effects and to relieve any side effects you have. The most important step you can take is to let your team know what you’re feeling. We’ve helped many patients and families through this process and know ways to ease your experience. 

Often, there are medicines to help, like anti-nausea drugs. Based on the side effect, there may be a range of other helpful options too, like diet changes, physical therapy and emotional and practical support. We also offer integrative medicine, including acupuncture. Fred Hutch researchers continue to look for the best ways to keep side effects at bay.

Your care team at Fred Hutch will explain your treatment schedule. We’ll also talk with you about the recovery process, like how long you can expect side effects to last. Medicines like monoclonal antibodies and immune checkpoint inhibitors are given in cycles. You’ll get a dose and then have a rest period before the next treatment. For example, rituximab is commonly given every three weeks for up to eight cycles. CAR T-cell therapy is different. It’s typically a one-time infusion.