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Kristin & Benny: Immunotherapy and Acute Lymphoblastic Leukemia

Kristin & Benny: Immunotherapy and Acute Lymphoblastic Leukemia

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Immunotherapy and Leukemia and Lymphoma

In recent years scientists have made new discoveries about how the immune system works and how to control it. This has led to new immunotherapy treatments for leukemia and lymphoma.

The type of immunotherapy used depends on the exact subtype of blood cancer being treated. Many treatment options are still only available through clinical trials. If you are interested in immunotherapy, talk with your doctor about your options, including clinical trials.

Types of Immunotherapy

Monoclonal Antibodies

Cancer cells often have substances called antigens on their surface. An antigen causes your immune system to produce antibodies against it. This means your immune system does not recognize the substance and is trying to fight it off.

Antigens can be attacked with monoclonal antibodies. These are drugs made in the lab. They act like natural antibodies in our immune system.

One example is the monoclonal antibody rituximab. It recognizes the CD20 antigen on the surface of B lymphocytes and destroys those cells. Rituximab was the first monoclonal antibody shown to be effective in treating cancers that start in B-cells. It is still a key treatment for these leukemias and lymphoma.

There are a growing number of similar drugs that target specific antigens in many leukemias and lymphomas. In some cases, these drugs are combined with chemotherapy drugs or radioactive particles to deliver treatment directly to cancer cells.

Adoptive Cell Therapies

In adoptive T cell therapy, white blood cells called T cells are removed from a person with cancer. They are taken to a lab and changed. When they are returned to the person, these changed T cells can find and destroy cancer cells. This is being tested in several types of cancers. One type of adoptive cell therapy, called CAR T cell therapy, is approved to treat certain leukemias and lymphomas. CAR T cell therapy is only available in certain cancer centers.

For more information, see our CAR T Immunotherapy booklet.

Cancer Vaccines

Vaccines that treat cancer (called therapeutic vaccines) teach the immune system to recognize a person's tumor and attack it. The goal is to produce a treatment that will let the immune system quickly recognize an antigen it has seen before and keep destroying the cancer cells for a long time. This is called immune memory. To do that, scientists identify a specific feature of the cancer cell that will trigger the immune response.

Cancer vaccines show promise in treating leukemia and lymphoma. These cancers often are caused by or have genetic changes (mutations) that provide targets for vaccines.

One example is the Philadelphia chromosome. This is a genetic mutation found in 95% of people with chronic myeloid leukemia (CML). The immune system is able to recognize this mutation and attack it. However, the response is not good enough to kill all the cancer cells.

Some clinical trials are using a vaccine to try to boost the immune system’s response to CML cells and promote an immune memory.

Other trials are using cancer vaccines to treat some types of leukemia such as acute myeloid leukemia (AML). In many cases, these cancer vaccines don't get rid of all the blood cancer. But they keep it in check or curb its growth.

Side Effects of Immunotherapy

Side effects can be very different depending on the type of immunotherapy used, and the kind of cancer being treated. Some immunotherapy side effects include:

  • Fevers
  • Flu-like symptoms
  • Drops in blood pressure
  • Rashes
  • Fatigue

Some people also have colitis (inflammation of the inner lining of the colon) or thyroid problems. Others may develop confusion (especially with CAR T cell therapy)

The increased activity of the immune system can cause these side effects. While the goal is to kill the cancer cells, the boost in the immune response can affect normal cells too.

For many people with cancer, these side effects are fairly mild and don’t last long. More serious problems are usually controlled with drugs, including steroids.

Let your treatment team know right away if you develop any symptoms after you begin immunotherapy or at any time during your treatment.

The Future of Immunotherapy for Leukemia and Lymphoma

The field of immunotherapy for leukemia and lymphoma is still in its very early stages. Researchers are finding new targets for more types of blood cancer. They are learning more about why some people respond so well and others do not.

Scientists are using what they learn about the relationship between cancer cells and the immune system to develop new treatments. This will improve the outcomes for people with many different types of leukemia and lymphoma.