Monoclonal antibody therapy for NHL
Antibodies are part of the body’s natural defence against infection.They recognise harmful cells and destroy them. Monoclonal antibodies are man-made drugs designed to target certain types of cells. Monoclonal antibody treatments used for NHL are designed to target and destroy lymphocytes.
The treatment is given as a drip into a vein (intravenous infusion) and can usually be given to you as an outpatient.
The monoclonal antibody most commonly used to treat NHL is rituximab (Mabthera®). Other monoclonal antibodies that are sometimes used include ibritumomab tixuetan (Zevalin®) and tositumomab (BEXXAR®).
Rituximab (Mabthera®) is used to treat some types of B-cell non-Hodgkin lymphoma, including the two most common types:
Rituximab may be given on its own or in combination with chemotherapy.
Rituximab attaches to a protein called CD20 on the surface of B-cell lymphocytes. This stimulates the body’s natural defences to attack and destroy the lymphocytes.
Treatment with rituximab reduces the number of healthy B-cell lymphocytes, as well as destroying lymphoma cells. But, once the treatment has finished, the level of healthy B-cells in your blood will gradually return to normal.
Rituximab can be used in different ways. We have more detailed information on this within our section about Rituximab.
Indolent B-cell lymphoma
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Rituximab is given in combination with chemotherapy as the first treatment for some types of indolent B-cell NHL, particularly follicular lymphoma.
If follicular lymphoma goes into remission after treatment with rituximab and chemotherapy, some people continue having rituximab every 2-3 months for up to two years. This is to keep the lymphoma away for as long as possible and is called maintenance treatment.
Rituximab can also be given on its own, once a week for four weeks, to treat indolent NHL that has come back after treatment.
Some types of aggressive NHL, such as diffuse large B-cell lymphoma (DLBCL), are treated with rituximab in combination with chemotherapy. The most commonly used combination is rituximab with CHOP chemotherapy (R-CHOP).
Radiolabelled monoclonal antibodies
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Some monoclonal antibodies have radioactive molecules attached to them, which give a dose of radiation directly to the lymphoma cells. Radiolabelled monoclonal antibodies used to treat B-cell NHL include ibritumomab tixuetan (Zevalin®) and tositumomab (BEXXAR®). They are most likely to be used to treat B-cell lymphomas that have come back after treatment.
Zevalin is licensed and can be prescribed in the UK, but the National Institute for Health and Clinical Excellence (NICE) hasn’t yet assessed it. NICE currently gives advice on which new drugs or treatments should be available for use in the NHS in England and Wales. The Scottish Medicines Consortium (SMC), which gives advice to the NHS in Scotland, has not recommended the use of Zevalin. As a result, Zevalin may not be widely available on the NHS.
Tositumomab is not widely available in the UK.
We have more information about what you can do if a treatment isn’t available.
Other monoclonal antibodies
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Alemtuzumab (CAMPATH®) attaches to a protein that is found on the surface of B-cell and T-cell lymphocytes. It’s being tested in clinical trials as a treatment for some types of T-cell lymphoma. Several other monoclonal antibodies are also being developed. You may be offered these as part of research trials.
Side effects of monoclonal antibodies
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Rituximab and other monoclonal antibodies tend to have similar side effects. Possible side effects include:
Sometimes, people have a reaction while being given a monoclonal antibody, or soon after. The symptoms of a reaction may include a high temperature (fever), shakes (rigors), a rash, low blood pressure, and feeling sick (nausea).
A reaction is most likely to happen the first time you have the treatment, so you’ll be given your first infusion very slowly to reduce the chance of one occurring. You’ll also be given medicines to help reduce any reaction that does occur. Reactions are usually milder with a second infusion, and any that follow.
Reduced number of blood cells
This is most likely to affect you if you’re having a monoclonal antibody in combination with chemotherapy, or if you’re given a radiolabelled monoclonal antibody. Go to our section on side effects of treatments for more information about the side effects that can be caused by a reduced number of blood cells.