Targeted therapies for non-Hodgkin lymphoma

Monoclonal antibodies are man-made drugs designed to target certain types of cells. In NHL, they are used to target and destroy blood cells called lymphocytes. This reduces the number of abnormal lymphocytes (lymphoma cells) and normal healthy lymphocytes in the body. Once the treatment is over, the level of healthy lymphocytes gradually returns to normal

A monoclonal antibody called rituximab (Mabthera®) is most often used to treat NHL. It can treat several types of B-cell NHL including; diffuse large B-cell lymphoma and follicular lymphoma. Rituximab is usually given in combination with chemotherapy, but can be given on its own.

Other monoclonal antibodies include ibritumomab tixuetan (Zevalin®) and tositumomab (BEXXAR®). New treatments are also being developed – you may be offered these as part of a research trial.

Monoclonal antibody treatment is given as a drip into a vein (intravenous infusion). You won’t usually need to stay in hospital.

What is monoclonal antibody therapy?

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

Rituximab (Mabthera®) is used to treat some types of B-cell NHL, including the two most common types: follicular lymphoma and diffuse large B-cell lymphoma. 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 information about it.

Rituximab for indolent B-cell lymphoma

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 treatment with rituximab. It’s given every 2–3 months for up to two years. This is called maintenance treatment. The aim is to keep the lymphoma away for as long as possible. Some types of NHL such as splenic marginal zone lymphoma may be treated with rituximab on its own as a first treatment.

Rituximab for aggressive B-cell NHL

Some types of aggressive NHL, such as diffuse large B-cell lymphoma , are treated with rituximab in combination with chemotherapy. The most commonly used combination is rituximab with CHOP chemotherapy (R-CHOP).


Radiolabelled monoclonal antibodies

Some monoclonal antibodies have radioactive molecules attached to them. They are called radiolabelled monoclonal antibodies. They give a dose of radiation directly to the lymphoma cells. They 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.

These drugs are not widely available through the NHS. Your cancer specialist can apply for a drug to be funded if they believe it would benefit you.

In England, this can be done through the Cancer Drugs Fund. In the other countries of the UK, your cancer specialist can apply to the Health Board (Health and Social Care Board in Northern Ireland) asking for the drug to be made available as an exception to the usual rules.

We have more information about what you can do if a treatment isn’t available and about the Cancer Drugs Fund.


Other monoclonal antibodies

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.