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Immune Checkpoint Inhibitors for Non-Hodgkin Lymphoma

Immune Checkpoint Inhibitors for Non-Hodgkin Lymphoma
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Published on September 2, 2020

What is Non-Hodgkin Lymphoma?  

NHL.MK 2020 126B 03B.UNS.RecProg.July 1200x800Non-Hodgkin lymphoma (NHL) is a type of cancer that originates in the lymphatic system, the disease-fighting network spread throughout your body. Approximately 77,240 people will be diagnosed with NHL this year, according to the American Cancer Society, making it one of the most common cancers in the United States 1. 

Caught early, this type of lymphoma is often treatable, although some patients with aggressive subtypes of non-Hodgkin lymphoma may need to undergo several lines of therapy to experience progression-free survival (PFS). This means the disease has been stopped in its tracks and is considered stable but not cured.  

 

Symptoms of Non-Hodgkin Lymphoma 

Non-Hodgkin lymphoma symptoms can include:  

  • swollen lymph nodes 
  • abdominal pain or swelling 
  • chest pain 
  • coughing or trouble breathing 
  • persistent fatigue 
  • fever
  • night sweats
  • unexplained weight loss  

Many patients have a combination of symptoms.  

These are also common symptoms of other cancers and ailments, however, so blood tests will tell your medical team more precisely what is going on in your system.  

Diagnosing Non-Hodgkin Lymphoma  

2019 0034 02 AML DiagnosisSignsSymptomsFirstStep 1200x800One of the most important factors in patient outcomes for any type of cancer is getting an early and accurate diagnosis.  

Dr. Sarah Rutherford, a lymphoma expert from Weill Cornell Medicine, recently discussed the importance of second opinions in a Patient Power exclusiveEmerging Treatments for Diffuse Large B-Cell Lymphoma. 

Sometimes we have advocated for patients to go, if they're not already in an academic center, to go for a second opinion at an academic center, even if they are going to ultimately get treated closer to home. Or, if they don't live near an academic center, at least have their pathology reviewed somewhere else as a second opinion, to make sure that the diagnosis is accurate,” said Dr. Rutherford  

This can’t be emphasized enough. Ask for your pathology report and get a second opinion. These days, both can be done online, without the need to travel.  

Checkpoint Blockade Therapy 

Patients who have been through several lines of therapy may need what oncologists call salvage therapy. Patients with relapsed/refractory non-Hodgkin lymphoma have limited options and checkpoint blockade therapy (CBT) is one.  

CBTs, also called immune checkpoint inhibitors, are treatments that help the body recognize and attack cancer cells. While studies have shown that CBT alone is not helpfulit may pave the way for other treatments by sensitizing tumors for future chemotherapy. This gets the cancer cells ready for apoptosis, or cell death.  

Researchers in England analyzed how checkpoint blockade therapy performed in patients with NHL looking at overall response rate for patients after receiving CBT.  

The researchers reviewed data for 59 patients with aggressive or advanced disease. The post‐CBT regimens included chemotherapy (49%), targeted therapy (30%), clinical trial (17%), transplant conditioning (2%) and CAR T-cell therapy (2%).  

The overall response rate to post‐CBT treatment was 51%, with median progression-free survival of 6.1 months. In patients with at least stable disease (a term used to describe a tumor that is neither growing nor shrinking) to post-CBT, the median duration of response (DOR) was significantly longer than to pre‐CBT, suggesting sensitization. Nineteen patients received stem-cell transplants after post‐CBT therapy 2 

Larger studies will better inform hematologist-oncologists about strategies for patients who have experienced NHL treatment and still relapse, requiring second-tier, and third-tier options. Fortunately, treatment options continue to evolve, giving patients hope. 

"There's always going to be a need for patients that have the disease come back, the relapsed-refractory patient population, and now we have many more options than we did," says Dr. Rutherford. “And I expect that five years from now, we'll have more and more, and that's really exciting for patients.”  

Questions for your doctor: 

  • What happens if the frontline therapy (or therapies) do not work?
  • What should my goals be going forward if a cure is not the intent?
  • What are the risks and benefits of immune blockade therapies? 
  • What are the side effects? 

Looking for more NHL content? Sign up for non-Hodgkin lymphoma e-news and we’ll deliver it right to your inbox.  

~ Lauren Evoy Davis


References:

  1. Key Statistics for Non-Hodgkin Lymphoma. American Cancer Society 
  2. Carreau NA, Armand P, Merryman RW, et al. Checkpoint blockade treatment sensitises relapsed/refractory non‐Hodgkin lymphoma to subsequent therapy. BJ Haem. May 2020. 

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