Options for People Who Relapse
- About one-third of people with diffuse B-cell non-Hodgkin lymphoma will relapse
- The next step is to try a cocktail of chemotherapy drugs
- People who respond to chemo may then have a stem cell transplant
- For those who aren’t sensitive to chemotherapy, several new immune-based therapies are available
It can be disappointing to have your cancer come back after you’ve already gone through the rigors of treatment, but these days, your doctor has several ways to manage your cancer if it does return. Thanks to great progress in lymphoma research, today there are a number of new drugs — including combinations of chemotherapy and immunotherapy — to treat relapsed lymphoma.Read More
Various chemotherapy combinations have been studied in relapsed lymphoma. Your doctor will choose the one that’s best suited to you, based on the features of your lymphoma and your other medical conditions.
Are You Chemosensitive?
Once you try a round of chemotherapy, your doctor can see whether your cancer is “chemosensitive,” which means that it’s responding to the chemotherapy drugs. If the answer is yes, “that’s when we would want to proceed with the stem cell transplant,” Dr. Crombie says.
A stem cell transplant replaces damaged stem cells — the young cells in your bone marrow that eventually grow into blood cells — with healthy stem cells. Usually the stem cells are collected from you before the procedure, but sometimes they come from a donor. The stem cell transplant is a way for you to get high-dose chemotherapy to treat your relapsed lymphoma.
New Lymphoma Drugs on the Block
The last few years has seen an explosion in the number of treatments available for relapsed diffuse large B-cell lymphoma. Here are a few of them.
Polatuzumab vedotin (Polivy) is a new kind of drug called an antibody-drug conjugate. Unlike chemotherapy, which destroys all kinds of quickly-dividing cells, both healthy ones and cancer, Polivy finds and targets your cancer cells specifically. Once it attaches to these cells, it releases an anti-cancer drug. Doctors give Polivy together with the chemotherapy drug bendamustine, and Rituxan. You may be a good candidate for this treatment if your lymphoma has come back after you’ve tried at least two other therapies.
Tafasitamab (Monjuvi) is a monoclonal antibody. It targets the protein CD19 on the surface of cancer cells. You may get Monjuvi, together with lenalidomide (Revlimid), if your cancer has come back and you’re not a good candidate for a stem cell transplant.
Selinexor (Xpovio) is a first-of-its-kind treatment called a nuclear export inhibitor. It prevents cancer cells from protecting themselves. The FDA approved Xpovio in June 2020 for people with diffuse large B-cell lymphoma who’ve tried at least two other treatments.
If your cancer isn’t sensitive to chemotherapy, your doctor will explore other treatment approaches, Dr. Crombie tells SurvivorNet. “That’s when we would look at immune-type therapies, and the most exciting one at the moment is CAR T-cell therapy.”
CAR T-cell therapy takes your own immune cells and re-engineers them to find and attack your cancer. Two of these therapies are FDA-approved to treat relapsed large B-cell lymphoma:
- Axicabtagene ciloleucel (Yescarta)
- Tisagenlecleucel (Kymriah)
CAR T-cell therapy is “effective, even in patients who had no response to chemotherapy in the past,” Dr. Crombie says. “We’re glad to have a novel approach for those patients.”
While CAR T-cell therapy is the main immune therapy that is currently approved for relapsed lymphoma, many other immune therapies are in clinical trials. One type of immune therapy under investigation is bispecific antibodies, which are proteins with two arms — one that binds to another protein called an antigen on the cancer cell, and the other that binds to the surface of the T cells — to bring them close to each other.
Other immune therapies that are under clinical investigation include bispecific T-cell engagers (BiTEs), drugs with two arms — one that binds to an antigen on the cancer cell, and one that activates T cells to come closer to the cancer cell to destroy it. New antibody-drug conjugate therapies — antibodies linked to a toxin — are also being investigated, including loncastuxumab teserine. When the antibody binds to a specifically targeted antigen on the cancer cell, the toxin enters the cancer cell to kill it.
Exploring Your Treatment Options
Because there are so many different treatments available for relapsed non-Hodgkin lymphoma, it’s important to understand all of your options. Discuss with your doctor the pros and cons of each treatment — the likelihood that it will put you into remission, as well as what side effects it might cause — so that you can make an informed choice.