Immunotherapy trains immune system cells to destroy cancer cells. It may cause fewer side effects than traditional treatments, as it does not kill healthy cells. It may also reduce the risk of cancer coming back and improve remission rates. However, immunotherapy for leukemia is a new treatment and does not work for all types of leukemia.
Immunotherapy for leukemia
Immunotherapy trains the immune system to fight cancer cells too, sometimes by introducing cancer-killing cells that scientists produce or modify in a lab.
In this article, we discuss different types of immunotherapy for leukemia, how they work, which types of leukemia they can treat, and how successful they can be. We also compare immunotherapy and chemotherapy.
Chimeric antigen receptor (CAR) T cell therapy can address several types of leukemia, including acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). There are numerous CAR T drugs, and the drug’s suitability will depend on the type of leukemia a person has and their overall health.
What to expect
CAR T cell therapy involves removing some of a person’s T cells, which are a type of white blood cell that helps treat infections and diseases. A laboratory technician then genetically engineers the cells by adding new pieces of DNA that teach the cells how to detect leukemia and some other cancers.
The new cells, which the medical community refers to as CAR T cells,
CAR T cell therapy can cause a wide range of side effects, including:
- cytokine release syndrome, which is an aggressive inflammatory response of the immune system that causes a collection of side effects
- a fever
Some people experience side effects that influence their nervous system, such as:
- shaking or twitching
- difficulty speaking and understanding what others say
- loss of balance
Donor lymphocyte infusion can treat several types of leukemia. They include:
What to expect
The procedure involves transferring a type of white blood cells called lymphocytes from the prior stem cell donor back into the person with leukemia. This can help the person’s immune system fight the cancer cells more effectively.
The main side effect of donor lymphocyte infusion is graft-versus-host disease (GVHD). This syndrome exists on a continuum, with symptoms ranging from mild to life threatening. It happens when the donor cells attack the recipient’s healthy cells, and it may cause:
Cytokines are proteins that help the cells send and receive signals. They play an important role in inflammation and the body’s immune response.
Cytokines may help with different types of leukemia,
What to expect
With cytokine therapy, a doctor injects human-made cytokines into the body to boost the immune response, helping the body detect cancer more effectively. Some examples of cytokine therapy are treatments with interferon or interleukin.
Side effects of interferons include:
Side effects of interleukins include:
- flu-like symptoms, such as vomiting, headache, and fever
- low white blood cell count, which could increase risk of infection
- skin rashes
- hair loss
Vaccines for leukemia are not yet widely available. However, clinical trials have shown promise.
For example, in a
The average age of the participants was 63 years, which is especially promising, since older age can be a risk factor for worse leukemia outcomes.
Monoclonal antibody therapy can train the body to fight a number of types of leukemia. Typically, the immune system uses antibodies to fight off infections, but it may not recognize cancer as a dangerous invader.
What to expect
Monoclonal antibodies are made in the laboratory, and healthcare professionals give them to patients intravenously.
These antibodies work in various ways. One way the therapy works is by helping the immune system recognize cancer cells as harmful. Another way is by directly killing these cells.
There are many types of monoclonal antibodies, and each works slightly differently. Below are some examples.
Blinatumomab binds to a protein on cancer cells and to a protein on the immune system’s T cells, bringing the cells together so the immune system can fight cancer.
Some people experience neurological issues, dizziness, and nausea after using this drug.
This drug binds to a protein on B cells, including leukemia B cells. Doctors typically recommend it after chemotherapy.
Radioimmunotherapy is a type of monoclonal antibody therapy that also uses a radioactive substance to help kill cancer cells.
When a doctor injects the monoclonal antibody into a person’s bloodstream, it helps locate and bind to cancer cells, and then the radioactive chemical kills them. It is a direct way of killing the tumor cells.
What to expect
Radioimmunotherapy does not kill healthy cells, which is why it produces fewer side effects than chemotherapy.
Side effects may appear up to several months after treatment, and they may include:
- lower blood counts, resulting in bleeding or infection
- bone marrow damage
- a fever
- low blood pressure
- a rash
Radioimmunotherapy requires multiple treatments. It can support the body to fight several types of leukemia, including AML and acute lymphoid leukemia.
The success of immunotherapy will depend on numerous factors, such as:
- the type of immunotherapy a person undergoes
- the type of leukemia they have
- their overall health
- their age
- how far the cancer has progressed
Immunotherapy may prolong survival and increase remission rates.
For example, a 2020 review includes information about a clinical trial involving patients with ALL, a highly fatal type of leukemia. Doctors compared monoclonal antibody therapy with chemotherapy alone. The monoclonal antibody group had remission rates of 24.6%, compared with 15.7% in the chemotherapy group.
Monoclonal antibody recipients also lived longer. The median survival was 7.7 months, compared with 4 months in patients undergoing chemotherapy.
The right treatment for leukemia depends on the type of leukemia, a person’s overall health, and treatment goals. In many cases, it is possible to use immunotherapy alongside other treatments or after other treatments are complete.
Other treatment options for leukemia include:
- medications to slow the growth of cancer cells
- stem cell transplants, which some doctors classify as a form of immunotherapy
- supportive care, such as antinausea drugs and antibiotics to treat infections in people with weakened immune systems
The following table may help explain the differences between immunotherapy and chemotherapy:
|Function||Chemotherapy attacks any cells that are quickly dividing in the body.||Immunotherapy boosts the immune response and teaches the body to find and destroy cancerous cells.|
|Side effects||Chemotherapy may attack healthy cells and result in damage to hair follicles and gut lining, causing hair loss and nausea.||Side effects come from an extreme or misdirected immune response. They can range from mild to life threatening.|
|Treatment duration||Tumors may begin to shrink immediately.||It may take longer for the immune response to mobilize.|
|Effectiveness||Chemotherapy works as long as it is in a person’s body. It may be more effective long term in combination with immunotherapy.||Immunotherapy can cause long-term protection due to immune memory even after treatment has finished.|
|Cancer types||Different types of chemotherapy may work against certain cancers, but some cancer types are resistant to chemotherapy.||Immunotherapy can work effectively against any type of cancer.|
Immunotherapy is a promising option for treating leukemia, although many types of immunotherapy are experimental and only available through clinical trials.
Immunotherapy may also be effective in combination with chemotherapy.
It is important to discuss the risks and benefits of treatment with a doctor, ask about available clinical trials, and speak with an oncologist about one’s treatment goals.
For example, some people hope to minimize treatment side effects when they have an aggressive form of leukemia, while others hope to live as long as possible regardless of side effects.
An oncologist can answer questions and help a person decide on treatment consistent with the person’s overall goals.