A monoclonal antibody is a laboratory-produced molecule that is engineered to attach to specific defects in cancer cells. Monoclonal antibodies mimic the antibodies the body naturally produces as part of our immune system’s response to germs, vaccines etc.
The most commonly used monoclonal antibody used in the treatment of haematological malignancy is Rituximab (Mabthera) an antiCD20 antibody which binds to a specific protein CD20 only found on the surface of B lymphocytes. Certain types of lymphoma arise from these B cells. When Rituximab attached to the CD20 on the B lymphocytes it makes the cells more visible to the immune system, which can then attack. Rituximab lowers the number of B cells including healthy B cells, but the body produces new healthy B cells to replace these. The cancerous B cells are less likely to recur.
Other monoclonal antibodies used in the treatment of blood cancers include Obinutuzumab and daratumumab.
Checkpoint inhibitors:
An important function of the immune system is its ability to tell between normal cells in the body and those it sees as “foreign.” This lets the immune system attack the foreign cells while leaving the normal cells alone. To do this, it uses “checkpoints.” Immune checkpoints are molecules on certain immune cells that need to be activated (or inactivated) to start an immune response.
Cancer cells sometimes find ways to use these checkpoints to avoid being attacked by the immune system. But drugs that target these checkpoints hold a lot of promise as cancer treatments. These drugs are called checkpoint inhibitors.
PD-1 is a checkpoint protein on immune cells called T cells. It normally acts as a type of “off switch” that helps keep the T cells from attacking other cells in the body.
Monoclonal antibodies that target either PD-1 or PD-L1 can block this binding and boost the immune response against cancer cells. These drugs have shown a great deal of promise in treating certain cancers.
PD-1 inhibitors: These drugs are given by IV (intravenously). Examples of drugs that target PD-1 include:
- Pembrolizumab (Keytruda)
- Nivolumab (Opdivo)
CART-T therapy
CAR-T – chimeric antigen receptor T-cell – therapy is specifically developed for each individual patient and involves reprogramming the patient’s own immune system cells which are then used to target their cancer. It is a complex and potentially risky treatment, but it has been shown in trials to possibly cure or improve survival in some patients with diffuse large-B-cell lymphoma, mantle cell lymphoma, acute lymphoblastic leukaemia and myeloma where other available treatments have failed.
Click on to Blood Cancer UK website
Autologous stem cell transplant
Autologous stem cell transplants are typically used in people who need to undergo high doses of chemotherapy to cure their disease or to improve survival. An autologous stem cell transplant helps to replace the damaged bone marrow following high-dose chemotherapy.
An autologous stem cell transplant is most often used to treat:
- Hodgkin’s lymphoma
- Myeloma
- Non-Hodgkin’s lymphoma
- Plasma cell disorders
Click Lymphoma Action and Myeloma UK website
Allogeneic stem cell transplant (donor transplant)
A donor stem cell transplant or allogeneic stem cell transplant is a treatment for blood cancers that are usually acute leukaemias. This treatment replaces bone marrow that is no longer working properly with healthy stem cells from another person (your donor).
The donor stem cells make new red blood cells, white blood cells and platelets. This gives you a new, healthy bone marrow.
Your donor may be a family member or an unrelated donor. Some people may be given stem cells from an umbilical cord (called a cord blood donation).
View the Blood Cancer UK website for further info.