You might not be aware that non-Hodgkin lymphoma (NHL) is actually a large group of blood cancers that encompasses more than 60 different subtypes. These subtypes can either be aggressive (fast-growing) or indolent (slow-growing) and may have different treatment approaches depending on the subtype.
Out of all the slow-growing subtypes of NHL, follicular lymphoma is the most common, accounting for about 11% of all NHL. Although follicular lymphoma almost always responds to initial treatment, it often relapses, usually years later.
What is Follicular Lymphoma?
Non-Hodgkin lymphomas begin in specific types of white blood cells called lymphocytes. Lymphocytes are manufactured in the bone marrow and circulate through the blood and through the lymphatic system of vessels and lymph nodes. The two main categories of lymphocytes are called B lymphocytes (or B cells) and T lymphocytes (or T cells). While subtypes of NHL include both T-cell NHL and B-cell NHL, B-cell subtypes are more common. B cells produce proteins called antibodies, which play a key role in helping the immune system fight infection and disease.
Standard Treatments for Follicular Lymphoma
Follicular lymphoma tends to grow slowly but occasionally progresses more quickly. Most patients present with advanced-stage disease, meaning that the lymphoma has spread around the body through the lymphatic system. Follicular lymphoma also often involves the bone marrow. Learn more about NHL staging.
Patients with advanced-stage follicular lymphoma can be divided into two groups: those with “high-tumor burden,” meaning the disease is bulky or causing symptoms or problems to the patient, and “low-tumor burden,” meaning the disease is not causing symptoms or immediate danger. Studies have shown that there is no benefit to patients to treat the disease before it reaches a high tumor burden, so patients often undergo a course of watchful waiting before initiating treatment. In fact, approximately 20% of patients who undergo watchful waiting do not require therapy for at least a decade, if at all.
Once treatment is determined to be necessary, there are several treatment options. These include the following:
- Chemotherapy. These are drugs that kill lymphoma cells throughout the body. The drugs are most often given intravenously (through a vein). The drugs then travel through the bloodstream, reaching lymphoma cells in almost all parts of the body.
- Targeted therapy. These drugs usually target specific, important proteins within cancer cells, thereby leading to death of cancer cells.
- Immunotherapy. Immunotherapy generally refers to the use of antibodies that target various proteins on cells. In follicular lymphoma, the monoclonal antibodies rituximab and obinutuzumab both target a protein called CD20 on the surface of the lymphoma cell and help to kill the lymphoma cell. Chimeric antigen receptor-modified (CAR) T-cell therapy is another recent advancement in lymphoma treatment. In this treatment, T-cells are genetically modified in a lab to allow them to better kill lymphoma cells. Finally, bispecific antibodies are a new class of immunotherapy for lymphoma, discussed further below.
- Radiation therapy. Radiotherapy uses high-energy rays to kill lymphoma cells. Follicular lymphoma is very sensitive to radiation therapy, which can be used to target bulky areas of tumor that have not been completely eradicated with drug therapies.
Lunsumio: A New Class of Immunotherapy for the Treatment of Advanced Follicular Lymphoma
The U.S. Food and Drug Administration (FDA) recently approved Lunsumio® (mosunetuzumab), a new immunotherapy for treating advanced follicular lymphoma. The drug is approved in cases where the patient’s follicular lymphoma returned or worsened after at least two earlier treatments. Lunsumio is the first bispecific antibody approved to treat any type of non-Hodgkin lymphoma.
In the clinical trials that led to the FDA approval of Lunsomio for patients with follicular lymphoma, about 80 percent of patients responded to the treatment. In about 60 percent of patients, the lymphoma went into a complete remission, meaning that the lymphoma was not detected on a scan after treatment.
Related reading: Why Would You Participate in a Clinical Trial?
How Lunsumio Works Against Lymphomas
Current treatments for non-Hodgkin lymphomas, such as CAR T immunotherapy and other targeted therapies, work on only a single target. Lunsumio differs in that it is a bispecific antibody that simultaneously binds to protein targets on both the malignant B cell and the nonmalignant T cell. When binding occurs, Lunsumio stimulates the patient’s T cell to secrete substances that lead to death of the cancerous B cell.
Lunsumio is given through an infusion in an outpatient setting. If your RMCC blood cancer specialist has recommended adding Lunsumio to your treatment plan, you can expect to receive the drug once a week for the first three weeks and then once every three weeks at one of our Colorado cancer centers.
As with most cancer treatments, there are some side effects that patients have reported after receiving Lunsumio. The most serious risk associated with Lunsumio is Cytokine Release Syndrome (CRS), which can produce symptoms ranging from mild to severe. Signs and symptoms of CRS can include:
- Fatigue or weakness
- Headache
- Trouble breathing
- Fever and chills
- Low blood pressure
- Anxiousness
- Irregular or rapid heartbeat
- Nausea and/or vomiting
- Dizziness or lightheadedness
Fortunately, most patients treated with Lunsumio do not experience serious CRS. If you are a patient treated with Lunsumio, contact your cancer care team immediately if you experience any of these symptoms. Other potential side effects of Lunsumio include immune suppression and susceptibility to infections.
Lunsumio Treatment Available at Rocky Mountain Cancer Centers for Patients With Advanced Follicular Lymphoma in Colorado
The Rocky Mountain Cancer Centers hematologists are dedicated to caring for people with all types of lymphoma, including hard-to-treat NHL subtypes. If you or a loved one was diagnosed with follicular lymphoma that has returned or been unresponsive to previous non-Hodgkin lymphoma treatments, please reach out for a consultation regarding the possible use of Lunsumio.
Our blood cancer specialists care for patients in Denver, Colorado Springs, Boulder, and throughout the Front Range. Request an appointment at a location near you. We also offer second opinions so you can feel confident in our multidisciplinary approach and recommended treatment. All of our lymphoma treatments, including Lunsumio, can be administered close to home at one of our convenient locations.
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