Can immunotherapy increase the effectiveness of following treatments for patients with relapsed or unresponsive non-Hodgkin lymphoma?

This study examined if pre-treatment with immunotherapy could improve the effectiveness of following treatment for patients with hard-to-treat non-Hodgkin lymphoma (NHL). The results indicated that immunotherapies increased the effectiveness of other treatments such as chemotherapy for some patients.

While most patients have success with treatment for NHL, some do not respond to treatment (refractory) and NHL returns after treatment to others (relapsed). Patients with relapsed/refractory NHL require other treatment options. 

Immunotherapies that prevent cancer cells from switching off the immune system have been successful for other types of cancer but less so for patients with NHL. These drugs are called checkpoint blockade therapy (CBT). It is possible, however, that pre-treatment with CBT could make NHL more sensitive to other treatments such as chemotherapy.

59 patients with relapsed or refractory NHL were given CBT before other treatments. Patients had received an average of 3 therapies before CBT. After CBT, 49% of patients received chemotherapy, 30% received targeted therapy, 17% participated in a clinical trial, 2% received high-dose chemotherapy and 2% received chimeric antigen receptor T cell (CAR-T) therapy. Patients were followed for an average of 12.6 months.

After CBT, 51% of patients responded to further treatments. 19% of patients had no signs of NHL following both treatments and 32% had a significant reduction. The effects of treatment lasted 138 days on average. For the 41 patients where cancer did not grow following both treatments, the effects of treatment lasted 310 days.

Of the patients who received chemotherapy after CBT, 48% had a reduction in NHL. 56% of patients who received targeted therapy after CBT had a reduction in NHL. NHL was reduced in 50% of patients who participated in clinical trials following CBT.

After 12.6 months, 34% of patients had no signs of NHL (remission). The average survival of patients before cancer worsened was 6.3 months.

The authors concluded that CBT can be used to sensitize relapsed or refractory NHL to other treatments.

No comparison treatment was used so it is difficult to compare this treatment strategy to others. This study would benefit from including more patients and focusing on treatment types and NHL subtypes more. This study used medical records data, meaning that not all information was available.