Some types of immunotherapy have been approved to treat leukemia, a cancer of the white blood cells. Cancer immunotherapies are medications that help a person’s natural immune system recognize and fight cancer.

There are four main types of leukemia:

• Acute myeloid leukemia (AML)
• Acute lymphoblastic leukemia (ALL)
• Chronic myeloid leukemia (CML)
• Chronic lymphocytic leukemia (CLL)

Immunotherapies that are effective at treating one type of leukemia may not effectively treat other types.

Benefits of Using Immunotherapy To Treat Leukemia

Using a person’s own immune system to fight cancer has several benefits:

• The immune system can tell the difference between a person’s normal cells and leukemia cells.
• The immune system is capable of continually attacking cancer cells — even after those cells have become resistant to medications.
• The immune system remembers what cancer cells look like, so it can target and kill cancer cells even faster if they try to return later.

Immunotherapy drugs harness these qualities to provide treatment that is more targeted to cancer cells and that usually causes milder side effects compared to other treatments.

Types of Immunotherapy for Leukemia

There are multiple types of immunotherapies. Though each type works by a different mechanism, they all help the immune system target and kill leukemic cells.

Targeted Antibodies

Targeted antibodies are designed to affect one or more specific immune pathways. Antibodies are made naturally by the immune system to bind to specific targets, including bacteria, viruses, and cancer cells. Scientists have learned how to synthesize some of the antibodies that are most effective at fighting cancer.

Targeted antibodies include:

• Monoclonal antibodies, which target one specific pathway
• Bispecific antibodies, which can target multiple pathways
• Antibody-drug conjugates, which are antibodies combined with a drug to deliver the drug to a specific target

Campath (alemtuzumab) is a monoclonal antibody approved to fight CLL.

Blincyto (blinatumomab) is a bispecific antibody with two targets: a tumor-cell target and a T-cell target. T cells work to signal other immune cells, regulate the immune response, and kill cancer cells directly. Blinatumomab works by bringing T cells close to cancerous cells and activating them to kill. The U.S. Food and Drug Administration (FDA) has approved it for refractory (treatment-resistant) ALL.

Mylotarg (gemtuzumab ozogamicin) and Besponsa (inotuzumab ozogamicin) are antibody-drug conjugates. The combination delivers toxic drugs specifically to cancer cells. These targeted antibodies have been approved for some adults and children living with ALL.

Gazyva (obinutuzumab), Rituxan (rituximab), and Arzerra (ofatumumab) are monoclonal antibodies that have been FDA-approved to fight CLL. In some cases, they are a part of initial treatment.

Adoptive Cell Therapies

Adoptive cell therapies entail taking out a person’s T cells, growing them in a laboratory, and then giving the T cells back to the person. Chimeric antigen receptor (CAR) T-cell therapy is a type of adoptive cell therapy, in which the T cells are taught how to better attack and kill cancer cells in the laboratory and then given back to the person with leukemia.

Kymriah (tisagenlecleucel) is a CAR T-cell therapy approved to treat some children and young adults with ALL.

See what Dr. Matt Kalaycio says about uses for CAR-T therapies.

Immunomodulators

Immunomodulators work to stimulate or suppress the immune system. Examples of immunomodulators include vaccines, cytokines, and the medication levamisole. So far, only two cytokines have been approved for the treatment of leukemia: interferon alfa-2a and interferon alfa-2b.

Interferon alfa-2a is a cytokine approved for some people living with Philadelphia chromosome-positive CML and hairy cell leukemia.

Interferon alfa-2b is a cytokine approved for some people living with hairy cell leukemia.

Side Effects of Immunotherapy Treatment

Like many cancer treatments, immunotherapy may work well for some people and not for others. Side effects of immunotherapy are often different from those of typical cancer treatments. They are usually caused by stimulation of the immune system. Side effects are typically minor and can include:

• Fever
• Skin reactions
• Fatigue
• Nausea
• Body aches
• Headaches
• Changes in blood pressure
• Chills
• Other flu-like symptoms

However, major life-threatening side effects have also been reported. Oncologists and researchers are working to better understand the risk factors for severe immunotherapy side effects.

Clinical Trials for Leukemia Immunotherapies

There are ongoing clinical trials to test new targeted antibodies, cancer vaccines, immunomodulators, adoptive cell therapies, and oncolytic virus therapies. Many immunotherapies that haven’t been approved specifically to fight leukemia are available through these trials.

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people living with leukemia and their loved ones. On MyLeukemiaTeam, more than 8,600 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Have you had immunotherapy for leukemia? Share your experience in the comments below, or start a conversation by posting on MyLeukemiaTeam.