Leukaemia

Biological therapies

Biological or immuno-therapies are derived from, or target substances that occur naturally in the body. They have been designed or modified in the laboratory to target and destroy particular types of cancer cells. Biological therapy may be used together with other treatments for various kinds of leukaemia but for chronic myeloid leukaemia (CML) it is used alone as first line treatment.

Imatinib (Glivec)
In CML, the uncontrolled multiplication of white blood cells is a caused by a growth signal being permanently switched to “on”. The biological drug imatinib (Glivec) attacks the growth signal, stopping the uncontrolled growth, producing remission. Following development and clinical trials during the 1990s, imatinib came into routine use in Britain in 2002, revolutionising the treatment and prognosis of CML. People we spoke to had been among the first to have it in the UK. Some initially had it in a clinical trial and continued taking it afterwards. Another woman obtained the drug outside a trial but before it was routinely used in the NHS.

Imatinib (Glivec) is taken daily as a single capsule or tablet, or four smaller tablets. Most people took it with their evening meal to avoid nausea. Having felt sick after taking it in the mornings, one woman preferred to take it at bedtime. Most people had few or mild side-effects, but Elizabeth at first reacted badly to the drug, was hospitalised and had to stop and restart it repeatedly before achieving remission (see ‘Unwanted effects of treatments’).
Imatinib is also used as a treatment for people with Philadelphia chromosome positive acute lymphoblastic leukaemia (Ph+ ALL) and has improved the prognosis of these patients when it is combined with chemotherapy. Bone marrow transplant remains the recommended treatment for this disease.

Newer biological therapies for CML
There are two new biological therapies that are similar to imatinib (Glivec), dasatinib (Sprycel) and nilotinib (Tasigna), and can be given when people with CML do not respond, become resistant to imatinib or have too many side effects on imatinib. Other drugs are also being developed.

Monoclonal antibodies
The body makes antibodies in response to infection, enabling the immune system to recognise infections it has met before and deal with them quickly. Monoclonal antibodies made in a laboratory can recognise particular types of cancer cells and make the immune system attack them. 

Rituximab (Mabthera)
This targets a protein on the surface of B lymphocytes (a type of white blood cell) and destroys them. It is given intravenously and is used mainly to treat non-Hodgkin’s lymphoma but now also CLL in combination with chemotherapy (FCR). Rituximab may also be used to treat B-cell ALL.One man with chronic lymphocytic leukaemia (CLL) was given it after his lymphocytes attacked his red blood cells causing them to break down (haemolysis). This autoimmune haemolytic anaemia (AIHA) is a complication of CLL. Later he received another monoclonal antibody, alemtuzumab (MabCampath), as part of preparation for a stem cell transplant.

Glyn was given alemtuzumab (MabCampath) after his CLL had not responded to chemotherapy. He went to hospital three days each week and initially was given the drug intravenously, then by injection under the skin (subcutaneously).

Gemtuzumab (Mylotarg) is a combination of a monoclonal antibody and a chemotherapy drug. The ending '-mab' in the name indicates that it is a monoclonal antibody. It attaches to a protein on the surface of leukaemia cells thereby destroying them without harming normal cells. Some people with acute myeloid leukaemia (AML) were given a drug called gemtuzumab (Mylotarg) as part of a clinical trial. There are other biological therapies for AML which are currently being tested as part of clinical trials, but are not yet licensed in the UK. These are; clofarabine (Evoltra), everolimus (Afinitor) and CEP701.

Lenalidomide (Revlimid)
Lenalidomide can block the growth of blood vessels and so prevent cancers spreading. It is a new drug whose action is not fully understood and it is not routinely used in leukaemia. Glyn’s doctors applied to the local Primary Care Trust for permission to give him lenalidomide after chemotherapy and antibody therapy had not worked. The drug is taken as capsules at home and Glyn had a slight upset stomach at first. He had no other side effects and his CLL is now in remission.

Vaccines
Vaccines have long been used to stimulate the immune system to fight bacteria and viruses and they are now being developed to fight cancer cells in the same way. Elizabeth heard about a trial in the USA of a vaccine to be taken alongside imatinib (Glivec) and got permission from her doctors to take part. She paid for her travel to America but once there the drug company covered all expenses. She had some of her CML cells harvested to tailor the vaccine to her disease before receiving nightly injections of the vaccine. Her white blood cell count dropped temporarily but then rose again.

Tretinoin (Vesanoid; ATRA)
This drug is a form of vitamin A. It is given alongside chemotherapy to people with a type of AML called acute promyelocytic leukaemia (APML). It helps the leukaemic cells to mature normally. Side effects are common but it may be difficult to distinguish them from those caused by chemotherapy.

“It’s important not to become pregnant while taking ATRA. It shouldn’t be given to women who are under 12 weeks pregnant as this can cause damage to the developing baby. After 12 weeks it can be given safely. It’s usually given without chemotherapy as this is safer for the baby and still effective. “ (Macmillan Cancer Support)

*CML – Chronic myeloid leukaemia

Last reviewed: August 2015.
Last updated: August 2015.

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