About Lymphoma | Advocacy | Art | CAM | Clinical trials | Doctors - Experts - Centers | Guidelines at Diagnosis | News
Risk Factors | Side Effects | Statistics | Support | Symptoms | Tests | Treatments | Types of Lymphoma

Search Site         Guidelines at Diagnosis | About Clinical Trials            How to Help!

Patients Against Lymphoma

 

Treatments > Biologics

Last update: 03/23/2014

TOPICS
   
CpG | G-CSF (Neupogen) | GM-CSF (Leukine) |
INF-alpha & Pegylated INF | IL-2 (Proleukin)IL-11 (Neumega) | IL-12 | Pegfilgrastim (Neulasta) | Erythropoietin (Procrit)  
Tips on Giving Subcutaneous Injections

Also see Biologics Index | Antibodies for NHL | Rituxan

What is a Biologic? 

The FDA considers a biologic to be any therapeutic serum, toxin, antitoxin, vaccine, virus, blood, blood component or derivative, allergenic product, or analogous product, or derivatives applicable to the prevention, treatment, or cure of injuries or disease of man. 

Resources

bullet
Presentation: Growth factors in cancer care  curetoday.com pdf 
bullet
Safety Information on Therapeutic Biological Products  FDA.gov

Name

Description & Links

CpG
Stimulates immunity
Related Abstracts
Return to top

CpG oligonucleotides

Main purpose:  Experimental; immune modulator

"CpG activates the immune system in the way it evolved to be activated, by detection of bacterial products. You activate a well-orchestrated symphony of responses that synergize with each other." Everything enters on cue: cells, cytokines, and actions. Toxicity is minimal. Immune factors, although great medicines, drive "an artificial, disorganized response. You have to use very high doses to get any activity, and because of that, you also get a lot of toxicity."  Sponsor's description
 

bullet
Background: Coley Toxin's Hidden Message From a 19th century mystery comes a potential new class of drugs: CpG oligonucleotides
bullet
Boosting Mabs and vaccines? CpG-DNA activates dendritic cells in vivo: T helper cell-independent cytotoxic T cell responses to soluble proteins. Eur J Immunol. 2000 Dec;30(12):3591-7 Related abstracts
G-CSF
Stimulates blood cell development
Neupogen® 
(filgrastim)

Neulasta ®
(pegfilgrastim)

Related Abstracts
Return to top

Granulocyte Colony Stimulating Factor 

Main purpose: Treatment of neutropenia (low white blood cell counts)

Use in myelosuppressive chemotherapy in nonmyeloid malignancy, decrease neutropenia interval in BMT; mobilizing Peripheral Blood Stem Cells (PBSC)

Potential Benefits: Can decrease risk of infection, and help cancer patients continue their treatment without interruption.

bullet
Precautions and common side effects  chemocare
bullet
Details  rxlist.com
bullet
Ann Oncol (2011):Randomized comparison of pegfilgrastim day 4 versus day 2 for the prevention of chemotherapy-induced leukocytopenia http://bit.ly/X8SR0X

Patients of age 61–80 years with aggressive lymphoma were randomly assigned to receive 6 mg pegfilgrastim on day 2 or 4 of a 2-week chemotherapy regimen (R-CHOP-14). 
bullet
Impact of granulocyte colony-stimulating factor (CSF) and granulocyte-macrophage CSF in patients with malignant lymphoma: a systematic review. Br J Haematol. 2003 Aug;122(3):413-23. Review. PMID: 12877668
  
In conclusion, G-CSF/GM-CSF given during conventional chemotherapy in malignant lymphoma patients reduced the RR of neutropenia, febrile neutropenia and infection. However, there is no evidence that G-CSF/GM-CSF improved CR and OS in this clinical setting.
bullet
ASCO 2003  Risk of Infection Doubles With Reduced (Filgrastim) Administration
 
- Optimal Usage of White Blood Cell Stimulator Important to Facilitating Dose-Dense Chemotherapy Regimens  docguide.com
bullet
Tips and Resources for giving subcutaneous Injections  PAL
 
 
GM-CSF
a growth factor, that helps to increase the number and function of white blood cells
Leukine® 
(Sargramostim)

Stimulates progenitor cells to divide and differentiate in the granulocyte-macrophage pathways.

Related Abstracts
Return to top

Granulocyte-macrophage colony stimulating factor
(Leukine / Sargramostim)

Main purpose: Treatment of neutropenia (low white counts). Increases myeloid (blood cell) recovery. Treats delayed engraftment in bone marrow transplants (BMT). Helps mobilize peripheral blood stem cells. Treats neutropenia following BMT/PBSCT. Used experimentally to improve immune therapies, such as therapeutic cancer vaccines. 

Potential Benefits: Can decrease risk of infection, and help cancer patients continue their treatment without interruption. 

Common side effects MedlinePlus 
 
"
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment.  Patients should check with their physician about any side effects that continue or are bothersome."  *

For a list of common side effects see: 
 * chemocare 

Uncommon side effects
 
"
You should always inform your health care provider if you experience any unusual symptoms."  

For a list of many uncommon side effects see:  *

Contraindications: rxlist.com  Patients with:

bullet

Excessive leukemic myeloid blasts in the bone marrow or 
peripheral blood.

bullet

Known hypersensitivity to GM-CSF, yeast-derived products or any component of the product

bullet
About    RxMed | Leukine | MedlinePlus | FDA | cancerbacup.org.uk
bullet
Leukine (gm-csf) details   berlex.com 
bullet
Granulocyte-Macrophage Colony-Stimulating Factor Receptor
Stage-Specific Expression and Function on Late B Cells  bloodjournal.org pdf 
By K.J. Till, J. Burthem, A. Lopez, and J.C. Cawley
Using sensitive triple-layer immunophenotypic techniques, we show here that both the (Y and @. chains of the GMR are expressed on hairy cells (HCs) and myelomatous plasma cells (PCs), but not on chronic lymphocytic leukemia (CLL) or prolymphocytic leukemia (PLL) lymphocytes. The receptor was demonstrable on normal PCs in  tonsil, but not on either activated or resting tonsillar B cells or on circulating normal B lymphocytes.
bullet
Impact of granulocyte colony-stimulating factor (CSF) and granulocyte-macrophage CSF in patients with malignant lymphoma: a systematic review. Br J Haematol. 2003 Aug;122(3):413-23. Review. PMID: 12877668
  
In conclusion, G-CSF/GM-CSF given during conventional chemotherapy in malignant lymphoma patients reduced the RR of neutropenia, febrile neutropenia and infection. However, there is no evidence that G-CSF/GM-CSF improved CR and OS in this clinical setting.
bullet
Precautions and common side effects  MedlinePlus
bullet
Neutralizing antibodies to granulocyte-macrophage colony-stimulating factor, interleukin-1a and interferon-a, but not other cytokines in human immunoglobulin preparations  blackwell-synergy.coml
bullet
Immediate hypersensitivity to human recombinant granulocyte-macrophage colonystimulating factor associated with a positive prick skin test reaction - Renata J M Engler, MD* and Raymond B Weiss, MD  PDF
bullet
Tips and Resources for giving subcutaneous Injections
 
 
INF-alpha 
Antiviral; modulates immunity
Also see Pegylated INF below
Benefit to survival?

 "None of the other studies yet, as a single, show any survival benefit, but one had argued and the FDA did approve that if clinically aggressive indolent lymphomas, and that definition is a little bit hard to pin down, are treated with anthracycline- based regimens and then given interferon, there might be a prolongation of the disease-free interval or the failure-free survival, about a year and half. That needs to be managed and measured against the toxicity of those patients getting interferon for that period of time."

SOURCE: Current Therapies in the Treatment of Non-Hodgkin's Lymphoma: Chemotherapy, Richard I. Fisher, MD - Medscape 
(free login req.)
Related Abstracts
Return to top

Interferon Alpha 2b

"Interferon is called so, because they interfere with viral RNA and protein synthesis; interferon probably induces enzymes that destroy viral RNA and other proteins. Human can produce at least 3 types of interferon (a, b, g); they are glycoproteins with a molecular weight of 20-25 kD".  mfi.ku.dk

Main purpose: Adjuvant treatment for lymphoma

Use as consolidation of chemotherapy treatment (see below); Investigational use in combination with Rituxan.

bullet
About Interferon  cancerbacup.org.uk  
bullet
Interferon interacts with p53 to provide defense against cancer and viruses 
oncolink

Potential Benefits: Prolongation of the disease-free interval or the failure-free survival.

Treatment of lymphoma
bullet
ASH 2003 [1437] Increased Angiogenesis Predicts Favorable Outcome in Patients with Follicular Lymphoma Treated with the Combination of Chemotherapy and Interferon-Alpha2b. Session Type: Poster Session 549-I  abstractsview
bullet
Role of interferon-alfa in NHL: still controversial? Oncology (Huntingt). 1999 Aug;13(8):1147-59; discussion 1159-60, 1163. Review. PMID: 10499247  PubMed
bullet
Interferon in Oncological Practice: Review of Interferon Biology, Clinical Applications, and Toxicities  Eric Jonasch, Frank G. Haluska Massachusetts General Hospital, Boston, Massachusetts, USA  alphamedpress.org
bullet
Interferon alpha & Follicular Non-Hodgkin's Lymphoma  www.ncbi.nlm.nih.gov
bullet
Interferons and hematology Rev Med Interne. 2002 Nov;23 Suppl 4:481s-488s. Review. French. PMID: 12481403  PubMed
bullet
Regression of splenic lymphoma with villous lymphocytes after treatment of hepatitis C virus infection. N Engl J Med. 2002 Jul 11;347(2):89-94. PMID: 12110736  PubMed
bullet
Meta-analysis to assess the efficacy of interferon-alpha in patients with follicular non-Hodgkin's lymphoma Medline
Side effects
bullet
Hyperactive stress response to interferon-alpha predicts development of depression  oncolink 
bullet
Managing toxicities of - Interferon in Oncological Practice: Review of Interferon Biology, Clinical Applications, and Toxicities  Eric Jonasch, Frank G. Haluska Massachusetts General Hospital, Boston, Massachusetts, USA  alphamedpress.org
 
PEG-Intron 
Interferon - pegylated
Antiviral; modulates immunity
PEGASYS®
Return to top

 

Interferon -
Pegylated Interferon (Peginterferon alfa-2b)

Main purpose: Antiviral treatment

To help interferon last longer in the body scientists have attached a special strand (a PEG) to the interferon molecule. Once attached, the PEG helps protect the interferon from being destroyed by your immune system. This pegylated Interferon can last longer in the body, which might improve its efficacy and allow for dosing that can reduce side effects.

Potential Benefits: Use as consolidation of chemotherapy treatment (see below); Investigational use in combination with Rituxan.

bullet
ASH 2002:  Quality of Life is Significantly Better with Polyethylene Glycol Interferon than with the Standard Formulation   PeerviewPress.com
bullet
Product  Information  FDA | CenterWatch | hepwatch.com
bullet
Tips and Resources for giving subcutaneous Injections 
IL-11 (oprelvekin)
Neumega® 
Related Abstracts
Return to top

 

IL-11 (oprelvekin)

"Neumega is a platelet growth factor that can help prevent extremely low platelet counts caused by chemotherapy. Treatment with Neumega may help cancer patients continue their treatment without interruption."

Main purpose: Treatment or prevention of low platelets.

"Neumega is a thrombopoietic growth factor that directly stimulates the proliferation of hematopoietic stem cells and megakaryocyte progenitor cells and induces megakaryocyte maturation resulting in increased platelet production."

Potential Benefits: Can decrease risk of bleeding, and help cancer patients continue their treatment without interruption.

  1. About  FDA | MedlinePlus
  2. Randomized placebo-controlled study of recombinant human interleukin-11 to prevent chemotherapy-induced thrombocytopenia in patients with breast cancer receiving dose-intensive cyclophosphamide and doxorubicin. J Clin Oncol. 1997 Nov;15(11):3368-77. PMID: 9363868 

 

IL-12
Related Abstracts
Return to top

 

Interleukin-12

Main purpose:  Experimental; immune modulator

Approved for the treatment of certain types of cancer. 

Potential Benefits: Immune enhancement

Risks: "The major drawback of IL-2 therapy has been significant dose-related toxicity (see next page), which limits its use to patients who have excellent performance status, normal cardiac and pulmonary function, and no active infections." - Thomas Davis et al.  

bullet
About  NCI
bullet
Phase 1 study of interleukin-12 in combination with rituximab in patients with B-cell non-Hodgkin lymphoma. Blood. 2002 Jan 1;99(1):67-74. PMID: 11756154
 
IL-2

 (Aldesleukin)
Modulates immunity
Proleukin® 
Related Abstracts
Return to top

 

Interleukin-2

Main purpose:  Experimental; immune modulator.

Approved for the treatment of certain types of cancer. 

Potential Benefits: Immune enhancement

bullet
Product information  MedlinePlus
bullet
Possible side effects  MedlinePlus
bullet
ASH 2002: Proleukin® Plus Rituxan® may Reduce Recurrences Following Stem Cell Transplant in Non-Hodgkin’s Lymphoma  CancerConsultants.com 
 

 

Pegfilgrastim
Stimulates production of neutrophils
 
Neulasta®
longer lasting version
Related Abstracts
Return to top

 


 
Pegfilgrastim (Neulasta)

Main purpose: Treatment or prevention of low white counts (neutropenia).

Prevention of severe chemotherapy-induced neutropenia - a severe drop in infection-fighting white blood cells (neutrophils). A common side effect of some kinds of chemotherapy

Potential Benefits: Can decrease risk of infection and help cancer patients continue their treatment without interruption.

bullet
FDA: Neulasta® (Pegfilgrastim)
Information for Patients and Caregivers
http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/125031s0142lbl.pdf 
bullet
Pegfilgrastim on the Same Day Versus Next Day of Chemotherapy in Patients With
Breast Cancer, Non–Small-Cell Lung Cancer, Ovarian Cancer, and Non-Hodgkin's
Lymphoma: Results of Four Multicenter, Double-Blind, Randomized Phase II Studies
http://1.usa.gov/1hatNeO

A possible biologic explanation for the increase in FN observed in the same-day arms
may be that the initial stimulation of myeloid progenitor cells by pegfilgrastim
renders these cells more sensitive to the effects of cytotoxic chemotherapy.5,9 This
interpretation is consistent with median ANC curves (Fig 1), in which the measurable
difference in neutrophil kinetics seems to occur before the nadir. Furthermore,
although the magnitude varied by the degree of myelosuppression in each regimen, the
effect was the same in every study.
bullet
Neulasta, full prescribing information:
http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/125031s082lbl.pdf
bullet
Product  Information  MedlinePlus
bullet
Possible side effects  MedlinePlus
bullet
A Single Dose of Pegfilgrastim Is as Effective as Daily Filgrastim to Reduce the Duration of Severe, Chemotherapy-Induced Neutropenia. hemonctoday
bullet
Single Injection Pegfilgrastim Supports Delivery of Dose-Dense Chemotherapy  pslgroup.com/
bullet
Pegfilgrastim (Neulasta) for chemo-induced neutropaenia  docguide.com
Erythropoietin
Stimulates production of erythrocytes --
red blood cells
Procrit® 
 
Related Abstracts
Return to top

 

Erythropoietin or Epoetin

Main purpose: Treatment of anemia of patients on chemotherapy, which causes fatigue.

Stimulates red blood cell production. Triggers the division and differentiation of committed erythroid progenitors in the bone marrow.

Potential Benefits: Can reduce fatigue and help cancer patients continue their treatment without interruption.

bullet
About  MedlinePlus | noblood.com
bullet
Possible side effects  MedlinePLus
bullet
Use of Epoetin in Patients With Cancer  ASCO.org | Full text PDF
bullet
Epoetin therapy is effective against anemia - Randomized, double-blind, placebo-controlled trial of recombinant human erythropoietin, epoetin Beta, in hematologic malignancies. J Clin Oncol. 2002 May 15;20(10):2486-94. PMID: 12011126
 abstract
Subcutaneous Injections
Return to top

Subcutaneous Injections

bullet Tips for giving subcutaneous injections
Rituxan
Return to top
bullet
See Rituxan
 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
Patients Against Lymphoma, Copyright © 2004,  All Rights Reserved.