Learning about your lymphoma can be like learning a new language. It takes time and practice. Please keep this information handy so you can refer back to it as often as you need to.
New treatments for lymphoma are changing how we treat this complex group of cancers. Two of the newest types of treatment are Bispecific Antibodies and Antibody Conjugates. Both are advanced types of Monoclonal Antibodies (MABs).
MABs work by helping your immune system find and destroy lymphoma cells more effectively.
What Does “Monoclonal” Mean?
The word monoclonal means made from one (mono) single type of cell that is cloned (duplicated) many times. Scientists make monoclonal antibodies in a laboratory so they are identical and target a specific antigen (protein or receptor) on lymphoma cells.
What Are Antibodies?
Antibodies are natural proteins made by plasma cells to fight infection. Plasma cells are specialised mature B-cell lymphocytes — an important part of the immune system.
Each antibody locks onto a specific target called an antigen. All cells (healthy and unhealthy) have antigens, but each antibody recognises only one type. This helps the immune system destroy germs or diseased cells.
Scientists copy and genetically modify antibodies to target lymphoma cells specifically. These are then cloned and used as medicine.
Rituximab
Rituximab is a monoclonal antibody used in Australia since 1998. It targets an antigen called CD20.
It was first approved for Diffuse Large B-cell Lymphoma (DLBCL) and is now used in many CD20-positive Non-Hodgkin Lymphoma subtypes.
Many people have achieved long-term remission or cure because of rituximab.
Common Side Effects of All MABs
- Fever and/or chills
- Severe tiredness (fatigue)
- Headache
- Muscle aches or weakness
- Rash or itching
- Nausea
- Diarrhoea
- Low blood pressure during infusion
- Infusion-related reactions (usually mild and temporary)
Premedication (paracetamol, antihistamines, steroids) is often given to reduce these effects.
Bispecific Antibodies
How They Are Made
Bispecific antibodies combine two antibody parts into one molecule:
- One part attaches to the lymphoma cell
- The other part attaches to a T-cell
This brings T-cells directly to the lymphoma so they can destroy it.
How They Work
They act as a bridge between T-cells and lymphoma cells. When bound, T-cells release cytokines (immune chemicals) that kill lymphoma cells and activate other immune cells.
Approved Treatments in Australia
- Epcoritamab (Epkinly®) – Relapsed/Refractory DLBCL
- Blinatumomab (Blincyto®) – B-cell Acute Lymphoblastic Leukemia/Lymphoma
- Glofitamab (Columvi®) – Approved but not yet publicly funded (as of November 2025)
Side Effects
Common: Fever, chills, fatigue, rash, mild diarrhoea, low blood counts.
Serious:
- Cytokine Release Syndrome (CRS)
- Neurological effects (ICANS)
- Severe infection
Cytokine Release Syndrome (CRS)
CRS is the most common serious side effect. It happens when your immune system produces large amounts of cytokines.
CRS always causes fever. If you develop a fever of 38°C or higher after treatment:
Go to the emergency department immediately AND call your haematologist or specialist lymphoma nurse.
Symptoms of CRS
- Low blood pressure
- Low oxygen levels
- Nausea or vomiting
- Difficulty swallowing
- Extreme fatigue
- Shortness of breath
- Dizziness
- Confusion
- Diarrhoea
- Body aches
- Rash
- Swelling
CRS is treatable but may require urgent medication such as Tocilizumab.
Neurotoxicity (ICANS)
ICANS (Immune Associated Neurotoxicity Syndrome) can occur due to cytokine release.
Symptoms
- Difficulty talking
- Difficulty writing
- Confusion
- Difficulty concentrating
- Agitation
ICANS needs urgent treatment but is usually reversible.
Antibody Conjugates
How They Work
Antibody conjugates attach a toxin, chemotherapy drug, or radioactive particle to an antibody. The antibody delivers the medicine directly to lymphoma cells.
Examples in Australia
- Brentuximab vedotin (Adcetris®)
- Polatuzumab vedotin (Polivy®) – Approved but not publicly funded
- Loncastuximab tesirine-lpyl (Zynlonta®) – Not PBS listed
Common Side Effects
- Tiredness
- Nausea
- Diarrhoea
- Low blood counts
- Peripheral neuropathy
Serious Side Effects
- Severe infection
- Liver, kidney, heart or lung changes
- Infusion reactions
- Tumour Lysis Syndrome (TLS)
Tumour Lysis Syndrome (TLS)
TLS happens when large numbers of lymphoma cells break down quickly. It is serious but very treatable if detected early.
Safety Screening Before Treatment
- Hepatitis B & C testing
- Tuberculosis screening
- Heart, liver, lung and kidney function tests
- Pregnancy testing
- Medication review
- Allergy history
Infection Prevention
- Wash hands regularly
- Avoid sick people
- Wash fruit and vegetables
- Avoid buffets
- Only eat fresh leftovers (less than 24 hours old)
- Take prescribed antibiotics/antivirals
Fertility, Contraception & Breastfeeding
Do not become pregnant during treatment. Use barrier protection. Ask your doctor about fertility preservation before treatment.
More information:
Pregnancy and Lymphoma
During and After Treatment
Treatments are given via injection under the skin or intravenous infusion. Premedication is given beforehand.
You may need overnight monitoring during early doses.
Call Your Doctor Immediately If You Have:
- Fever ≥ 38°C
- Shortness of breath
- Chest pain
- Confusion or seizures
- Yellowing of skin/eyes
- Severe tingling or weakness
Clinical Trials
Search trials at:
www.australiancancertrials.gov.au
Support & Resources
Lymphoma Australia
- Website: www.lymphoma.org.au
- Nurse Hotline: 1800 953 081
- Email: nurse@lymphoma.org.au
- YouTube: Lymphoma Australia Channel
Disclaimer
This information was written in November 2025. It does not replace medical advice. Always speak with your doctor about the best treatment options and possible side effects.
