Checkpoint inhibitors, monoclonal antibodies and CAR-T pathways — Dr. Basudev Pokhrel brings the most current immunotherapy protocols to Hyderabad, available at CION Cancer Clinics, Banjara Hills.
Immunotherapy is not one drug — it's a category of treatments that harness or activate the immune system to attack cancer. In blood cancers, it has transformed outcomes over the last 15 years.
The immune system is designed to recognise and destroy abnormal cells — including cancer cells. Blood cancers have evolved mechanisms to hide from this surveillance — suppressing the immune response, disguising themselves as normal cells, or exhausting the T-cells meant to kill them. Immunotherapy works by disrupting these evasion strategies.
In haematology, immunotherapy has been transformative. Rituximab — introduced in the late 1990s — changed the treatment of B-cell lymphomas fundamentally. Bortezomib and thalidomide-based immunomodulatory drugs changed myeloma. Pembrolizumab in Hodgkin lymphoma achieves response rates that chemotherapy alone couldn't touch. And CAR-T therapy is producing complete remissions in patients who had failed every other treatment.
I include immunotherapy as a core component of my clinical practice — not as an experimental option but as standard of care where evidence supports it. Whether it's rituximab in lymphoma, daratumumab in myeloma, or pembrolizumab in Hodgkin disease, the goal is always to give each patient the most effective current protocol for their specific cancer.
Unleashing the immune system
Cancer cells exploit immune "checkpoints" — proteins like PD-1 and CTLA-4 — to switch off T-cells that would otherwise attack them. Checkpoint inhibitors block these proteins, allowing the immune system to recognise and destroy cancer cells.
In blood cancers, pembrolizumab and nivolumab are now standard therapy for relapsed Hodgkin lymphoma and have shown activity in several non-Hodgkin subtypes. Response rates in Hodgkin lymphoma exceeded 65–80% in major trials — results that were unimaginable with prior salvage regimens.
Targeted immune attacks
Monoclonal antibodies are engineered proteins that bind to specific targets on cancer cells — marking them for destruction by the immune system or directly blocking their growth signals. Some carry toxic payloads directly to the cancer cell (antibody-drug conjugates).
Rituximab (anti-CD20) revolutionised B-cell lymphoma treatment two decades ago and remains standard today. Daratumumab (anti-CD38) has transformed myeloma. Blinatumomab (BiTE — bispecific T-cell engager) brings T-cells directly to leukaemia cells.
Engineering your own immune cells
CAR-T (chimeric antigen receptor T-cell) therapy involves collecting T-cells from the patient's blood, engineering them in a laboratory to express receptors that target specific cancer proteins, and returning them to the patient as a living drug. The engineered T-cells hunt and kill cancer cells expressing that target.
CAR-T has produced complete remissions in patients with relapsed/refractory B-cell lymphoma, ALL and myeloma who had failed all other treatments. Dr. Basudev manages the complete CAR-T clinical pathway — from eligibility assessment through to post-infusion monitoring and management of complications.
Each blood cancer has specific immunotherapy agents that are standard of care or evidence-supported. Here's what's used and when.
Pembrolizumab and nivolumab are standard second-line treatment for relapsed/refractory Hodgkin lymphoma. Brentuximab vedotin (anti-CD30 antibody-drug conjugate) is used both in relapsed disease and increasingly in frontline therapy for advanced Hodgkin disease. Response rates are exceptionally high — Hodgkin lymphoma is one of the most immunotherapy-responsive cancers known.
Rituximab combined with chemotherapy (R-CHOP) is standard first-line treatment for most B-cell NHLs. Obinutuzumab has replaced rituximab in some CLL and follicular lymphoma settings. For relapsed aggressive NHL, polatuzumab vedotin and CAR-T (axicabtagene, tisagenlecleucel) achieve remissions where chemotherapy fails.
Daratumumab is now used in both newly diagnosed and relapsed myeloma — often in combination with bortezomib and lenalidomide. Isatuximab (another anti-CD38) is also approved. For relapsed/refractory myeloma, anti-BCMA CAR-T (ciltacabtagene, idecabtagene) achieves deep and durable responses in patients who have failed multiple prior lines.
Blinatumomab (BiTE antibody) is approved for relapsed/refractory B-cell ALL and has been incorporated into frontline therapy for MRD-positive ALL. Inotuzumab ozogamicin (anti-CD22 antibody-drug conjugate) achieves high remission rates in relapsed ALL. CAR-T (tisagenlecleucel) is approved for paediatric and young adult relapsed ALL.
Obinutuzumab and rituximab are used alongside targeted oral agents in CLL. Venetoclax — a BCL-2 inhibitor with immunomodulatory properties — combined with obinutuzumab achieves MRD-negative remissions in a significant proportion of patients, with fixed-duration therapy replacing lifelong oral agents as an option.
Azacitidine (hypomethylating agent) has immunomodulatory properties beyond its direct DNA methylation effects. Magrolimab (anti-CD47) combined with azacitidine is being studied for high-risk MDS. Lenalidomide has immunomodulatory properties central to its effectiveness in del(5q) MDS and myeloma.
Chemotherapy kills rapidly dividing cells — cancer cells and some normal cells (hair follicles, gut lining, bone marrow) — which causes the well-known side effects. Immunotherapy doesn't directly kill cells. Instead, it activates or modifies the immune system to recognise and attack cancer cells specifically. The side effect profile is different — immune-related side effects (inflammation of lungs, liver, gut, skin) rather than the bone marrow suppression and nausea of chemotherapy. Some immunotherapies are better tolerated than chemotherapy. Others have their own serious side effects. The choice between chemotherapy and immunotherapy — or a combination — depends entirely on the cancer type and patient factors.
Not yet — but the list is growing rapidly. Immunotherapy is now standard or evidence-supported for Hodgkin lymphoma, B-cell non-Hodgkin lymphoma, CLL, multiple myeloma, and B-cell ALL. For other blood cancers like AML, MDS and T-cell lymphomas, immunotherapy options exist but are less established — often in clinical trials or second/third-line settings. The pace of development in blood cancer immunotherapy is faster than almost any other area of oncology. I stay current with the evidence and apply the most recent approved protocols.
CAR-T (chimeric antigen receptor T-cell) therapy involves collecting your own T-cells, engineering them in a laboratory to target specific proteins on cancer cells, and returning them as a living, self-replicating cancer-fighting drug. It has produced remarkable results in relapsed/refractory B-cell lymphoma, ALL and myeloma — complete remissions in patients who had failed every other treatment. CAR-T cell infusion is available in India at specialised centres. Dr. Basudev manages the complete clinical pathway: eligibility assessment, work-up, referral to an appropriate CAR-T centre, and post-infusion monitoring and toxicity management back in Hyderabad.
Yes — though the side effect profile is very different from chemotherapy. The main immune-related adverse events are caused by the immune system becoming over-activated: immune-related pneumonitis (lung inflammation), colitis (gut inflammation), hepatitis, thyroid dysfunction and skin rashes. These can range from mild to severe. Monoclonal antibodies like rituximab can cause infusion reactions, manageable with pre-medication. CAR-T therapy has specific toxicities — cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) — that require experienced management. I explain the specific side effect profile of each agent before starting treatment. You should never receive immunotherapy without understanding what to watch for.
Rituximab is a monoclonal antibody that binds to CD20 — a protein expressed on the surface of B-cells and most B-cell lymphomas. When rituximab binds CD20, it marks the cancer cell for destruction by the immune system and directly triggers cell death. Added to chemotherapy (R-CHOP for DLBCL, R-CVP for follicular lymphoma), rituximab improved overall survival in B-cell lymphoma by approximately 10–15% compared to chemotherapy alone — one of the most significant advances in lymphoma treatment. It is now considered a standard part of virtually all B-cell lymphoma treatment protocols.
This is one of the most important questions in blood cancer oncology. The short answer is: possibly — and in some diseases, yes with high probability of response. For relapsed Hodgkin lymphoma failing chemotherapy, pembrolizumab achieves responses in 65–80% of patients. For relapsed DLBCL failing first-line R-CHOP, salvage immunochemotherapy followed by autologous BMT, or CAR-T if eligible, remain options. For relapsed myeloma, combinations involving daratumumab and newer agents achieve meaningful responses even after multiple prior lines. If your chemotherapy has failed, please come with your complete treatment records. The options available depend on exactly what you've had, what response you achieved, and your current clinical status.
Immunotherapy costs vary enormously by agent. Rituximab (generic available in India) is now much more affordable than when it launched — a cycle can cost ₹20,000–50,000 depending on the dose and supplier. Daratumumab for myeloma remains expensive — ₹1–2 lakh per infusion. Checkpoint inhibitors like pembrolizumab are approximately ₹1.5–2.5 lakh per 3-week cycle. CAR-T therapy is currently the most expensive — costs at Indian centres range from ₹25–50 lakh for the entire procedure. Most health insurance policies cover standard approved immunotherapy agents. At CION Cancer Clinics, the team discusses the complete cost structure before treatment begins. I know cost is not a footnote for most families — it's a central part of the decision.
Dr. Basudev Pokhrel at CION Cancer Clinics, Hyderabad, specialises in immunotherapy for blood cancers — incorporating checkpoint inhibitors, monoclonal antibodies and CAR-T pathways into standard treatment protocols. He is trained at CMC Vellore and JIPMER, with 14+ years of haematology practice. Available at ANR Centre, Banjara Hills, Hyderabad. Contact +91 9063490160.
For Hodgkin lymphoma, many patients are cured with standard chemotherapy — PET-adapted protocols achieve cure rates above 85%. Immunotherapy (pembrolizumab, brentuximab vedotin) is primarily used in the relapsed setting, and some of these patients also achieve durable long-term remissions. For aggressive non-Hodgkin lymphoma like DLBCL, R-CHOP chemotherapy cures approximately 60–70% of patients. CAR-T therapy for relapsed DLBCL is achieving 30–40% long-term remission in patients who had failed all prior therapy — results that were not achievable before CAR-T. So yes — immunotherapy has become a curative option for some patients with lymphoma who would previously have had no realistic chance of long-term remission.
Immunotherapy infusions are generally not painful. Monoclonal antibodies like rituximab and daratumumab are given intravenously — some patients experience infusion reactions (chills, fever, low blood pressure) during the first infusion, which is why pre-medication is given and the first infusion is given slowly under monitoring. Checkpoint inhibitors like pembrolizumab are also given intravenously and are generally well tolerated during the infusion itself — the side effects, when they occur, develop over days to weeks after the infusion. CAR-T therapy has specific toxicities (cytokine release syndrome) that can develop 2–10 days after infusion and require close monitoring. None of these are described as painful — the side effects are related to immune activation rather than tissue damage.
Whether you're newly diagnosed or have been told that chemotherapy has failed — come with your reports and let's discuss what immunotherapy options are available for your specific situation.