There are five common treatment modalities employed by
healthcare providers treating patients with NHL. They include: chemotherapy,
radiation therapy, stem cell transplantation, immunotherapy, and
radioimmunotherapy. Stem cell transplantation is a procedure that involves the
injection of healthy stem cells into a patient’s body. Once inside the body,
the stem cells differentiate into blood cells. The stem cells are acquired from
the patient (autologous) or from a donor. This procedure is done after patients
undergoes chemotherapy or radiation treatment. Recently, a study was done to
determine the efficacy of autologous hematopoietic stem cell transplantation in
patients 65 and older, diagnosed with B-cell Non-Hodgkin’s lymphoma. This was
of concern to the researchers because the number of elderly patients receiving
this treatment has risen in recent years. These patients have shown increased
mortality and morbidity as a result of the transplant and comorbid diseases.
Therefore, it is imperative that research is done to determine if this
treatment modality is worth the risks these patients may incur.
The researchers collected data on
thirty-six patients age 65 and older. All these patients were diagnosed with
B-cell Non-Hodgkin’s lymphoma and underwent autologous hematopoietic stem cell
transplantation. Patients received chemotherapy or radiation therapy prior to
this procedure. Researchers performed a survival analysis using the data they
collected. The overall survival was 58%. Of that 58%, patients who had a complete
response to chemotherapy and radiation therapy had a greater survival
advantage. Patients that received BEAM therapy, a form of radiation therapy had
better results. When researchers grouped the recipients as younger than 70 and
older than 70, data showed no statistical difference between the two.
showed that autologous hematopoietic stem cell transplantation can be
beneficial in elderly patients despite the risk of transplant related mortality
and disease comorbidity. However, certain criteria were met by the patients who
survived. Of those who had increases survivability, the majority had complete
or partial response to first-line therapy before undergoing stem cell
transplantation. Those who experienced complete response had a statistically
significant advantage on survival rate and their overall survival length was
longer. The researchers also determined that there was no significant
difference in survival rates between patient younger than 70 and older than 70.
Therefore, age was not a relative factor. The researchers concluded that stem
cell transplantation is a viable treatment option for patients age 65 and
older, and long as they met the criteria mentioned.
As a nurse
taking care of patient undergoing stem cell transplantation, your primary role
is as an educator. Prior to the procedure, a patient may undergo chemotherapy.
Chemotherapy can impact a patient’s immune system making them more susceptible
to infections. The patient may be placed in an isolation room. The nurse should
inform the patient and their family about the importance of maintaining
isolation precautions. They should instruct them to wash their hands and
perform other isolations control measures. The nurse should also be
knowledgeable and be able to educate the patient about what to expect during
and after the procedure. If the patient is about to undergo the procedure, it
is the nurse’s duty to obtain informed consent, and make sure the patient
understands what he or she is about to undergo.
It may be
beneficial for you to monitor the nutritional status of patients undergoing
stem cell transplantation. Malnutrition may result from a multitude issues that
arise during the procedure or from the underlying illness itself. Therefore,
they should be screened by the nurse for malnutrition. These patients may also
be on a low-microbial diet, because it reduces the risk of getting sick. The
nurse can recommend foods that the client can eat while on this diet. For
example, a patient should be taught to avoid unpasteurized dairy products such
as soft cheeses (i.e. brie, camembert, goat) and to consume commercially
packaged pasteurized cheeses (i.e. swiss, parmesan, monterey jack).
treatment option for patients with NHL is immunotherapy, which boosts a
patient’s immune system or utilizes man-made antibodies to fight cancer cells.
Researchers recently did a study about the effectiveness of Brentuximab vedotin in the treatment of relapse and
refractory NHL. Brentuximab vedotin consists of a man-made anti-CD30 antibody attached
to monomethyl auristatin E (MMAE) an antimitotic agent. The drug attaches to
CD30 on the surface of cancer cells, is internalized, and disrupts the
microtubule network in the cell, arresting the cell-cycle and promoting
apoptosis. Brentuximab vedotin is a relatively new drug and researchers wanted
to test out its ability to treat NHL.
a literature search, the researchers compiled data. The majority of data was
collected from phase I and phase II trials, and case studies in which patients
with refractory or relapsed NHL were treated with Brentuximab vedotin. They
found a total of 359 patients that met these criteria and divided them into
groups based on the pathology of their non-Hodgkin’s lymphoma: B-cell
malignancies, T-cell malignancies, and non-B/T-cell malignancies. The
researchers determined the effectiveness of using Brentuximab vedotin in the
treatment of NHL, by measuring objective response rates, partial response
rates, and complete response rates.
Patients with B-cell
malignancies (i.e. DLBCL, FL, PMBL, PTLD, GZL) showed an objective response
(OR) of 51% and a complete response (CR) of 29%.Those with T-cell malignancies
experienced an OR of 48% and a CR of 35%. Not enough information was gathered
in the last group of malignancies to make a determination about the efficacy of
treatment. The data shows that Brentuximab vedotin lead to significantly better
outcomes in patients being treated for B-cell and T-cell malignancies.
Therefore, researchers found evidence the Brentuximab vedotin was effective in
treating these subtypes of non-Hodgkin’s lymphoma.
A nurse treating a
patient on Brentuximab vedotin should assess their patient for adverse
reactions and side effects of taking the medication. These include peripheral
neuropathy, anaphylaxis, tumor lysis syndrome, skin rash and PML. A nurse
should monitor a patient’s CBCs to determine the degree of neutropenia. The
nurse should educate the patient and their family about Brentuximab vedotin.
Instruct them to notify the provider if they experience numbness or tingling in
their hands and feet, or if they experience generalized muscle weakness. Teach
them to be cognizant of the signs and symptoms of infection and to notify the
provider immediately if they occur. If the patient is a female in childbearing
years, they should be warned about the potential effect the drug could have on
a developing fetus. Therefore, they should be advised to use contraceptives to
avoid pregnancy. A mother should also be advised to avoid breastfeeding while
on this drug.