ABSTRACT
Strategies for the treatment of childhood cancer have significantly evolved over time. Years ago, surgery was the only option for treating childhood cancer. Now, research has advanced treatment options to include multimodal therapy with chemotherapy, radiation, surgery and hematopoeitic stem cell transplantation. The focus on gene therapy research is also increasing. Pediatric nurses must have a thorough understanding of the treatment for childhood cancer so that as frontline healthcare providers, they give accurate information to patients and their families, deliver appropriate care, and assist with gathering data in support of ongoing research.
Subject(s)
Neoplasms/therapy , Adolescent , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Bone Marrow Transplantation/adverse effects , Bone Marrow Transplantation/methods , Child , Child, Preschool , Combined Modality Therapy , Female , Genetic Therapy/adverse effects , Genetic Therapy/methods , Humans , Male , Neoplasm Staging , Neoplasms/diagnosis , Neoplasms/mortality , Neoplasms/nursing , Nursing Assessment , Pediatric Nursing/standards , Pediatric Nursing/trends , Prognosis , Radiotherapy/adverse effects , Radiotherapy/methods , Risk Assessment , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/methods , Survival Analysis , Treatment OutcomeABSTRACT
In murine models, transgenic chemokine-cytokine tumor vaccines overcome many of the limitations of single-agent immunotherapy by producing the sequence of T-cell attraction followed by proliferation. The safety and immunologic effects of this approach in humans were tested in 21 patients with relapsed or refractory neuroblastoma. They received up to 8 subcutaneous injections of a vaccine combining lymphotactin (Lptn)- and interleukin-2 (IL-2)-secreting allogeneic neuroblastoma cells in a dose-escalating scheme. Severe adverse reactions were limited to reversible panniculitis in 5 patients and bone pain in 1 patient. Injection-site biopsies revealed increased cellularity caused by infiltration of CD4+ and CD8+ lymphocytes, eosinophils, and Langerhans cells. Systemically, the vaccine produced a 2-fold (P =.035) expansion of CD4+ T cells, a 3.5-fold (P =.039) expansion of natural killer (NK) cells, a 2.1-fold (P =.014) expansion of eosinophils, and a 1.6-fold (P =.049) increase in serum IL-5. When restimulated in vitro by the immunizing cell line, T cells collected after vaccination showed a 2.3-fold increase (P =.02) of T-helper (TH2)-type CD3+IL-4+ cells. Supernatant collected from restimulated cells showed increased amounts of IL-4 (11.4-fold; P =.021) and IL-5 (8.7-fold; P =.002). Six patients had significant increases in NK cytolytic activity. Fifteen patients made immunoglobulin G (IgG) antibodies that bound to the immunizing cell line. Measurable tumor responses included complete remission in 2 patients and partial response in 1 patient. Hence, allogeneic tumor cell vaccines combining transgenic Lptn with IL-2 appear to have little toxicity in humans and can induce an antitumor immune response.
