ABSTRACT
Ibritumomab tiuxetan is a radiolabled monoclonal antibody that targets B-cell non-Hodgkin lymphoma tumor cells. Yttrium-90 (Y-90), the radioisotope used to deliver the therapy, may act as a vesicant, potentially causing severe tissue damage if extravasation occurs. Particularly important to nurses is that Y-90 may not show signs or symptoms of extravasation until weeks or months after the IV injection. A case study of a man with B-cell non-Hodgkin lymphoma presented in this article shows the progression of the extravasation and steps taken to treat and eventually heal the extravasation site. Included is information about ibritumomab tiuxetan treatment, administration, eligibility criteria, and guideline recommendations for extravasation.
Subject(s)
Antibodies, Monoclonal/adverse effects , Erythema , Extravasation of Diagnostic and Therapeutic Materials , Lymphoma, B-Cell/therapy , Aged, 80 and over , Antibodies, Monoclonal/administration & dosage , Drug Administration Schedule , Drug Monitoring/methods , Drug Monitoring/nursing , Erythema/chemically induced , Erythema/diagnosis , Erythema/therapy , Ethics Committees, Research , Extravasation of Diagnostic and Therapeutic Materials/diagnosis , Extravasation of Diagnostic and Therapeutic Materials/etiology , Extravasation of Diagnostic and Therapeutic Materials/therapy , Humans , Male , Nursing Assessment/methods , Oncology Nursing/methods , Patient Selection , Practice Guidelines as Topic , Radioimmunotherapy/adverse effects , Radioimmunotherapy/methods , Radioimmunotherapy/nursing , Wound HealingABSTRACT
OBJECTIVES: To describe the rationale for radioimmunotherapy as a treatment of non-Hodgkin's lymphoma. To present the similarities and differences in the two radioimmunotherapies and the nursing implications in caring for patients receiving these agents. DATA SOURCES: Published literature and review of published clinical trials. CONCLUSION: Radiolabeled monoclonal antibodies bind to specific antigens and provide a means of targeting tumor cells with cytotoxic radioactivity. The infusion of radiolabeled monoclonal antibodies requires an understanding of antibody therapy, radiation therapy, and principles of time, distance, and shielding. IMPLICATIONS FOR NURSING PRACTICE: As the use of radioimmunotherapy grows, nurses must be aware of the background for, logistics of, and follow-up required for patients receiving this form of radiation treatment.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Antigens, CD20/immunology , Antineoplastic Agents/therapeutic use , Lymphoma, Non-Hodgkin/radiotherapy , Oncology Nursing/methods , Radioimmunotherapy/methods , Aftercare/methods , Antibodies, Monoclonal, Murine-Derived , Clinical Protocols , Combined Modality Therapy , Drug Administration Schedule , Forecasting , Humans , Lymphoma, Non-Hodgkin/nursing , Nursing Assessment , Patient Selection , Radiation Oncology/methods , Radioimmunotherapy/adverse effects , Radioimmunotherapy/nursing , Rituximab , Treatment OutcomeABSTRACT
This session addressed the major clinical endpoints of radioimmunotherapy trials, dose calculation for single administration of a radioimmunotherapy product, and strategies for the education of patients and caregivers. Attendees learned about the benefits of radioimmunotherapy from the perspective of a survivor of non-Hodgkin lymphoma.
Subject(s)
Lymphoma, Non-Hodgkin/therapy , Oncology Nursing/methods , Radioimmunotherapy , Attitude to Health , Humans , Infection Control/methods , Lymphoma, Non-Hodgkin/psychology , Nurse's Role , Patient Education as Topic , Radiation Protection/methods , Radioimmunotherapy/methods , Radioimmunotherapy/nursing , Radioimmunotherapy/psychologyABSTRACT
OBJECTIVES: To detail recent developments pertaining to the efficacy and safety of radioimmunotherapy with yttrium 90 (90Y) ibritumomab tiuxetan for patients with B-cell non-Hodgkin's lymphoma (NHL). DATA SOURCES: Published clinical trials of 90Y ibritumomab tiuxetan and secondary literature on radioimmunotherapy and NHL. CONCLUSION: Yttrium 90 ibritumomab tiuxetan is safe and effective in the indicated population. It has a good safety profile and is generally well tolerated. It is not associated with the adverse events from conventional chemotherapy and external beam radiation therapy. IMPLICATIONS FOR NURSING PRACTICE: Nursing professionals who are aware of the efficacy and safety data associated with 90Y ibritumomab tiuxetan can optimize efficacy and educate patients and their caregivers about the regimen.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents/therapeutic use , Lymphoma, B-Cell/nursing , Lymphoma, B-Cell/radiotherapy , Oncology Nursing , Radioimmunotherapy , Antibodies, Monoclonal/pharmacology , Antigens, CD20 , Antineoplastic Agents/pharmacology , Controlled Clinical Trials as Topic , Dose-Response Relationship, Radiation , Humans , Nursing Methodology Research , Oncology Nursing/methods , Patient Education as Topic , Radioimmunotherapy/methods , Radioimmunotherapy/nursing , Radiotherapy Dosage , Yttrium Radioisotopes/therapeutic useABSTRACT
OBJECTIVES: To present pertinent issues involved in radiation safety in radioimmunotherapy with 90Y ibritumomab tiuxetan. DATA SOURCES: Published clinical trials of 90Y ibritumomab tiuxetan and secondary literature on radiation safety and radioimmunotherapy. CONCLUSION: Radioimmunotherapy with 90Y ibritumomab tiuxetan is safe and effective in the indicated population, and radiation safety requirements for caregivers and patients are minimal. Yttrium 90 ibritumomab is routinely and safety administered as an outpatient procedure; safety precautions are universal precautions, with the addition of acrylic shielding for the preparation and administration of the radiolabeled dose. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses play a key role in the multidisciplinary team. By observing universal precautions, and advising patients to do the same, oncology nurses may facilitate the safe and effective administration of the ibritumomab tiuxetan regimen.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antineoplastic Agents/adverse effects , Lymphoma, B-Cell/nursing , Lymphoma, B-Cell/radiotherapy , Oncology Nursing , Radioimmunotherapy , Antibodies, Monoclonal/administration & dosage , Antigens, CD20 , Antineoplastic Agents/administration & dosage , Dose-Response Relationship, Radiation , Humans , Nursing Methodology Research , Oncology Nursing/methods , Patient Education as Topic , Radiation Injuries/etiology , Radiation Injuries/prevention & control , Radioimmunotherapy/methods , Radioimmunotherapy/nursing , Risk Factors , Safety , Yttrium Radioisotopes/adverse effectsABSTRACT
Radioimmunotherapy is a new cancer therapy that combines the cytotoxicity of radiation with the tumor-specific targeting of monoclonal antibodies. Yttrium 90 (Y-90) ibritumomab tiuxetan (Zevalin, IDEC Pharmaceuticals Corporation, San Diego, CA) is indicated for the treatment of patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma (NHL), including patients with rituximab-refractory follicular NHL. Y-90 ibritumomab tiuxetan requires only universal safety precautions and does not impose undue risks or radiation safety restrictions on patients or healthcare workers. The ibritumomab tiuxetan regimen can be administered safely in an outpatient setting. Nurses should become familiar with the necessary precautions in caring for patients treated with Y-90 ibritumomab tiuxetan, both to educate patients about safety issues and to minimize the risk of radiation exposure to staff and others.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Radiation Protection/methods , Radioimmunotherapy , Safety Management/methods , Ambulatory Care/methods , Humans , Lymphoma, Non-Hodgkin/therapy , Nurse's Role , Occupational Health , Oncology Nursing/methods , Patient Education as Topic/methods , Practice Guidelines as Topic , Radiation Monitoring/methods , Radiation Monitoring/standards , Radiation Protection/standards , Radioimmunotherapy/adverse effects , Radioimmunotherapy/methods , Radioimmunotherapy/nursing , Safety Management/standardsABSTRACT
OBJECTIVES: To describe the use of monoclonal antibodies labeled with iodine-131 tositumomab and yttrium-90 ibritumomab-tiuxetan as treatment for non-Hodgkin's lymphoma. DATA SOURCES: Literature review of trials of radioimmunotherapy. CONCLUSIONS: Radiolabeled monoclonal antibodies recognize and react with specific antigens to provide targeted therapy to tumor cells, particularly hematopoietic tumor cells. This therapy delivers greater amounts of radiation to malignant cells than normal cells and spares critical organs that do not express the antigen. Strict safety and patient precautions must be in place with the use of radiotherapy. IMPLICATIONS FOR NURSING PRACTICE: As the use of radiommunotherapy in the treatment of non-Hodgkin's lymphoma grows, the role of nursing in the care of these patients will also grow. Nurses will play an important part in patient and family education, as well as staff preparation.
