Nursing Considerations for Cytokine Release Syndrome in Relapsed/Refractory Multiple Myeloma: Experience with Teclistamab from the MajesTEC-1 Study.

OBJECTIVES: Cytokine release syndrome (CRS) is a systemic inflammatory response that is commonly observed as a class effect of T-cell-redirecting therapies. This article provides important practical guidance for nurses relating to the diagnosis, monitoring, and management of CRS in patients receiving teclistamab, based on experience from the MajesTEC-1 clinical trial and real-life nursing practice. METHODS: MajesTEC-1 is a phase 1/2 study of teclistamab in heavily pretreated patients with relapsed/refractory multiple myeloma. To mitigate the risk of high-grade CRS, patients were carefully monitored for early signs and symptoms of CRS (including fever, which must have fully resolved before teclistamab administration). RESULTS: A survey of nurses from several of the study sites provided additional real-life insights into nursing best practices for managing CRS from four academic institutions in three countries. CONCLUSIONS: In MajesTEC-1, 72% of patients treated with teclistamab experienced CRS, the majority of which was low grade. All cases resolved and none led to treatment discontinuation. Real-life supportive measures for CRS are generally aligned with those outlined in the study. IMPLICATIONS FOR NURSING PRACTICE: Because nurses are on the frontline of patient care, they play a crucial role in promptly recognizing the signs and symptoms of CRS and responding with timely and appropriate supportive treatment. This review provides important practical guidance for nurses on diagnosis, monitoring, and management of CRS in patients receiving teclistamab, based on experience from the MajesTEC-1 trial and real-life nursing practice.

Reductions in vancomycin and meropenem following the implementation of a febrile neutropenia management algorithm in hospitalized adults: An interrupted time series analysis.

OBJECTIVE: To evaluate broad-spectrum intravenous antibiotic use before and after the implementation of a revised febrile neutropenia management algorithm in a population of adults with hematologic malignancies. DESIGN: Quasi-experimental study. SETTING AND POPULATION: Patients admitted between 2014 and 2018 to the Adult Malignant Hematology service of an acute-care hospital in the United States. METHODS: Aggregate data for adult malignant hematology service were obtained for population-level antibiotic use: days of therapy (DOT), C. difficile infections, bacterial bloodstream infections, intensive care unit (ICU) length of stay, and in-hospital mortality. All rates are reported per 1,000 patient days before the implementation of an febrile neutropenia management algorithm (July 2014-May 2016) and after the intervention (June 2016-December 2018). These data were compared using interrupted time series analysis. RESULTS: In total, 2,014 patients comprised 6,788 encounters and 89,612 patient days during the study period. Broad-spectrum intravenous (IV) antibiotic use decreased by 5.7% with immediate reductions in meropenem and vancomycin use by 22 (P = .02) and 15 (P = .001) DOT per 1,000 patient days, respectively. Bacterial bloodstream infection rates significantly increased following algorithm implementation. No differences were observed in the use of other antibiotics or safety outcomes including C. difficile infection, ICU length of stay, and in-hospital mortality. CONCLUSIONS: Reductions in vancomycin and meropenem were observed following the implementation of a more stringent febrile neutropenia management algorithm, without evidence of adverse outcomes. Successful implementation occurred through a collaborative effort and continues to be a core reinforcement strategy at our institution. Future studies evaluating patient-level data may identify further stewardship opportunities in this population.

A Multiscale Characterization of Two Tropical Embiopteran Species: Nano- and Microscale Features of Silk, Silk-Spinning Behavior, and Environmental Correlates of their Distributions.

Embioptera display the unique ability to spin silk with their front feet to create protective domiciles. Their body form is remarkably uniform throughout the order, perhaps because they all live within the tight confines of silken tubes. This study contributes to an understanding of the ecology of Embioptera, an order that is rarely studied in the field. We conducted a census to quantify the habitats of two species with overlapping distributions on the tropical island of Trinidad in a search for characteristics that might explain their distinct ecologies. One species, Antipaluria urichi (Saussure) (Embioptera: Clothodidae), lives in larger colonies with more expansive silk in habitats throughout the island, especially in the rainforest of the Northern Range Mountains. The other, Pararhagadochir trinitatis (Saussure) (Embioptera: Scelembiidae), was found only in lowland locations. We quantified silk-spinning behavior and productivity of the two species and found that A. urichi spins thicker silk sheets per individual and emphasizes spin-steps that function to create a domicile that is more expansive than that produced by P. trinitatis. Their silks also interact differently when exposed to water: the smaller-diameter silk fibers of P. trinitatis form more continuous films on the surface of the domicile after being wetted and dried than that seen in A. urichi silk. This tendency gives P. trinitatis silk a shiny appearance in the field compared to the more cloth-like silk of A. urichi. How these silks function in the field and if the differences are partially responsible for the distinct distributions of the two species remain to be determined.