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Monoclonal Antibody Therapies for Follicular Non-Hodgkin's Lymphomas: Moving Toward a Cure
Program Overview
The clinical development of monoclonal antibodies represents
a major advancement in the treatment of patients with
follicular NHL. In this educational symposium, the principles of
antibody-based therapy will be described in 3-D video
animation. This presentation will be followed by a historical
review of follicular NHL treatment options and the current
treatment landscape. An overview of how treatment decisions
are made based on prognostic parameters will be given. A
case presentation will facilitate discussions on the appropriate
nursing management of patients with follicular NHL receiving
monoclonal antibody therapy. Oncology nurses' understanding
of presented issues and their own practice patterns will be
questioned via audience response technology.
Learning Objectives
Upon completion of this program, participants should be
better able to:
- Describe various clinical presentations of follicular NHL
- Discuss with patients when treatments for follicular NHL
are indicated
- Describe current therapeutic options for patients with
follicular NHL
- Explain mechanisms of action and clinical applications of
conjugated and unconjugated monoclonal antibodies for
follicular NHL
- Manage potential side effects of monoclonal antibodies
used in the treatment of follicular NHL
- Discuss ongoing challenges as they relate to the treatment
of NHL
Program Abstracts
NON-HODGKIN’S LYMPHOMAS
Molly E. Moran, MSN, CNP
Non-Hodgkin’s lymphoma (NHL) is among the top 10 types of cancer diagnosed in men
and women in the United States. An estimated 63,000 new cases are diagnosed annually
and incidence rates have nearly doubled since the early 1970s. Additionally, NHL is one of
the top 10 causes of death from cancer. Follicular lymphoma accounts for approximately
one third of NHLs in adults and has a heterogeneous prognosis. Numerous treatments are
available. The disease course is usually characterized by a response to initial treatment
followed by relapses. Pathological classifications, such as the World Health Organization
classification, and prognostic indexes, such as the Follicular Lymphoma International
Prognostic Index, have proven useful for assessing the prognosis of this patient
population. This information can be helpful in selecting the most appropriate treatment for
patients. Because oncology nurses are the primary educational resource for patients and
their families, it is important that they have an understanding of this complex patient
population.
OPTIMAL UTILIZATION OF MONOCLONAL
ANTIBODIES IN THE MANAGEMENT OF FOLLICULAR
NON-HODGKIN'S LYMPHOMAS
Richard I. Fisher, MD
Prior to the introduction of monoclonal antibodies, treatment modalities for follicular non-
Hodgkin's lymphomas (NHL) had little impact on survival-despite the fact that patients
often developed dramatic responses to chemotherapy and radiation. After the pivotal study
showing a 50% response rate in heavily pretreated NHL patients with rituximab alone
(McLaughlin et al., 1998), the door was open for initiation of trials to evaluate the effect of
monoclonal antibodies with chemotherapy and coupled to radioactive agents. As a result
of these carefully performed controlled clinical studies, it was determined that the addition
of monoclonal antibodies to cytotoxic and radioactive agents led to dramatic improvements
in response rates, disease-free survival, and overall survival (Fisher et al., 2005). Efficacy
has been documented both in newly diagnosed patients and patients whose lymphomas
have relapsed. Further studies indicate that prolonged use of rituximab in the maintenance
setting may also be associated with improved results. Rituximab has been approved for
maintenance and for induction treatment combined with chemotherapy. Many questions
regarding optimal use of monoclonal antibodies remain unanswered and await the results
of additional studies. Currently a SWOG/CALGB randomized trial is comparing
chemotherapy plus rituximab to chemotherapy plus radioimmunoconjugate (131I
tositumumab) in patients with advanced stage follicular lymphoma.
NURSING MANAGEMENT OF PATIENTS WITH
FOLLICULAR NON-HODGKIN'S LYMPHOMAS
Katherine L. Byar, MD
Advances in treatment have increased survival for patients with follicular Non-Hodgkin's
lymphoma (NHL). Oncology nurses play a major role in optimizing outcomes to treatment.
Patient education is extremely important for both patients and their caregivers. Nurses
must provide adequate and accurate information about complex diagnostic procedures
and new treatments, such as monoclonal antibodies. Oncology nurses are responsible for
managing patient care and attending to any adverse events that may occur during or after
the administration of monoclonal antibodies. Acute adverse events are usually related to
the monoclonal antibody infusion; most are transient and respond to standard
interventions. The most common reactions are fever, chills, rigors, uticaria, nausea,
diarrhea, and arthralgias. Dyspnea, hypotension, and bronchospasm occur infrequently. As
a precaution, patients may be premedicated with acetaminophen and diphenhydramine.
Adverse events related to radioimmunotherapy, such as ibritumomab tiuxetan or 131I
tositumomab, are primarily hematological and are predictable, manageable, and reversible.
Hematologic toxicity has been correlated directly with the percentage of bone marrow
involvement with NHL; treatment is generally contraindicated if there is more than 25%
bone marrow involvement. With the new modalities of treatment, caring for patients with
follicular NHL can be challenging; however, the outcomes can be equally rewarding.