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Home > Hematology / Non Hodgkin's Lymphomas |  |
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FacultyLisa H. Downs, RN, MSN, CRNP-BC (Chairperson)
Abramson Cancer Center of the University of Pennsylvania
Ms. Downs is coordinator of the Lymphoma Program at the Hospital of the University of Pennsylvania, Philadelphia. She received her master’s degree in nursing from Thomas Jefferson University in Philadelphia. She works in a collaborative practice with Dr. Stephen Schuster. Her research is focused on developing new biologic therapies for lymphomas. Ms. Downs lectures regionally and nationally on topics related to lymphoma and the care of patients with hematologic malignancies. Lisa H. Downs, RN, MSN, CRNP-BC, reported a financial interest/relationship or affiliation in the form of: Consultant, Celgene Corporation, Genentech BioOncology, and Enzon Pharmaceuticals; Speakers’ Bureau, sanofi-aventis U.S., Millennium Pharmaceuticals, Inc., and Ortho BioTech Products, LP; Ownership, Celgene Corporation (spouse). Indolent Lymphomas: Disease OverviewLow-grade lymphomas are a heterogeneous group of malignancies with diverse pathologic characteristics, natural histories, and patterns of response to therapy. New diagnostic tests, including molecular markers and imaging techniques, have enabled clinicians to provide more accurate diagnosis and staging of specific subtypes. For the majority of individuals with stage III or IV indolent non-Hodgkin’s lymphoma (NHL), treatment options are varied, ranging from active observation to intensive chemotherapy, and less frequently, allogeneic stem cell transplantation. However, there is no curative treatment strategy for individuals with indolent NHL, nor is there a consensus on the best treatment approach. Therefore, ongoing clinical research is imperative. Agents approved by the FDA during the past 5 to 10 years continue to be heavily investigated. It is still unclear, however, how therapies such as tositumomab, ibritumomab tiuxetan, and rituximab best fit into the treatment paradigm of low-grade lymphomas. New therapeutics under investigation include agents with novel mechanisms of action and delivery systems such as nanoparticles, small molecules, immunomodulatory medications, and new monoclonal antibodies. The major challenge of treating patients with NHL lies in the ability to devise stepwise treatment plans that will allow the use of the multiple available therapies throughout the disease trajectory, with the ultimate goal of a potential cure or increase in overall survival. Breast Cancer Survivorship Pyschological Support UpdateIn recent years, cancer survivorship issues have received greater attention and research interest as the number of cancer survivors increases in the United States, and the cancer advocacy movement gains in strength. Cancer survivorship is defined as a continuum from the time of diagnosis to the end of life. It has been conceptualized as a progression through three phases or “seasons” of survival incorporating: (1) surviving the treatment and its side effects, (2) beginning to return to normal life while being monitored for recurrence, and (3) long-term adjustment, when the cancer experience is viewed as an episode in a full life. In 2004, the most recent year with complete Surveillance, Epidemiology, and End Results (SEER) data, there were 10.1 million cancer survivors; of these, more than 2.4 million were breast cancer survivors. Family members, friends, and caregivers of the woman diagnosed with breast cancer are also considered to be cancer survivors. Psychosocial distress, at varying levels of severity, accompanies the cancer experience. There are calls to consider distress the sixth vital sign; it would then be routinely monitored along with pulse, blood pressure, respiration, temperature, and pain. Periods of highest distress for the woman with breast cancer are associated with transition points in treatment. Completion of treatment may be a cause of increased anxiety rather than joy. There are many potential barriers to meeting the psychosocial needs of women with breast cancer after active treatments ends. The Institute of Medicine of the National Academies has released several reports during recent years describing strategies to acknowledge and meet these needs, declaring that provision of psychosocial services should be a standard of care for survivors of cancer. Oncology nurses play a key role in assessing the patient, family members, and caregivers for signs of distress. In so doing, an atmosphere of compassion and trust is created such that the breast cancer survivor feels free to share psychosocial concerns and have them addressed by appropriate specialists if necessary. Mathias J. Rummel, MD, PhD
Justus-Liebig-University Hospital, Giessen, Germany
Dr. Rummel is an oncologist in the Department of Internal Medicine at University Hospital, Frankfurt/Main, Germany. His research interests include cancer therapeutics, with a focus on patients with non-Hodgkin’s lymphoma. His research is widely published in such journals as the European Journal of Vascular and Endovascular Surgery, Investigational New Drugs, and Annals of Hematology. Mathias Rummel, MD, PhD, reported a financial interest/relationship or affiliation in the form of: Consultant, Mundipharma International Ltd., Roche Laboratories, Inc., and Amgen, Inc. Novel Treatment Approaches to Follicular Lymphoma and Chronic Lymphocytic LeukemiaThere are many options for treatment of follicular and indolent lymphomas including chemotherapy, targeted agents, and bone marrow/stem cell transplantation. Bendamustine is a newly approved novel chemotherapy for chronic lymphocytic leukemia. As a single agent, it has ben shown to increase response rate in heavily pretreated patients with non-Hodgkin’s lymphoma who were refractory to rituximab and refractory to alkalator therapies. The results of clinical trials comparing rituximab alone and rituximab in combination with chemotherapy in the first-line treatment of patients with indolent and mantle cell lymphoma will be discussed, along with novel treatment approaches for newly diagnosed and relapsed/refractory indolent lymphomas. Update on Clinical Trials of Antiangiogenesis Agents in Breast Cancer/Metastatic Breast Cancer Treatment UpdateMetastatic breast cancer (MBC) remains a largely incurable disease. However, survival rates continue to increase as advances in the understanding of the biology of tumorigenesis are made. Angiogenesis plays a major role in tumor formation and therefore, agents targeting this process, including the monoclonal antibody bevacizumab, are particularly successful at treating tumors. In addition, the introduction of the monoclonal antibody trastuzumab has dramatically improved outcomes for women with human epidermal growth factor receptor 2 (HER2)-positive MBC and reaffirmed the value of targeting specific cellular proteins as a means of controlling disease. This has led to the development of a plethora of new agents for the treatment of HER2-positive breast cancer in the metastatic setting, though optimal chemotherapy regimens are still under investigation. Craig Moskowitz, MD
Memorial Sloan Kettering Cancer Center/Cornell University Medical College
Dr. Moskowitz is an associate professor of medicine at Weill Medical College of Cornell University in New York City, and an attending physician and clinical director in the Division of Hematologic Oncology at Memorial Sloan-Kettering Cancer Center, also in New York City. He received his doctor of medicine from Wayne State University School of Medicine in Detroit, Michigan. Dr. Moskowitz has led several clinical trials investigating treatment options for patients with non-Hodgkin’s lymphoma. His research has been published in journals such as Journal of Clinical Oncology, British Journal of Haematology, and Annals of Oncology. Craig H. Moskowitz, MD, reported a financial interest/relationship or affiliation in the form of: Contracted Research, Genentech BioOncology, Amgen, Inc., and Eli Lilly and Company. Novel Treatment Approaches to Mantle Cell LymphomaRepresenting 5% to 7% of all non-Hodgkin’s lymphomas (NHLs), mantle cell lymphoma (MCL) was identified as a separate subtype of NHL in 1992 and incorporated into NHL classification in 1997. MCL is associated with the unfavorable features of both indolent and aggressive lymphomas: incurability and moderate-to-rapid rate of growth. Historically, the median survival was 4 years but this has nearly doubled with the use of consolidative autologous stem cell transplantation and the introduction of new agents, which will be highlighted in this presentation.
Susan M. Blumel, RN, BSN, OCN®
University of Nebraska Medical Center
Ms. Blumel is clinical study coordinator for the lymphoma clinical trials at the University of Nebraska Medical Center, in Omaha. She received her degree in nursing from the University of Nebraska Medical Center, College of Nursing in Omaha. She has written articles and lectures regularly to regional and national audiences on issues related to the treatment of lymphomas and ongoing clinical trials. Susan Blumel, RN, BSN, OCN®, reported no areas of conflict. Comprehensive Nursing Management of Patients Receiving Novel Agents for Indolent LymphomasIndolent lymphomas are incurable diseases characterized by multiple relapses resulting in the need for different treatment strategies throughout the course of disease. The growing knowledge of this group of malignancies has led to the identification of a number of novel strategies targeting the lymphoma cell. Therapeutic agents including bortezomib, temsirolimus, thalidomide, lenalidomide, and bendamustine are under investigation in the clinical setting as single-agent therapies. Once optimal dosing strategies for single-agent management are defined, the opportunity for multiagent therapies will emerge. Additionally, clinical trials continue to evaluate stem cell transplantation, including allogeneic transplantation methods, in an effort to minimize life-threatening toxicities and enhance efficacy outcomes. With the ever-changing treatment landscape, it is imperative that nurses keep abreast of new developments in therapeutic options and management strategies thereby enabling a proactive approach to care and facilitating optimal patient outcomes. This presentation will provide a comprehensive look at the oncology nurse’s role in education and symptom management of patients receiving novel therapies for indolent lymphomas.
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