Management of Hematologic Adverse Events Associated With Immune Checkpoint Inhibitors.

Immune checkpoint inhibitors target suppressor receptors, including cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed cell death ligand 1 (PD-L1). The activated T cells are not antigen specific; therefore, the blockade of the immune checkpoint may result in the development of autoimmune adverse events. The most common immune-related adverse events (irAEs) are rash, colitis, and endocrinopathies. However, irAEs that affect the hematologic system are rare and can affect red blood cells (e.g., autoimmune hemolytic anemia), white blood cells, and platelets (e.g., immune thrombocytopenia). Usually one cell line is affected; however, in some cases, multiple cell lines can be affected. Other changes in the hematologic system can also be affected (e.g., cryoglobulinemia, cytokine release syndrome). Due to the rarity and lack of recognition of these AEs, the timing, spectrum of events, and clinical presentation are poorly understood. Management of hematologic irAEs usually involves the use of steroids; however, other agents (e.g., IVIG, cyclosporine, rituximab) or procedures (e.g., plasma exchange, transfusions) can also be used.

Management of Acute Pancreatitis Associated With Checkpoint Inhibitors.

Pancreatitis is a rare immune-related adverse event (irAE) associated with the use of immune checkpoint inhibitors (ICIs). It is more often associated with combined immunotherapy than by any single agent. Early signs of pancreatitis may only include elevation of lipase and amylase. Additional symptoms associated with pancreatitis include symptoms such as severe epigastric abdominal pain (that may radiate to the back, chest, or flank), nausea and/or vomiting, or dyspnea, and may indicate more advanced disease. Some researchers note that the presence of symptoms is not an indicator of more severe pancreatitis or long-term adverse outcomes. Radiologic changes can be useful in the diagnostic workup of ICI-associated pancreatitis, but radiologic tests may not show any changes in some patients with active pancreatitis. The management of ICI-associated pancreatitis can include those interventions used to manage acute pancreatitis (e.g., IV fluids, holding the agent, antibiotics, and steroids). The National Comprehensive Cancer Network Guidelines only recommend intervention for moderate to severe pancreatitis. Holding the associated ICI(s) is the most commonly used intervention when patients experience pancreatitis that is thought to be related to ICIs. Steroids are usually used in the management of irAEs associated with checkpoint inhibitors; however, there are no studies available at this time to indicate that this is the best method to treat pancreatitis associated with ICIs. Additional studies are needed to determine if steroids are the best method to manage irAE-associated pancreatitis or if additional management strategies are important in the management of pancreatitis in patients receiving checkpoint inhibitors.

Overview of non-Hodgkin's lymphoma.

OBJECTIVES: To provide an overview of non-Hodgkin's lymphoma (NHL). DATA SOURCES: Review and research articles. CONCLUSION: NHLs are divided primarily into two main categories based on their rate of growth: aggressive and indolent. Within these two groups are various subtypes that have various clinical features. Prognostic features have been useful in determining the potential outcome of treatment of patients with NHL. IMPLICATIONS FOR NURSING PRACTICE: Nurses play an important role in the education of patients regarding the type of lymphoma they have and the steps necessary to make an accurate diagnosis, which is important in determining the appropriate treatment.