Imbruvica®â–¾(ibrutinib) patient support programme for chronic lymphocytic leukaemia and mantle cell lymphoma.

Single-agent ibrutinib is an effective therapy for three types of non-Hodgkin lymphoma: chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma, both in relapsed and refractory cases and as a frontline treatment; relapsed and refractory mantle cell lymphoma; and Waldenstrom's macroglobulinaemia in patients who have been treated previously with a different medication. This novel agent has changed the landscape for the aforementioned three subtypes of lymphoma therapies as an oral alternative to traditional chemoimmunotherapy. You&i™ is a no-cost support programme, funded by Janssen, that connects patients taking Imbruvica with a nurse who can answer their questions and help address treatment challenges. This programme offers patients information about their disease, their treatment regimen and side effects management by telephone. The You&i programme was tested at an NHS hospital. Case studies of patients and feedback from health professionals who have used this service show its potential benefits to the patient experience and service delivery.

Why patients prescribed oral agents for cancer need training: a case study.

BACKGROUND: Oral agents for cancer (OACs) are a common form of treatment. However, with OACs, the responsibility shifts from supervised healthcare providers who work in a clinic to patients and caregivers who must manage treatment on their own at home. Consequently, patients and caregivers must be knowledgeable about all aspects of care. In addition, most patients with cancer are older and have multiple comorbid conditions treated by several providers who prescribe medications, further complicating care. OBJECTIVES: This purpose of this article is to present a patient perspective of managing treatment with OACs in the home setting. METHODS: A case study format was used to describe challenges faced by a patient newly prescribed OACs. FINDINGS: Data from the patient interviews support the urgent need for patient and caregiver training; the outcome of treatment for patients taking OACs depends significantly on the patient or caregiver managing treatment in the home setting.

Management of patients with chronic lymphocytic leukemia treated with lenalidomide.

Lenalidomide is an immunomodulatory drug that has shown preliminary activity in the treatment of chronic lymphocytic leukemia (CLL). Much is known about the safety profile of lenalidomide from experience in other hematologic malignancies, such as myelodysplastic syndromes and multiple myeloma. In addition to the known adverse effects associated with lenalidomide (e.g., myelosuppression, rash, fatigue), some unique effects (e.g., tumor flare reactions, tumor lysis syndrome) have arisen during clinical studies of CLL. Typical signs of tumor flare reactions include early onset of painful enlargement of the lymph nodes or spleen, with or without low-grade fever, rash, and bone pain. Management may require nonsteroidal anti-inflammatory drugs or a short course of corticosteroids. Dose delays or reductions usually are not required for tumor flare reactions. Signs of tumor lysis syndrome may include shortness of breath, peripheral edema, generalized weakness, sweating, fever, and tachycardia. Untreated tumor lysis syndrome can result in renal impairment and congestive heart failure. Careful monitoring and appropriate management of treatment-related side effects can help ensure that patients with CLL achieve maximum therapeutic benefit from lenalidomide therapy.

Hematopoietic cell transplantation in the treatment of leukemia.

OBJECTIVES: To review the current evidence regarding the role and benefits of hematopoietic cell transplantation (HCT) in leukemia. DATA SOURCES: Review articles, original articles, internet web sites, and books. CONCLUSION: HCT is a potentially curative treatment modality for patients with hematologic malignancies such as leukemia. IMPLICATIONS FOR NURSING PRACTICE: Nurses working with patients undergoing HCT need awareness of the type of leukemia, source of the hematopoietic cell product, type of preparative regimen used, and the complications of the procedure will enable nurses to educate and intervene with patients and their family members throughout the transplant trajectory.

Diagnosis, treatment, and nursing care of patients with chronic leukemia.

OBJECTIVES: To provide an update on the impact of new information about the molecular biology of chronic leukemia and new treatment modalities available to patients. DATA SOURCES: Published articles, books, and research studies. CONCLUSION: There has been significant progress in the diagnosis and management of chronic myeloid and chronic lymphocytic leukemia. New therapies provide more options for patients and longer treatment periods. IMPLICATIONS FOR NURSING PRACTICE: With increasing treatment options and longer survival, patients with chronic myelogenous or chronic lymphocytic leukemia need increased education, support, and assistance with symptom management. Nurses caring for these patients must remain knowledgeable about new treatments and their management.

Treatment of chronic lymphocytic leukemia with alemtuzumab: a review for nurses.

PURPOSE/OBJECTIVES: To review the use of the monoclonal antibody alemtuzumab in patients with advanced refractory B cell chronic lymphocytic leukemia (B-CLL) and nursing management during treatment. DATA SOURCES: Published articles, abstracts, book chapters, Web sites, and training material. DATA SYNTHESIS: Alemtuzumab can achieve disease remission in patients with chemorefractory B-CLL; however, management of high-risk patients presents certain challenges. Infusion-related events can be minimized by stepwise administration and appropriate prophylaxis. Cytopenia can be minimized by drug postponement and cytokine support or red blood cell or platelet transfusions. Patients also are at risk for infection because of lymphopenia, and anti-infective prophylaxis is mandatory at initiation of therapy until at least two months post-treatment. CONCLUSIONS: With satisfactory supportive measures in place, patients with chemorefractory B-CLL can experience the benefits of alemtuzumab therapy without excessive toxicity. IMPLICATIONS FOR NURSING: Nurses should be familiar with treatment and prophylactic protocols, be ready to offer supportive therapy to control side effects, and invest time in patient education.

Nursing care of the patient with chronic lymphocytic leukemia.

Patients with chronic lymphocytic leukemia (CLL) have traditionally been managed conservatively. However, a better understanding of the biology of CLL, a younger patient, the development of new purine analogues, and bone marrow transplant clinical trial success have caused renewed interest in the disease. There are new challenges for the health care team which focus on patient management in an outpatient setting, patient/family education, and support related to chronicity of illness and quality of life issues. Patients can now enter aggressive clinical trials with the promise of long-term survival.