CD-19
This immunotherapy targets CD-19 on leukemia cells
Blinatumomab
A systemic inflammatory response syndrome related to blinatumomab
Cytokine release syndrome
Practice recommendation #1: Nurses Recognize Patients with ______ Disease Burden as being at ______ ____ for CRS
Higher,
higher risk
This can be caused by blina or an infection
Fever
It is strongly recommended that nurses also monitor for this toxicity in addition to CRS
Neurotoxicity
Another therapy that targets CD-19
CAR-T
3 symptoms of CRS
Mild: fever, myalgias, malaise, anorexia
More severe: hypotension, tachycardia, capillary leak, respiratory distress, and disseminated intravascular coagulation
Practice Recommendation #2: Nurses Recognize the Time Period for Which Patients are at the Greatest Risk of CRS
First 4 days of infusioin
Practice Recommendations #4: Nurses Need to Quickly Escalate the Level of Care in pts with CRS; grade of CRS at which infusion interruption is needed
Grade 3 and/or 4
List 3 symptoms of neurotoxicity
Seizure, tremor, aphasia, confusion and more
What BiTE stands for
Bi-specific T-cell engager
2 strategies to reduce risk of CRS-related morbidity and mortality
Accurate nursing assessment
Early identification of CRS
Initiation of appropriate therapy
Where patients should be when at high risk of CRS
In-patient
IL-6 antagonist that may be given to decrease symptoms of CRS
Tociluzimab
Prophylaxis medication for seizures and neurotxicity
Keppra
The most common and potentially life-threatening toxicity associated with T-cell engaging therapies
Cytokine Release Syndrome (CRS)
When nurse scientists look at studies that have been published
Literature search
Practice Recommendation #3: Nurses Closely Monitor these q4 or more often
VS: temp, HR, RR and oxygen saturation
Total length of blina infusion
28 days
When grade 3 neurotoxicity can be expected to improve
24-48 hours after the infusion is stopped
The 2 targets of of the BiTE antibody blinatumomab
CD-19 on the leukemia cell
CD-3 on the T-cell
Premedication given prior to blinatumomab
Dexamethasone
CRP, ferritin, cytokines (IL-6 or IL-10) examined to see if there is a way to predict risk of CRS (what are these called)
Biomarkers
First tested in relapsed patients, blina is now given to these patients
Almost all standard and high risk pre-B ALL (except standard with favorable cytogenetics)
How to get a bag of blina for a kid who shows up de-accessed in the ED
Emergency bag in the supportive care section of oncology navigator - and yes, the pharmacy can make it overnight!