Immunotherapy is used in haematological cancers to induce an immune response against the tumour cells, to produce active or passive immunity to tumour cells with vaccines, or to target the tumour cell with a monoclonal antibody. This chapter will focus on nursing care and education of patients being treated with monoclonal antibodies. Monoclonal antibodies are custom-made immunoglobulins produced in the laboratory to a specific cell surface antigen. These antibodies, when injected into patients, will attach to a specific target and kill the cell by inducing apoptosis or direct the patient’s immune system to attack the tumour cell by a process called antibody-dependent cellular cytotoxicity.
Immunotherapy with monoclonal antibodies can be divided into two categories – unlabelled or ‘cold’ antibodies and radiolabelled or ‘hot’ antibodies. To form a radioimmunoconjugate, a radioisotope is attached to the antibody so that the target cells also receive radiation. This process is called radioimmunotherapy (RIT) [1–3]. The advantage of immunotherapy and RIT over chemotherapy is that they are more targeted than chemotherapy. In general, chemotherapy is less selective and is often toxic to normal organs as well as the cancer itself. Antibodies can have toxicity too because the antigen they target is often found on some normal cells. In the case of RIT, the highest amount of radiation is delivered to the tumour cell with the only toxicity being myelosuppression (Figure 20.1).
Antibody therapy by nature is more selective than chemotherapy in targeting tumour cells. Used by permission from Biogen IDEC (San Diego, CA and Cambridge, MA).
When a patient is anticipating immunotherapeutic treatment for lymphoid cancers, it is important that they understand all aspects of these treatments to reduce anxiety and ensure the safest and most effective treatment possible. This teaching is typically performed by the treatment nurse. Most patients have had experience with chemotherapy and it is important for the patient to understand the similarities and differences between immunotherapy and chemotherapy. Common side-effects of chemotherapy include alopecia, nausea, vomiting, diarrhoea, constipation, stomatitis, cardiomyopathy, and neuropathy – all of which are uncommon with immunotherapy. Chemotherapy often produces myelosuppression, which produces anaemia, neutropaenia, and thrombocytopaenia with the consequent risk of fatigue, infection, and bleeding. However, a common side-effect of immunotherapy not often seen with chemotherapy is infusion-related toxicity including fever, chills, rigors, bronchospasm, urticaria, and hypo- or hypertension. These symptoms can occur suddenly and be severe, and if the patient and staff are not knowledgeable about these reactions, they can be very frightening for the patient and the nursing staff alike. Cold antibodies such as rituximab and alemtuzumab target lymphoid cells such that infection is a risk – more so with alemtuzumab than rituximab. Radiolabelled antibodies definitely produce myelosuppression that predictably occurs at about 4–8 weeks. In summary, before the patient receives monoclonal ...