Treatment Monitoring

Patients should be monitored for infusional toxicities with frequent vital sign measurements as well as clinical assessment by a trained healthcare provider. Common toxicities associated with monoclonal antibody therapy, particularly chimeric or humanized antibodies such as rituximab, include chills and hypotension. These side effects are most associated with the first infusion of monoclonal antibody and particularly common in patients who have high tumor burdens or evidence of circulating malignant cells. Such patients with high tumor burdens may be additionally prophylaxed with allopurinol and vigorous hydration as needed to prevent tumor lysis syndrome.

Once the patient has successfully completed the therapeutic infusion, the primary toxicity to monitor is hematologic and the secondary sequellae of pancytopenia. Patients should at the minimum receive a weekly blood count with differential and platelet count from the time of the treatment dose through the patient's nadir and recovery of hematopoietic function. This nadir typically occurs six to eight weeks after the treatment dose and may require over 12 weeks to recover to the patient's baseline counts. Finally, the patients should be cautioned that if they develop fevers, chills, or other signs of infection, as well as signs of bleeding prior to recovery of their hematopoietic function, these should be immediately reported to their primary healthcare provider as neutrope-nic sepsis or serious bleeding complications hypothetically may occur. Additional supportive measures also may be needed in selected patients at the discretion of the patient's primary clinician, such as hematopoietic growth factor support and/or blood product transfusion.

In addition to monitoring the toxicities of the aforementioned approach, the patient's primary clinician will also routinely monitor the efficacy of the therapy either by physical examination and/or radiographic imaging. It is important to note that the maximal effect of RIT, unlike chemotherapy, may occur beyond six months after the therapeutic dose.

0 0

Post a comment