Brielle Benyon

While CAR-T cell therapy has drastically improved the outcomes of many patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), some serious side effects can occur.

“CAR T-cell represents new treatment for diffuse large B-cell lymphoma in the relapsed/refractory setting,” said Dr. Andrew D. Zelenetz, from Memorial Sloan Kettering Cancer Center.

“As a result, it’s been included in the NCCN guidelines for transformed follicular lymphoma, transformed marginal zone lymphoma, and for diffuse large B-cell lymphoma, as well as refractory diffuse large B-cell lymphoma.”

Zelenetz recently discussed CAR T-cell therapy for this patient population at the NCCN 2020 Virtual Congress on Hematologic Malignancies.

He gave an overview of the ZUMA-1 trial, which tested Yescarta (axicabtagene ciloleucel) and the JULIET trial, which tested Kymriah (tisagenlecleucel). Both trials tested CAR-T cell therapies in patients with relapsed or refractory DLBCL, which is traditionally difficult to treat and has poor outcomes.

In ZUMA-1, 74% of patients responded to treatment with Yescarta. The average response time was six months.

“The better your T cells expand after infusion, the more likely you are to have an ongoing response,” Zelenetz explained. “Interestingly, at 24 months, among the responders, 66% of the patients still have detectable CAR T cells that are circulating.”

Similarly, in the JULIET trial, more than half (52%) of patients responded to Kymriah, and 40% had a complete response, meaning that clinicians could not detect any disease.

While these statistics are promising, patients undergoing CAR-T cell therapy should talk with their health care team about the side effects that can occur. As most patients on both trials experienced some kind of toxicity.

“If we look at safety, not surprisingly, every patient had some (side effect). Serious (side effects) were seen in 65% of patients,” Zelenetz said, referring to the JULIET trial.

The two major side effects that can occur as a result of CAR-T cell therapy are cytokine release syndrome (CRS) and neurotoxicity.

CRS occurs when cancer treatments cause an influx of cytokines – molecules that help control the immune system and inflammation – to be released into the patient’s blood stream. Symptoms include high fever, low blood pressure, irregularly fast heartbeat, weight gain and a decrease in protein/albumin in the blood.

If a patient experiences any of those effects, they should contact their care team right away. Luckily, CRS is treatable, usually with Actemra (tocilizumab) with or without corticosteroids.

Neurotoxicity, on the other hand, is difficult to treat. This is the result of damage to the brain or the nervous system. Symptoms can range from being subtle – like having difficulty finding words – to more severe, like cerebral edema and seizures.

“Most often, this is a reversible syndrome, though there have been some toxicities reported,” Zelenetz said. “It’s not clear what – if any – treatments are really effective.”

Despite the downsides of side effects, CAR-T cell therapy could be a promising treatment option for eligible patients with DLBCL. However, it is crucial that they stay in contact with their treatment team regarding any malady that they are feeling.

A version of this article was originally published on OncNursingNews.com as, “

CAR T-Cell Therapy: High Response Rates, High Toxicity Rates

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CAR-T cell therapy is drastically improving outcomes for patients with diffuse large B-cell lymphoma. However, the treatment can come with some severe side effects that patients need to know about. 

CAR-T Cell Therapy Side Effects: Know What to Look Out For

Androgen deprivation therapy (ADT), also known as hormone therapy, for prostate cancer can have a negative impact on bone health, but a healthy lifestyle can mitigate skeletal side effects and promote overall wellbeing.

“The foods you choose to eat and the amount of physical activity you get can impact your health, as well as your prostate cancer risk, recovery, and survival,” said Dr. Cassandra N. Moore of the Mayo Clinic, at the 

Educated Patient® Prostate Cancer Summit.

ADT can increase body fat, insulin resistance, and can affect blood vessels. It can also increase a patient’s likelihood of developing diabetes, cardiovascular disease, and fractures – especially in men undergoing continuous ADT for six months or longer.

“These treatments for prostate cancer, although they benefit the cancer treatment, can have a negative impact on your body,” Moore said. “So not only does the normal aging process (affect health), but also hormone therapy can lead to a loss of muscle mass and bone density, which can possibly result in osteoporosis.”

To combat bone deterioration, it is advised that patients do not smoke or drink alcohol in excess, as both can individually contribute to poor bone health. Additionally, participating in weight-bearing aerobic and resistance exercises can improve bone density. Exercise also improves muscle strength, physical function, and balance in men with prostate cancer – thus reducing fall risk and improving quality of life.

“An active lifestyle through exercise is essential to bone health and men with prostate cancer on hormone therapy,” Moore said. “Both weight-bearing aerobic and resistance exercises are beneficial in improving bone density in men with normal bone density, and also in those who are at risk of osteoporosis.”

Moore explained that exercise has been shown to have positive impacts on quality of life, fatigue, lean muscle mass, muscle strength, physical function, and balance in patients with prostate cancer.

Getting the proper nutrients every day can also contribute to bone health, Moore emphasized.

Particularly, patients should be sure that they are getting enough calcium and vitamin D – preferably together, as vitamin D (which may improve muscle strength and function) helps the body absorb calcium and phosphorous (which are good for bone health). Data have shown that a daily dose of vitamin D (800 IU) reduced hip fractures for people aged 65 or older.

“General recommendation for while you are on hormone therapy is to have a bone mineral density test every one to two years. And it will be important to discuss with your doctor as to your particular health conditions if it is safe to increase your total daily dietary supplemental calcium intake to 1500 (milligrams) and vitamin D to 800 IUs a day,” Moore said.

While vitamin supplements can be beneficial, Moore said that it is best for people to get their nutrients from whole foods, including at least five servings of fresh fruits and vegetables daily, whole-grains, healthy sources of protein (such as fish, eggs, and beans), and healthy fats, like olive oils, nuts, and avocados.

Sugar-sweetened drinks, like sodas and many fruit juices and excess salt should be avoided.

“It’s more important to aim for a healthy eating pattern rather than focusing on specific foods,” Moore said. “We really don’t have data to support any one specific food. It’s just better to aim at an overall healthy eating pattern.”

Prostate cancer treatment can be detrimental to bone and muscle health, but an exercise regimen and healthy eating habits can help. 

Exercise, Diet Can Boost Bone Health in Prostate Cancer

Clostridioides difficile – commonly referred to as C. diff – is a serious infection that can negatively impact outcomes in patients with cancer. So, it is crucial that patients and their loved ones do their part to decrease the spread, according to Karen Wohlgezogen, a clinical nurse manager at the City of Hope National Medical Center.

“C. diff is a spore-forming [bacterium] that is very resilient, and difficult to kill,” Wohlgezogen said in a recent presentation about preventing the spread. “It causes life-threatening diarrhea and colitis.”

After seeing a spike in C. diff rates at their hospital a few years ago, Wohlgezogen and her team analyzed the problem and then created an intervention plan to stop the spread.

The initial analysis showed some potential reasons why more people were being infected with C. diff than usual. First, the researchers found that many people visiting individuals with C. diff in the hospital did not wash their hands as they were leaving patient rooms.

Additionally, C. diff was spreading in hospital rooms that were next to each other, which likely was a result of staff spreading the infection. When given surveys on C. diff protocols, some employees were not able to correctly answer questions regarding the cleaning of shared equipment.

“Anytime you’re cleaning anything having to do with C. diff, you definitely have to use bleach, so it’ll kill the spores. Alcohol gel and alcohol wipes don’t do it,” Wohlgezogen said. “But we had complaints from staff, patients, and families about using bleach. They didn’t like the strong smell, it seemed to stain the clothes of the staff using it.”

After they better understood why C. diff was spreading, Wohlgezogen was able to institute a plan to decrease rates, starting with patient and staff education. To mitigate excess travel of family members around the hospital, and ensure that proper cleaning policies were in place, nurses began to get patients and their visitors things that they may want or need, such as coffee or snacks.

On the patient side, clinicians emphasized the importance of daily bathing for patients with C. diff, to decrease the amount of bacteria that was on their body.

Staff made changes, too. They started using single-use items for medical equipment like commodes. “Once we did the bedside commode buckets as a single use, we definitely saw a decrease [in C. diff],” Wohlgezogen said.

The team also decided to keep vital sign machines and computers on wheels in isolated patients’ rooms, when possible, so that they would not have to be rolled from one room to another.

“Our recommendation is to maintain a high focus on [C. diff] infection prevention, and that the education just continues with the nursing [and medical] staff, patient families, and all the people who touch the patients,” Wohlgezogen said.

This article was originally published on OncLive as, “

Prevent the Spread of C. Diff on Oncology Units

Everyone has a role to play in decreasing Clostridioides difficile infection rates on oncology units, recent research shows. 

Patients, Visitors and Clinicians Can Stop the Spread of C. Diff on Cancer Units

While chemotherapy drugs are powerful in fighting various types of cancer, they can be hazardous if an individual is exposed to them outside of the realm of treatment. Recent study results presented at the 2020 Oncology Nursing Society (ONS) Bridge virtual conference demonstrate that these kind of drug encounters may very likely occur in hospital or clinic bathrooms.

Nurse researchers at the Seattle Cancer Care Alliance started a quality improvement project that analyzed the degree of contamination in both the patient and staff bathrooms at an ambulatory comprehensive cancer center. Specifically, they were testing for the two most common chemotherapy agents: 5FU and oxaliplatin.

“We did this project back in October and November of last year, and we had a couple of goals in mind. One was to take a look at the amount of contamination. We assumed that we were going to see some in patient bathrooms. Then as a parallel, we also wanted to see if we had any contamination in a staff bathroom that was locked behind a security door,” lead author Seth Eisenberg, RN, OCN, BMTCN, professional practice coordinator, infusion services at Seattle Cancer Care Alliance, said in his presentation.

The researchers tested the bathrooms by wiping the surfaces and then analyzing the swabs for chemotherapy contamination. This occurred each morning before the patients arrived and then again at the end of the day, between 5:00 and 6:00 p.m.

There was measurable contamination in the patient bathrooms every day of testing. One day had a major spike in hazardous drugs found.

“We looked at reasons for why there might have been such a huge spike there, [since there were no patient falls and no reported spills,” Eisenberg said. “So, we can assume that it was related to the fact that there was some more urine on the floor area.”

Contamination was also found in the staff bathrooms – which are located behind a security door that only staff members can enter – and there was an increase of contamination on the same day.

Although the researchers are not entirely sure why there was a bump of chemotherapy contamination in the staff bathroom that day, they did reach two conclusions. One, these drugs are excreted through urine; and two, they are difficult to clean.

Eisenberg said that more research should be done on this topic to improve the cleaning of staff and patient bathrooms, thus making a safer environment for everyone.

“We’ve actually got a different product that we’re going to try here soon, once things are back to normal [after the COVID-19 pandemic], and we will evaluate whether or not that product made a change in the amount of exposure we saw on the floors,” Eisenberg said.

For more news on cancer updates, research and education, don’t forget to

A version of this article originally appeared on OncNursingNews.com as, “

Drug Contamination Present in Patient and Staff Bathrooms

Recent study results demonstrated that there was contamination of popular chemotherapy agents in both patient and staff bathrooms of a cancer center.

Author | Brielle Benyon

CAR-T Cell Therapy Side Effects: Know What to Look Out For

Exercise, Diet Can Boost Bone Health in Prostate Cancer

Patients, Visitors and Clinicians Can Stop the Spread of C. Diff on Cancer Units

Study Finds Cancer Center’s Patient and Staff Bathrooms Contaminated by Chemo Agents