First Quarter 2008 - Issues in Hematology - ION Solutions

nurse’s forumOUTPATIENT MANAGEMENT OF TUMORLYSIS SYNDROME IN PATIENTS WITHDIFFUSE LARGE B-CELL LYMPHOMA:CONSIDERATIONS FOR THEONCOLOGY NURSEby: Tamika M. Turner, M.S.N., N.P.-C., O.C.N.oncologistics volume 7, issue 1 - spring 2008 46Approximately 80-90% of chemotherapy is given inthe outpatient setting. 1 Oncology nurses who work inoutpatient chemotherapy infusion clinics are the keyplayers in fi rst recognizing adverse side effects fromchemotherapy. These nurses spend time with patientsfrom the initiation of chemotherapy to the completion ofeach infusion. Oncology nurses must be knowledgeableregarding the possible adverse reactions of eachchemotherapy medication infused to appropriatelycare for patients in this setting.The purpose of this article is to review tumor lysissyndrome as it relates to patients with non-Hodgkinlymphoma (NHL). This article will review one type ofNHL commonly treated in the outpatient infusion clinic,commonly used chemotherapy regimens to treat this typeof lymphoma, adverse reactions to these chemotherapymedications to include tumor lysis syndrome, and oncologynursing considerations.NHL is the fi fth most common cancer in men and womenin the United States: approximately 64,000 people inthe United States were diagnosed with non-Hodgkinlymphoma in 2007. 2 Lymphomas occur when lymphocytesundergo a malignant change. This change causes thecell to multiply out of control and crowd out healthy cells,thus causing tumors in the lymphatic system. The mostcommon places for lymphomas to start are in the lymphnodes or in organs like the stomach or intestines. Theseorgans have collections of lymphatic tissue that make themprone for lymphomas to originate. 2The oncology nurse may be asked what it is that increasesa patient’s risk for lymphoma. The incidence of NHL hasalmost doubled over the last century, and there are anumber of possible factors that may increase the risk forNHL. Immunosuppression is one of those risk factors.Patients with HIV have approximately 50 to 100 times theincidence of NHL than those without HIV. The Epstein-Barr virus has been found to increase the risk for Burkettlymphoma and Helicobacter pylori has been found toincrease the risk for MALT or gastric lymphoma. Farmershave also been found to have an increased risk for NHL.It is thought that this is from the pesticides and herbicidesused to maintain farms and/or crops. 2Diffuse large B-cell lymphoma is the most aggressive formof NHL and the most common form in the Western world.These lymphomas are aggressive but can be curable.Diffuse large B-cell lymphomas have large B lymphocytesmaking up the tumors, and there is usually extranodaland widespread involvement. Patients may present witha variety of symptoms, such as enlarged lymph nodes inthe neck, axillary area, or groin. Occasional symptoms willoccur in other areas of the body, such as bone, lung, orgastrointestinal tract. These patients may experience bonepain, cough, or gastrointestinal distress. Other symptomsmay include unexplained weight loss,