Oncology Nursing Update: Non-Hodgkin Lymphoma Edition, Issue 1, 2013

To bridge the gap between research and patient care, this activity features one-on-one interviews conducted by Dr Neil Love with leading non-Hodgkin lymphoma investigators. By providing information on the latest research developments in the context of expert perspectives, this activity is designed to assist oncology nurses, clinical nurse specialists and nurse practitioners with the formulation of state-of-the-art clinical management strategies to facilitate optimal patient care. This content is available in a number of formats for listening on the go with a mobile device or in the office or at home on a computer.

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TOPICS DISCUSSED


	Amy Goodrich, CRNP-AC Nurse Practitioner Johns Hopkins Kimmel Cancer Center Baltimore, Maryland		INTERVIEW WITH MS GOODRICH Case discussion: A 70-year-old woman with a prior history of breast cancer presents with asymptomatic Stage IIIA nonbulky follicular lymphoma (FL) and subsequently undergoes treatment with rituximab (R) on the RESORT study – Phase III ECOG-E4402 (RESORT) study comparing R maintenance to R re-treatment upon disease progression for low tumor burden indolent non-Hodgkin lymphoma (NHL) – Hypogammaglobulinemia and chronic infections in patients receiving maintenance R – Bendamustine-R (BR) as front-line therapy for FL – Counseling patients with FL about the similarities and differences between BR and R-CHOP – PRIMA: Maintenance R in patients with FL who achieve a response to R-chemotherapy – Use of R-lenalidomide (R²) in patients with FL who are intolerant to chemotherapy Case discussion: A 63-year-old woman with widespread adenopathy and aggressive, high-risk diffuse large B-cell lymphoma (DLBCL) – Monitoring and treatment of tumor lysis syndrome – Use of rasburicase prophylaxis for tumor lysis syndrome – CNS prophylaxis for patients with DLBCL Case discussion: A 64-year-old man with Stage IVA, Grade I FL is observed off treatment for 5 years and subsequently receives R in the face of progressive disease. The patient achieves a complete response to R followed by transformation to DLBCL – Treatment of transformed FL

	Mitchell R Smith, MD, PhD Director of Lymphoid Malignancies Program at Taussig Cancer Institute Cleveland Clinic Cleveland, Ohio		INTERVIEW WITH DR SMITH Case discussion: A 58-year-old woman with asymptomatic CLL and WBC rising to 200,000/mm³ – Detection, diagnosis and prognosis of CLL – Indications to initiate treatment for CLL – Hypersplenism in CLL – Management of tumor lysis syndrome — hydration, allopurinol and rasburicase – Undefined role of R maintenance in CLL – Overview of the similarities and differences between FL and CLL – Educating patients with indolent lymphoma about a “watch-and-wait” approach versus active treatment – Promising investigational agents in CLL: ibrutinib, idelalisib (GS1101) and the Bcl-2 inhibitor ABT-199 – Evolving role of lenalidomide ± R in CLL and other lymphomas – Avoidance of lenalidomide-associated tumor flare in CLL – Mechanisms of action of R and lenalidomide and rationale for their synergy when used in combination – Use of R monotherapy in CLL – Radioimmunotherapy (RIT) as a treatment option in indolent lymphomas Case discussion: A 63-year-old man with massive splenomegaly and progressively worsening fatigue is diagnosed with mantle-cell lymphoma (MCL) and undergoes treatment with modified hyper-CVAD – Diagnostic workup for MCL – Treatment approaches for younger and older patients with MCL – Maintenance R in patients with MCL responding to R-CHOP – BR followed by maintenance R for relapsed MCL – Promising investigational agents in MCL: mTOR inhibitors everolimus and temsirolimus Case discussion: A 60-year-old man with low-risk, germinal-center DLBCL receives R-CHOP-14, relapses 1 year later and receives R-ICE followed by HDT and ASCT followed by a second relapse 9 months later – Perspective on dose-dense R-CHOP-14 versus R-CHOP-21 in DLBCL – Phase III study of pixantrone/R versus gemcitabine/R for aggressive, relapsed NHL not eligible for stem cell transplant

	Steven M Horwitz, MD Assistant Attending Lymphoma Service, Division of Hematologic Oncology Memorial Sloan-Kettering Cancer Center New York, New York		INTERVIEW WITH DR HORWITZ Case discussion: A 69-year-old woman who responded well to initial treatment with EPOCH for angioimmunoblastic T-cell lymphoma (TCL) undergoes allogeneic stem cell transplant for a biopsy-proven recurrence and achieves remission – Overview of angioimmunoblastic TCL – Key clinical differences between B-cell and T-cell lymphomas – Activity and tolerability of EPOCH in angioimmunoblastic TCL – Common subtypes of systemic TCL – Perspective on allogeneic transplant for older patients with relapsed/refractory angioimmunoblastic TCL – Treatment options for relapsed/refractory angioimmunoblastic TCL – Mechanisms of action, efficacy and toxicity profiles of the novel agents romidepsin and pralatrexate used in the treatment of TCL – Activity and side effects of the antibody-drug conjugate brentuximab vedotin in CD30-positive lymphomas – Promising investigational agents in TCL: belinostat, bendamustine, KW-0761 and BTK inhibitors – Potential role of lenalidomide in the treatment of TCL Case discussion: An 81-year-old man with Stage 1B mycosis fungoides is enrolled in a clinical trial of pralatrexate and bexarotene after disease transformation – Presentation and symptomatology of mycosis fungoides – Educating patients about phototherapy for the treatment of cutaneous TCL (CTCL) – Treatment options for patients with relapsed/refractory CTCL – Phase I study of pralatrexate in combination with bexarotene for patients with relapsed or refractory CTCL

	Mollie Moran, MSN, CNP, AOCNP The James Cancer Hospital at The Ohio State University Columbus, Ohio		INTERVIEW WITH MS MORAN Case discussion: A 59-year-old man with MCL achieves a complete remission after treatment with R-hyper-CVAD – Overview of MCL – Educating patients about the side effects and toxicities of R-hyper-CVAD – Treatment options for recurrent MCL – Activity and side effects of bortezomib in MCL – Benefits and risks of lenalidomide in MCL Case discussion: A 63-year-old woman with Stage IVB DLBCL receives R-EPOCH on a Phase III trial and remains in complete remission after 2 years – CNS prophylaxis in DLBCL Case discussion: A 65-year-old man with FL who achieves a complete response to BR experiences disease relapse 2 years later and receives R² – Response and tolerability of BR versus R-CHOP as front-line therapy in FL – Consideration of R up front or as maintenance therapy for FL – Use of R² in patients with relapsed/refractory FL – Lenalidomide-associated tumor flare in FL – RIT as a treatment option in FL Case discussion: A 64-year-old man with CLL whose disease progresses through multiple lines of therapy is now under consideration for a clinical trial of the oral BTK inhibitor ibrutinib – Risk for infections in patients with CLL – Counseling patients with indolent lymphomas about their diagnosis, treatment and prognosis

	EDITOR: Neil Love, MD Research To Practice Miami, Florida

OVERVIEW OF ACTIVITY

Non-Hodgkin lymphoma (NHL) comprises a heterogeneous group of lymphoproliferative disorders and is one of the most rapidly evolving fields in hematology and oncology. In 2012, the numbers of estimated new cases of NHL and chronic lymphocytic leukemia (CLL) in the United States were 70,130 and 16,060, respectively, with approximately 23,000 deaths estimated from these diseases. Increasingly, the age of patients diagnosed with NHL has risen during the past 2 decades, which may result in more significant comorbid conditions that will complicate treatment. Published results from ongoing clinical trials lead to the continual emergence of new therapeutic agents and changes in the use of existing treatments. To provide oncology nurses with therapeutic strategies to address the disparate needs of patients with NHL/CLL, the Oncology Nursing Update audio series employs one-on-one interviews with medical oncologists and nurses who are experts in caring for patients with NHL/CLL. Upon completion of this CNE activity, oncology nurses should be able to formulate an up-to-date and more complete approach to the care of patients with NHL/CLL.

LEARNING OBJECTIVES

Relate therapeutic algorithms for the management of indolent and aggressive forms of B-cell NHL to appropriate patient-focused education to enhance clinical decision-making.
Apply the results of emerging clinical research to the therapeutic and supportive care of patients with newly diagnosed and relapsed/refractory CLL.
Explain the risks and benefits of evidence-based treatment approaches and agents to patients with T-cell lymphoma requiring systemic therapy.
Evaluate the preliminary safety profiles and response outcomes of investigational agents and treatment strategies undergoing evaluation in NHL and CLL, and counsel appropriately selected patients about the potential for enrollment in clinical trials.

ACCREDITATION STATEMENT

Research To Practice is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

CME credit is no longer available for this issue

CREDIT DESIGNATION STATEMENT

CME credit is no longer available for this issue

HOW TO USE THIS CNE ACTIVITY

This is an audio CNE program. Participants should read the learning objectives and faculty disclosures and listen to the audio MP3s.
CME credit is no longer available for this issue

CONTENT VALIDATION AND DISCLOSURES

Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CNE activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:

Amy Goodrich, CRNP-AC
Nurse Practitioner
Johns Hopkins Kimmel Cancer Center
Baltimore, Maryland

No real or apparent conflicts of interest to disclose.

Mitchell R Smith, MD, PhD
Director of Lymphoid Malignancies Program at Taussig Cancer Institute
Cleveland Clinic
Cleveland, Ohio

Advisory Committee: Cephalon Inc; Speakers Bureau: Allos Therapeutics, Cephalon Inc, Genentech BioOncology, Millennium: The Takeda Oncology Company, Spectrum Pharmaceuticals Inc.

Steven M Horwitz, MD
Assistant Attending
Lymphoma Service, Division of Hematologic Oncology
Memorial Sloan-Kettering Cancer Center
New York, New York

Advisory Committee: Allos Therapeutics, Celgene Corporation; Consulting Agreements: Allos Therapeutics, Bristol-Myers Squibb Company, Celgene Corporation, Kyowa Hakko Kirin Co Ltd, Seattle Genetics, Spectrum Pharmaceuticals Inc; Paid Research: Allos Therapeutics, Celgene Corporation, Kyowa Hakko Kirin Co Ltd, Millennium: The Takeda Oncology Company, Seattle Genetics, Spectrum Pharmaceuticals Inc.

Mollie Moran, MSN, CNP, AOCNP
The James Cancer Hospital at The Ohio State University
Columbus, Ohio

No real or apparent conflicts of interest to disclose.

EDITOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Algeta US, Allos Therapeutics, Amgen Inc, ArQule Inc, Astellas, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, EMD Serono Inc, Foundation Medicine Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly USA LLC, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Mundipharma International Limited, Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals Inc and Teva Oncology.

RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

This activity is supported by educational grants from Celgene Corporation and Genentech BioOncology/Biogen Idec.

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