APHON Pediatric Chemotherapy-Biotherapy Renewal

treated prophylactically with opioid therapy prior to each dose of the drug, as continuous infusion throughout the dinutuximab infusion, and for 2 hours after the infusion is complete. If the patient’s pain is severe, the rate of infusion of dinutuximab therapy may be reduced or the therapy may be discontinued altogether (Hoy, 2016; McGinty & Kolesar, 2017). Blinatumomab (Blincyto). Blinatumomab is a bispecific CD-19-directed CD3 T-cell engager (BiTE). Blinatumomab binds to CD19 expressed on the surface of B cells and the CD3 epsilon subunit found on mature T cells. When blinatumomab binds to a CD3-positive T cell and a CD19-positive B cell, it brings both cells together in a cytolytic synapse, and cell death is induced on the malignant B cell by the cytotoxic T cell (Newman & Benani, 2016). Blinatumomab is used to treat CD19-positive B-cell precursor ALL in both pediatric and adult patients. Pediatric dosing and administration involve a 28-day continuous infusion with close monitoring both by the nursing staff while the patient is hospitalized for the first days of the infusion and by the caregivers for the remainder of the infusion. Patient and caregiver education are of supreme importance because blinatumomab carries two black-box warnings with it: cytokine release syndrome and neurotoxicity. The nurse should employ the “teach-back method” of patient and caregiver education to confirm that the caregivers understand the instructions provided and that the patient’s safety will be ensured while the therapy is administered away from the hospital. Neurotoxicity associated with blinatumomab may be severe and can even result in the patient’s death. Neurological symptoms include headache and tremor, encephalopathy, seizure, speech disorders, confusion, disorientation, disturbances in level of consciousness and coordination, and balance disorders (Stein et al., 2019). Routine prophylaxis for seizures is not typically recommended; however, labeling from the manufacturer recommends discontinuation of the drug should the patient experience more than one seizure while receiving blinatumomab. Although events meeting the Grade 3 and Grade 4 Common Terminology Criteria for Adverse Events are not typically seen, adverse events occurred in at least 50% of patients treated with blinatumomab while on clinical trial, making recognition of neurotoxicity crucial if neurotoxicity is to be quickly treated or resolved for the best possible patient outcomes (Newman & Benani, 2016). Conclusion Neurotoxicities from chemotherapy and biotherapy pose challenges for both the patient and the medical team. These toxicities can be severe and therapy-limiting for the patient. Short- and long-term sequelae from CNS and peripheral nervous system toxicities can affect the patient’s quality of life for many years. CNS toxicities can prove challenging because the patient may develop encephalopathy, altered mental status, fatigue, headache, and seizures that can lead to a lifetime neurocognitive impairment, brain atrophy, progressive leukoencephalopathy, cerebrovascular disease, and more. It is incumbent on nurses to learn to recognize the neurotoxicities associated with both the chemotherapy and biotherapy their patients are receiving. This knowledge can lead to more thorough assessments and documentation, as well as