Pharmacologic: monoclonal antibodies
Chronic lymphocytic leukemia (CLL) refractory to fludarabine and alemtuzumab.
A monoclonal antibody that specifically binds to CD20 molecule found on the surface of B lymphocytes, resulting in B-cell lysis. Therapeutic Effects: ↓ numbers of leukemic cells in CLL
Adverse Reactions/Side Effects
CNS: weakness. CV: peripheral edema. GI: INTESTINAL OBSTRUCTION, REACTIVATION OF HEPATITIS B. Derm: sweating. Hemat: anemia, neutropenia, thrombocytopenia. MS: back pain, muscle spasm. Neuro: PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML). Misc: INFECTIONS, INFUSION REACTIONS, chills, fever.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Be alert for signs of progressive multifocal leukoencephalopathy. Signs include memory lapses, decreased cognition, vision loss, speech problems, incoordination, ataxia, and muscle weakness that can progress to paralysis, seizures, and coma. Report these signs to the physician or nursing staff immediately.
Report allergy-like responses such as wheezing, laryngeal edema, urticaria, and other skin reactions that occur during and after administration (infusion related events).
Watch for signs of reactivation of hepatitis B, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain. Report these signs to the physician or nursing staff immediately.
Monitor signs of severe constipation and intestinal obstruction, including lack of bowel movements, abdominal pain, and abdominal distension. Report these signs to the physician or nursing staff immediately.
Be alert for signs of infection, including fever, sore throat, chills, nausea, vomiting, diarrhea, and localized inflammation. Notify physician or nursing staff of these signs immediately.
Monitor and report signs of bone marrow suppression, including neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias.
Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.
Assess any back pain or muscle spasms to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.
Instruct patient or family/caregivers to report other side effects such as severe or prolonged weakness, chills, fever, or excessive sweating.