Gemtuzumab Ozogamicin

INTRODUCTION

Indications

Treatment of patients with patients with CD33-positive acute myeloid leukemia in first relapse who are ≥60 yr old and who are not considered to be candidates for cytotoxic chemotherapy.

Action

The antibody portion (gemtuzumab) attaches to the CD33 antigen on the surface of acute myeloid leukemic cells. Binding produces a complex that is internalized by the leukemic cells. Once internalized, the antitumor antibiotic portion of the drug (ozogamicin, also know as calicheamicin) is released and binds to DNA resulting in breaks in double-strand DNA and cell death. Therapeutic Effects: Death of acute myeloid leukemic cells.

Adverse Reactions/Side Effects

CNS: headache. Resp: dyspnea, hypoxia. CV: hypotension, hypertension. GI: mucositis, nausea, vomiting, hepatotoxicity. Derm: rash. Endo: hyperglycemia. F and E: hypokalemia. Hemat: NEUTROPENIA, anemia, bleeding, thrombocytopenia. Misc: chills, fever, postinfusion reaction, allergic reactions, infection, tumor lysis syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of bone marrow suppression, including neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician or nursing staff immediately.

• Report allergy-like responses (wheezing, tightness in the throat or chest, urticaria, other skin reactions) that occur during and after administration (infusion related events).

• Monitor neuromuscular signs of electrolyte imbalances that might indicate tumor lysis syndrome. Signs include severe muscle weakness or paralysis due to increased plasma potassium (hyperkalemia) or muscle hyperexcitability and tetany due to phosphate and calcium imbalances (hyperphosphatemia and hypocalcemia). Notify physician immediately if these signs occur.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension) or a decrease in BP (hypotension), especially if symptoms such as dizziness and syncope occur.

• Assess any breathing problems such as difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

• Because of the risk of abnormal BP responses, blood dyscrasias, and pulmonary problems, use caution during aerobic exercise and endurance conditioning. Terminate exercise ...