Tositumomab (I 131 Tositumomab)

INTRODUCTION

Indications

CD20-positive, follicular, non-Hodgkin's lymphoma refractory to rituximab and in relapse.

Action

Binds to CD20 antigens on the surface of specific lymphocytes producing antibody-mediated cytotoxicity and cell death due to ionizing radiation. Therapeutic Effects: Sustained depletion of CD20 lymphocytes, with ↓ progression of lymphoma.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, headache, weakness. CV: edema, hypotension. GI: abdominal pain, diarrhea, nausea, vomiting. Endo: hypothyroidism. Hemat: NEUTROPENIA, THROMBOCYTOPENIA, anemia. Metab: weight loss. MS: arthralgia, back pain, myalgia, neck pain. Misc: hypersensitivity reactions, including anaphylaxis, infusional toxicity, fever, secondary malignancies.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Notify physician or nursing staff immediately of these signs.

• Monitor signs of allergic reactions, including anaphylaxis. Reactions include pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) and skin reactions (rash, pruritus, urticaria). Be especially alert for these signs after drug infusion (infusion toxicity). Notify physician or nursing staff immediately if these reactions occur.

• Assess any increased joint, muscle, neck, or back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess blood pressure periodically. Report a problematic decrease in blood pressure (hypotension, See Appendix F), especially if dizziness and syncope occurs.

• 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 dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor signs of hypothyroidism such as bradycardia, lethargy, cold intolerance, weight gain, and muscle weakness. Notify physician of these signs.

• Be alert for signs of secondary malignancies, including a change in bowel or bladder habits, nonhealing sores, unusual bleeding or discharge, a lump in the breast or other parts of the body, chronic indigestion or difficulty in swallowing, obvious changes in a wart or mole, and persistent coughing or hoarseness. Report these signs to the physician immediately.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive ...