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Cilta-Cel Improves QOL, Extends Treatment Breaks vs SOC in R/R Myeloma

Acupuncture Use in BC Predicted by Social Determinants of Health

Gene expression in peripheral blood as well as patient-reported outcomes differed for those with acute myeloid leukemia undergoing induction chemotherapy.

Variability Found in PROs, Gene Expression During AML Induction Chemo

Using tools like the ICE Score could improve consistency in grading neurotoxicity tied to bispecific antibodies in hematologic cancers.

Blinatumomab-Linked ICANS Cases Higher Than Previously Reported

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A ready-to-dilute formulation of thiotepa has been approved by the FDA for use in breast and ovarian cancers.

Ready-to-Dilute Thiotepa Approved for Breast and Ovarian Adenocarcinomas

A network meta-analysis suggests zanubrutinib may offer improved efficacy over other BTK inhibitors for patients with high-risk relapsed/refractory CLL.

Zanubrutinib Shows Potential Efficacy Edge in High-Risk R/R CLL, Analysis Finds

Nurse practitioners and physician assistants can advocate to play a number of roles in oncology research, including primary investigators.

“Be Part of the Revolution”: APPs as Primary Investigators in Oncology

AYA Cancer Awareness Month offers an opportunity for nurses to go further in supporting AYAs with cancer.

Opinion: Increasing Support and Awareness for AYAs With Cancer

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In May 2023, the FDA granted accelerated approval to epcoritamab-bysp (Epkinly) for the treatment of adult patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL), including DLBCL arising from indolent lymphoma, and high-grade B-cell lymphoma (HGBL), following 2 or more lines of systemic therapies. Shortly thereafter, in June 2023, the FDA granted accelerated approval to glofitamab-gxbm (Columvi) as a fixed duration treatment for patients with R/R DLBCL not otherwise specified or large B-cell lymphoma (LBCL) arising from follicular lymphoma, after 2 or more lines of systemic therapy.

, Laura Zitella, MS, RN, ACNP-BC, AOCN, who is a hematology nurse practitioner in the Hematology, Blood, Marrow Transplant, and Cellular Therapy (HBC) program at UCSF Health and associate clinical professor in the Department of Physiological Nursing at the University of California San Francisco, joins 

 to discuss how these newly approved bispecific antibodies are expanding third-line treatment options for patients with DLBCL.

“Bispecific antibodies are antibodies that generally have at least 2 antigen binding sites: 1 binding site is to the antigen of interest on the cancer cell, and in lymphoma, that's often CD19, or CD20. The other antigen binding site is to CD3, which is a T-cell marker.”

“Unfortunately, we do not cure all patients with second-line therapy, [and] the bispecifics are used for third-line therapy, where we have historically had limited treatment options.”

“One of the big advantages of bispecific antibodies is that they are ‘off-the-shelf;’ they do not need to be manufactured, and they are available immediately.”

“Epcoratimab is a subcutaneous [administration] bispecific antibody, whereas glofitamab is an intravenous [administration]. Both require step-up dosing, which means that you start with a small dose and then the subsequent doses are a little bit higher, and a little bit higher until you reach your treatment dose.”

Glofitamab Gains Accelerated Approval for Relapsed/Refractory DLBCL

Epcoritamab Obtains Accelerated Approval for Relapsed/Refractory DLBCL

Investigators Unveil Real-World Experiences on Shared Decision-Making in R/R DLBCL

With New Bispecific Antibodies in Multiple Myeloma, Nurses Need to Know How to Manage CRS

Novel Immune Checkpoint Inhibitors, Bispecific Antibodies Become Clinical Mainstays in Melanoma Nursing

Smith Discusses Evolving Landscape of Lymphoma Treatments

Bispecific Antibodies May Change Lung Cancer Paradigm

Beth Faiman Discusses Recent Changes in Multiple Myeloma Treatment Landscape

Oncology Nursing Stories: Off-The-Shelf CAR T Therapy for Acute Lymphoblastic Leukemia

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Conversations Around Selinexor: Best Nursing Practices in Multiple Myeloma

Stephanie Jackson Unpacks Recent Advances in Leukemia Treatments

Laura Zitella, MS, RN, ACNP-BC, AOCN, discusses how newly approved bispecific antibodies are expanding third-line treatment options for patients with diffuse large B-cell lymphoma. 

Laura Zitella Discusses the Growing Arsenal of Bispecific Antibodies in DLBCL

Cema-cel was associated with largely durable CRs in patients with CD19 CAR T-cell therapy-naïve relapsed/refractory LBCL.

Cema-Cel Yields CR, Found Tolerable in CD19 CAR T-Cell Therapy–Naive R/R LBCL

The FDA has accepted the resubmission of a BLA for odronextamab for the treatment of patients with relapsed/refractory follicular lymphoma.

FDA Reviews Resubmitted BLA for Odronextamab in R/R Follicular Lymphoma

Lisocabtagene maraleucel demonstrated a statistically significant overall response rate in adults with relapsed/refractory marginal zone lymphoma.

Positive Responses to Liso-Cel Observed in Relapsed/Refractory Marginal Zone Lymphoma

Findings from the ECHELON-3 trial supported the approval of brentuximab vedotin plus lenalidomide and rituximab for relapsed/refractory LBCL.

FDA Approves Brentuximab Vedotin Combo for Relapsed/Refractory Large B-Cell Lymphoma

January's FDA oncology approvals offer new treatment options for breast cancer, mantle cell lymphoma, and other malignancies.

Oncology Drugs Approved by the FDA in January 2025

Lauren Verity Moore, DNP, MSN, AGACNP-BC, discusses how oncology nurses and APPs can best assess for any signs of ICANS in their patients during treatment.

Lauren Verity Moore, DNP, MSN, AGACNP-BC, Discusses SONO Presentation on Lymphoma Treatment Management

Tools like the Immune Effector Cell Encephalopathy (ICE) score allow oncology nurses and advanced practice providers (APPs) to monitor for immune effector cell-associated neurotoxicity syndrome (ICANS) when patients with lymphoma are treated with bispecific antibodies and CAR T-cell therapy.

At the recent 8th Annual School of Nursing Oncology, Lauren Verity Moore, DNP, MSN, AGACNP-BC, nurse practitioner at the Murfreesboro Clinic of Tennessee Oncology, presented on managing 

patients with lymphoma while undergoing treatment

 with bispecific antibodies and CAR T-cell therapy.

Oncology Nursing News also spoke with Moore to learn more about how oncology nurses and APPs can best assess for any signs of ICANS in their patients during treatment.

You are going to have frequent assessments using an ICE score or an ICE tool, Immune Effector Cell Encephalopathy score. And that should be standard across each institution. Regardless of what grading scale you use, you should be calculating an ICE score. And that's going to give you—it's a 10-point score. Hopefully, Darlene, you and I would score a 10 out of 10, if we did that scale right now. But patients often—if they're beginning to experience neurotoxicity, you're going to ask them, “Hey, what year, what month, what city, what hospital are you in?” And if they only get 3 out of those 4, they'll get 3 points. And you go to the next question, “Name 3 objects in the room.” So a chair, a pen, a stethoscope. And you go on to the next thing. Are they able to follow commands? Can they write a sentence clearly? So you're going to keep the sentence the same, and you're going to have this documented. They're going to physically write down a sentence every time you do this assessment. And then can they count backwards by 10s from 100.

So, all of those things [answers] are going to give you, again, an optimal score of 10. For each point that they miss, you're going to then grade them based off of that score. That's one piece of looking for ICANS and neurotoxicity. I would say that's probably the best thing.

Some of the other symptoms, you can see things like seizures, deep motor weakness, hemiparesis, but those are pretty significant. That's really when you're getting into that grade 3, grade 4 ICANS. Like I said, I have found, personally, in my experience, that ICE score is where you're really going to first notice some changes.

You're going to see maybe a small tremor in their sentence writing. They've scored great on everything. They got a 10, but that sentence, you can start to see, is getting a little bit shaky. And they're still going to get the full 10, but you're going to know, I need to keep a close eye on that. Maybe we're starting to get to that ICANS grade 1, or they have even sometimes, like expressive aphasia. They know what they want to say, but they can't quite find the words. And there's no specific grading for that. That's just, again, something that I've seen in practice.

And [engage] family members, too. Again, this is why I really like engaging my family members, because they know [the] patient better than I do. You know that they know them the best, and they're quick to say, “Hey, something seems a little bit off. You know, we were talking about something earlier, and they were just a little bit confused.” “OK, thank you for letting me know. I'm going to reassess, you know, in another hour. Let me just make sure that there's no changes, because things can happen pretty rapidly.”

So again, to recap, you can see things like altered mental status, delirium, tremor. You can see seizures. You can see some focal motor weakness, etc., but I don't typically see those changes as much as I see the early, you know—we're able to intervene before I see anything like that.

This transcript has been edited for clarity and conciseness.

The Immune Effector Cell Encephalopathy score and keeping a close eye on patients’ symptoms are critical when monitoring for potential ICANS during lymphoma treatment.

Advanced Practice Corner

Tools to Monitor for ICANS During Lymphoma Treatment With Bispecific Antibodies, CAR T-Cell Therapy

Andrea Wagner, M.S.N., RN, OCN, in an interview with Oncology Nursing News discussing her abstract on verbal orders for CRS. 

Nurse-Driven Orders May Expedite Tocilizumab Administration for CRS

Since patients experiencing cytokine release syndrome (CRS) tend to have better outcomes when administered tocilizumab (Actemra) soon after symptom onset, a group of clinicians from Hackensack Meridian Health established a nurse-driven order for the immunosuppressive drug in patients being treated with bispecific antibodies.

Findings from their intervention were presented at the 49th 

The use of bispecific antibodies for blood cancers — namely lymphoma and multiple myeloma — has grown over the last year. While these drugs are promising for the treatment of hematologic malignancies, they do come with a risk of CRS.

T-Cell Engagers Take Center Stage in Large B-Cell Lymphoma

“As a team, we decided that while tocilizumab falls under the umbrella of chemotherapy biotherapy, for which verbal orders should not be accepted per ONS guidelines and per Hackensack guidelines as well, we wanted to come up with a way that kind of still acts that way, but allows verbal orders to also be part of the workflow,” lead study author, Andrea Wagner, M.S.N., RN, OCN, an oncology clinical nurse specialist at Hackensack Meridian Health, said in an interview at the congress.

Wagner and colleagues established a system where patients consent to receiving tocilizumab upon admission for their bispecific antibody treatment. They also established a physician communication order on admission orders. This states that once it was confirmed that a patient had CRS, the nurse would be able to put in the order for tocilizumab with the proper dosing based on the patient’s weight.

With this new nurse-driven process, the majority of patients (82%) were given tocilizumab within 1 hour of the order entry — an increase from the 60% of patients who received tocilizumab within an hour after physicians or advanced practice providers placed the order entry.

“This really capitalized on getting the patient the drugs that they needed in a timely manner so we did not have any medication errors using the protocol or in general, which is good,” Wagner said.

Establishing a nurse-led system to administer tocilizumab in patients receiving bispecific antibodies tended to get the immunosuppressive drug to patients faster. 

Onc Nurse TV

Jessica MacIntyre, DNP, MBA, APRN, NP-C, AOCNP, discusses ways to standardize the process of referring patients to the Leukemia and Lymphoma Society.

Jessica MacIntyre on Improving LLS Referrals For Patients With Hematologic Malignancies

By developing an app which can be integrated into the electronic health record (EHR), nurse leaders helped improve the process of referring patients with hematologic malignancies to the leukemia and lymphoma society (LLS). Findings were presented in a poster during the 48th Annual Oncology Nursing Society Congress.

Jessica MacIntyre, DNP, MBA, APRN, NP-C, AOCNP, executive director of clinical operations and advanced registered nurse practitioner at Sylvester Comprehensive Cancer Center, presented on the findings. In a postpresentation interview, she discussed the key takeaways with 

Unfortunately, the costs of treatments for hematologic malignancies are expensive and can lead to financial difficulties, quality of life issues, and adherence challenges for many patients. These challenges are especially pronounced among those patients who belong to underserved groups.

The LLS offers information, supports services, and financial assistance to patients with these malignancies, yet, although these services are free, they are often underutilized. Nurse investigators helped to develop and implement a novel Fast Healthcare Interoperability Resource (FHIR) based app, which would be integrated into the EHR. This app was designed to facilitate the referral of patients with newly diagnosed blood disorders to critical support resources at LLS by using a Best Practice Advisory (BPA) alert to a hematologic cancer nurse navigator.

The nurse navigator would perform intake and discuss LLS services with the patient. He or she would then complete the information to transmit the referral to LLS. Patients were prompted to sign consent forms prior to their fist appointment. If a patient declined, an in-basket message would be sent to the social worker to reassess at a later date.

After receiving the signed consent form, an LLS information specialist would contact the patient to discuss different available resources and services.

Prior the FHIR app, referrals to LLS were not systematically captured at Sylvester. They were also in paper format. Over the past 2 years, fewer than 10 referrals were documented at the Cancer Center. Postimplementation, however, not only were the number of referrals improved, but metric tracking was also made possible.

Over the course of 15 months following implementation, 245 patients were electronically referred to LLS. During this time, LLS had approximately 700 interactions with these patients.

“It is a much easier process,” MacIntyre noted. “In the past, we used to do paper forms; we used to fax paper forms to our advocacy groups to refer patients for their services. Now it's a touch of a button, so it is much easier.”


MacIntyre J, Sae-Hau M, Disare K, Torrents S, Buckta B, Berkowitz S. Development of an electronic referral to the leukemia & lymphoma society (LLS): enhancing access to patient resources and information. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed April 28, 2023. 

https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12560

Jessica MacIntyre, DNP, MBA, APRN, NP-C, AOCNP, discusses ways to standardize the process of referring patients to the Leukemia and Lymphoma Society. 

Laura Zitella, MS, RN, ACNP-BC, AOCN, discusses third-line treatment options for patients with diffuse large b-cell lymphoma.

 | Lung Cancer | Gynecologic Cancers | Hematology | Skin Cancer | Supportive Care | Adverse Event Management | Brain Cancer | Disparities in Cancer Care | Drug Safety | Gastrointestinal Cancer | Genetics | Genitourinary Cancer | Head and Neck Cancers | Immuno-Oncology | Myeloproliferative Neoplasms | Nurse Navigation | Pediatric Cancer | Practice Management | Prevention | Radiation Oncology | Sarcomas | Survivorship View All >> Laura Zitella on Third-Line Treatment Considerations in Diffuse Large B-Cell Lymphoma

Combination chemotherapy with rituximab (Rituxan), known as R-CHOP, has been the standard of practice for diffuse large B-cell lymphoma for many years and is commonly used in many patients, explains Laura Zitella, MS, RN, ACNP-BC, AOCN. However, patients who do not respond to this chemoimmunotherapy treatment may progress to CAR T-cell therapy and other options in the second-line and beyond setting, such as loncastuximab tesirine (Zynlonta).

Zitella, a nurse practitioner at the University of California San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, and associate clinical professor at UCSF school of nursing, also recently presented at PER®s Onco-Nurse Academy about safely administering Integrating Novel Therapies Across the DLBCL Care Spectrum.

®, Zitella highlights what treatment options exist for patients whose disease progresses beyond CAR T-cell therapy options, and the important considerations nurses should keep in mind with the available third-line agents.

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