Congress Abstracts 2006

46

CLINICAL CHARACTERISTICS AND MANAGEMENT STRATEGY OF REVLIMID INDUCED TUMOR FLARE REACTION IN PATIENTS WITH CLL. Kena Miller, FNP, Laurie Musial, RN, and Dawn Depaolo, RN, Roswell Park Cancer Institute, Buffalo, NY; and Cynthia Crystal, RN, Celgene, New Jersey.

Tumor Flare Reaction (TFR) is new side effect (SE) unique to chronic lymphocytic leukemia (CLL) patients treated with lenalidomide. This SE is not reported but pose major concern in patient management. Oncology nurses (ON) learn first hand about SE occurring with new therapies and must develop effective strategies to identify and manage these SE and to promote patient education.

Purpose: To bring forth the clinical characteristics of TFR and share our management experience. Lenalidomide, an immunomodulatory oral agent, FDA approved for 5q deletion MDS and currently investigated in multiple myeloma and CLL patients.

TFR is characterized by a sudden/tender increase in disease effected lymph nodes (LN)/spleen with rash and/or low-grade fever, occurring within 24-48hours of lenalidomide treatment. Usually during 1st cycle and lasting for 14 days. Some patients show an increase in WBC.

Twenty-nine patients with relapsed/refractory CLL enrolled on a phase II trial received lenalidomide 15- 25 mg/d for 21d of 28-day cycle. ON noted sudden tender increase in LN sizes. Progressive disease was a concern but a concurrent decrease in leukemia counts helped identify this an immune reactivation phenomenon, now referred as TFR. TRF incidence was 67% mostly Grade 1/2. The ON devised following management strategy:

1. Ibuprofen(400-600mg) Q8-Hr x 10-14 days, at onset of pain/LN swelling.
2. Counseling
3. Oxycodone PRN for severe pain.
4. Benadryl PRN

These interventions through ON resulted in adequate management of TFR and improved compliance.

TRF is a new SE of lenalidomide with high incidence, peculiar to CLL. As this agent becomes commercially available, it is germane to the safety and welfare of patients that effective SE management strategies are utilized by ON and be shared with and clinical practitioners to improve patient outcomes. In our experience patient education, counseling and support by the ON played a critical role in early identification and management of this SE.