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Transcript

((Voice Over))
Welcome to the presentation titled “The Role of the Nurse in AML Management.”

VYXEOS is indicated for the treatment of adults with newly-diagnosed therapy-related AML or AML with myelodysplasia-related changes.

VYXEOS has different dosage recommendations than other daunorubicin and cytarabine-containing products. Do not interchange with products containing these ingredients.

Do not use in patients with a history of serious hypersensitivity reactions to cytarabine, daunorubicin or any other components of VYXEOS.

This segment is presented by Sandra Kurtin, a nurse practitioner at the University of Arizona Cancer Center in Tucson, Arizona. She will discuss ways the nurse can help in managing AML or acute myeloid leukemia.

((Sandra Kurtin, RN, MS, AOCN, ANP-C))

So then, let's talk a little bit about the role of the nurse in managing AML.

So, what are the roles? Medication review, monitoring, and administration, obviously -- we're going to talk about that in detail.

Looking for subtle changes that can signal complications associated with AML -- these patients can be quite sick for a period of time, and those little subtleties are important to basically identify early, and intervened promptly. And so, managing those side effects; preparing the patient to know what to look for and what to report -- really, really important.

Supportive care -- so, we do use a lot of transfusion support; we use antibiotics, fluids, etc.

And then, basically helping the patient and the caregiver through this process.

So, AML is a difficult disease, and in people who have had prior cancers, the experience is a little bit different; they may have some frame of reference for that whole experience of being a cancer survivor.

But nonetheless, here they are; they're abruptly plucked out of their survival mode into a new cancer mode, and one with a very poor prognosis needing quick decisions.

So, the nursing role actually is very critical to that process.

The pathophysiology of chemotherapy-induced cytopenias in AML ... So, you know you make the cells in your bone marrow, basically -- it is the origination of all of the components of blood.

So, the myeloid lineage, just like the lymphoid lineage…

…originates in your bone marrow.

When people develop cytopenias, there are a lot of different factors that play a role here, but basically, we say "Are you destroying them somehow? -- autoimmune hemolytic anemia; ITP; or, you're not making them?" And the only way to really know for sure ultimately is to do a bone marrow biopsy.

So, we're going to look for, in this case, myeloid...symptoms; fatigue, obviously; pale skin; shortness of breath. There can be others. Tachycardia.

Neutropenia -- there are different grades of neutropenia. So, mild would be an ANC less than 1,500; moderate, less than a thousand. We really start to be more concerned when they're less than 500. We know that febrile neutropenia has its own definition, so they changed the temperature scale here a few years back as well, and so it used to be 38.5, now it's 38.3 Celsius, over a 1-hour period. So, sustained temperature.

Fevers, infection, shaking chills -- very common. And these are the things that patients need to know need to be reported immediately.

If it's midnight you don't wait until 8 a.m. to come to the clinic -- you need to go to the emergency room, and they need to understand that plan.

Thrombocytopenia ... mild ... So, the lower limit of normal in most labs is 150,000…

…so mild is a hundred to a hundred and forty-nine; moderate, 50 to 99; severe is less than 50. The risk of spontaneous bleeding really is increased at 10,000, which is now our threshold for transfusion. So, we used to transfuse less than 20, and now the restrictive transfusion policy is based on good data, are less than 10,000.

What are some of the other common signs and symptoms that we can see in the presence of neutropenia? The risk of infection; any kind of disruption in the integrity of the skin or internal organs, so oral cavity, upper respiratory tract, you can see pneumonias particularly in this older population.

UTIs common in that older adult population; certainly bacteremias -- anybody with a line is at risk; and there can be…

…either bacterial, viral or fungal infections in this population, which each need to be monitored in the designated way.

((Voice Over))
Serious or fatal hemorrhage including CNS hemorrhage have occurred with VYXEOS. Monitor blood counts regularly and provide platelet transfusions as needed.

Due to the risk of cardiotoxicity, VYXEOS is not recommended in patients with impaired cardiac function. Discontinue in patients with impaired cardiac function unless the benefit of treatment outweighs the risk. Calculate the lifetime cumulative anthracycline exposure prior to each cycle of VYXEOS.

Discontinue in patients with severe or life-threatening hypersensitivity reactions, treat the signs and symptoms and monitor until resolution.

Use only if the benefit outweighs the risks in patients with Wilson’s disease or other copper-related metabolic disorders. Discontinue in patients who develop acute copper toxicity.

Administer by the intravenous route only.

Advise females and males of the potential for VYXEOS to cause fetal harm and to use effective contraception.

The most common adverse reactions include hemorrhagic events, febrile neutropenia, rash, edema, nausea, mucositis, diarrhea, constipation, musculoskeletal pain, fatigue, abdominal pain, dyspnea, headache, cough, decreased appetite, arrhythmia, pneumonia, bacteremia, chills, sleep disorders, and vomiting.

INDICATION

VYXEOS (daunorubicin and cytarabine) liposome for injection 44 mg/100 mg is indicated for the treatment of adults with newly-diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC).

IMPORTANT SAFETY INFORMATION

INDICATION

VYXEOS (daunorubicin and cytarabine) liposome for injection 44 mg/100 mg is indicated for the treatment of adults with newly-diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC).

Important Safety Information

WARNING: DO NOT INTERCHANGE WITH OTHER DAUNORUBICIN AND/OR CYTARABINE-CONTAINING PRODUCTS

VYXEOS has different dosage recommendations than daunorubicin hydrochloride injection, cytarabine injection, daunorubicin citrate liposome injection, and cytarabine liposome injection. Verify drug name and dose prior to preparation and administration to avoid dosing errors.