IMMUNOTHERAPY

&
BONE MARROW
TRANSPLANTATION
 GROUP MEMBERS

NISHA KADAM - 18 PRANJALI SHELKE - 42 STUTI TAYADE - 47

ISHIKA KAMBLE - 18 SWARANJALI SHELKE- 43 CHRISTINA THOMAS - 48

SHRUTI KASALE - 19 SEJAL SHINDE - 44 JUBY THOMAS - 49

PARMEET KAUR - 20 ESHA SINGH - 45 ALEENA VARGHESE - 50

ADEETI SHEJWAL -41 MUSKAN TAMBOLI - 46 JIYA WAGH - 51

 INDEX
SR NO- CONTENT

1 IMMUNOTHERAPY
-INTRODUCTION
-TYPES
-DIFFERENT FORMS
-SIDE EFFECTS
-NURSING IMPLICATION
-HEALTH EDUCATION

2 BMT
-DEFINITION
-INDICATIONS
-TYPES
-PRE, INTRA, POST PROCEDURE CARE
-PREVENTION OF INFECTION
 IMMUNOTHERAPY
Immunotherapy is treatment that uses a person's own immune
system to fight cancer. Immune the mpy can boast or change
how the immune system works so it can find & attack Cancer
cello If your treatment plan includes Immunotherapy, knowing
how it works and what to expect can often help the patient. to
prepare for treatment
 Types of immunotherapy-
There are several types of immunotherapy used to treat cancer-

1) Chimeric antigen receptor (CAR) T-cell therapy: This therapy takes

some T-cells from a patient's blood, mixes them with a special virus that
makes the T-cells learn how to attach to tumor cells, and then gives the cells
back to the patient so they can find, attach to, and kill the cancer.
2) Cytokines: This treatment uses cytokines (small proteins that carry
messages between cells) to stimulate the immune cells to attack cancer.
3) Immunomodulators: This group of drugs generally boosts parts of the
immune system to treat certain types of cancer
 Types of immunotherapy contd…

4) Cancer vaccines: Vaccines are substances put into the body to start an
immune response against certain diseases. We usually think of them as
being given to healthy people to help prevent infections. But some
vaccines can help prevent or treat cancer.
5) Monoclonal antibodies (mAbs or MoAbs): These are man-made versions
of immune system proteins. mAbs can be very useful in treating cancer
because they can be designed to attack a very specific part of a cancer
cell.
6) Oncolytic viruses: This treatment uses viruses that have been modified in
a lab to infect and kill certain tumor cells
 Side Effects Of Immunotherapy
Common side effects
• Arthritis • Headache
• Chills • Hypothyroidism
• Constipation • Infusion-related
• Coughing Reaction / Injection Site
• Decreased Appetite Pain
• Diarrhea • Itching
• Fatigue • Muscle Aches
• Fever And Flu-like • Nausea And Vomiting
Symptoms • Rash
 Severe side effects
While severe side effects are uncommon, when they do occur they
may be life-threatening and require immediate medical intervention.
• Colitis
• Hepatitis
• Inflammation of the lung, or pneumonitis
• Kidney failure
• Myocarditis or inflammation of the heart
• Neuropathy, paralysis, meningitis, or encephalitis
• Pancreatitis
• Severe infections
• Severe skin reactions
 How To Give Immunotherapy

Different forms of immunotherapy may be given in different ways.

These include:

INTRAVENOUS (IV)
The immunotherapy goes directly into
a vein.
 How to give immunotherapy

ORAL
The immunotherapy comes in
pills or capsules that you
swallow.
 How to give immunotherapy

TOPICAL
The immunotherapy comes
in a cream that you rub
onto your skin. This type of
immunotherapy can be
used for very early skin
cancer.
 How to give immunotherapy

INTRAVESICAL
The immunotherapy goes
directly into the bladder
 Nursing implications

The most common side effects from cancer vaccine therapy are inflammatory responses at the
injection site, such as erythema, pain, edema, heat, rash, and pruritus. Other potential adverse
events include flulike symptoms, low-grade fever, nausea, vomiting, myalgia, headache, and
fatigue. Because vaccines produce immune-mediated responses, the risk of a hypersensitivity
reaction exists and should be considered a medical emergency.
While administering these vaccines, adhere to hazardous drug safe-handling principles. Personal
protective equipment, including gloves and gowns, is required. And make sure you’re familiar with
your organization’s guidelines for administering immunotherapy.
Immunotherapy can consist of various substances used alone, such as IL-2, or combination
biotherapy, such as IFN- with 5- fluorouracil. The nurse’s role is to enhance the person’s quality of
life. • The major agents used are – Interleukin – I – Interleukin – II – Interferon – Cytokines
 Nurisng responsibilities

1)The nurses should wear sterile gloves , gowns and caps while providing care to the patient.
2)Nurse should exclusively follow aseptic techniques and also advise the same to family members .
3)Monitor for side effects: IFN- may cause mental slowing, confusion and lethargy, flu-like symptoms,
with chills and fever of 39.4 ° to 41.1 °C, nausea, vomiting, diarrhea, anorexia, severe fatigue and
stomatitis; erythropoietin may cause acute hypertension.
4)Monitor enzymes and appropriate biochemical indicators. •
5)Evaluate response to therapy and patients symptoms.
6)Assess the person’s coping behaviors and teach new strategies as needed. • Manage fatigue and
depression. • Encourage self-care and participation in decision making. • Provide close supervision for
people with altered mental functioning. • If the person is unable to manage alone, teach medication
administration and care of equipment to caregivers
 Health education

Minimize symptoms by managing fever and flu-like symptoms: increase

fluid intake, take analgesic and antipyretic medications, and maintain
bed rest until symptoms abate.
• Seek help for serious problems not managed by usual means, such as
dehydration from diarrhoea.
• Use correct techniques for providing subcutaneous injections.
• Identify how to work and care for ambulatory pumps when medication
is administered through an intra catheter or vascular access device
 BONE MARROW
TRANSPLANTATION
 DEFINITION

A bone marrow transplant is also

called as a stem cell transplant or
more hematopoietic stem cell transplant.
It is a medical treatment
that replaces your bone marrow with healthy
cells.
The replacement cells can either come from
your own body or from a donor.
 PURPOSE/ GOAL

The goal of a bone marrow transplant is to cure many diseases and types of
cancer.
When the doses of chemotherapy or radiation needed to cure a Cancer are so
high that a Person bone marrow stem cells will be permanently damaged or
destroyed by the treatment, a bone marrow transplant may be needed.
INDICATIONS OF
BONE MARROW
TRANSPLANTATION
 INDICATIONS
most-common indications for auto-transplant treatment are
● Myeloma
● Malignant lymphoma
● Acute myeloblastic leukemia
● lymphoblastic leukemia,
● dysmyelopoietic syndrome
● Chronic myeloblastic leukemia refractory to tyrosine kinase inhibitors
● then lymphoid malignancies and non-malignant disorders. (bone marrow
aplasia, severe immunodeficiencies, paroxysmal nocturnal hemoglobinuria,
etc.
TYPES OF BONE MARROW TRANSPLANTATION

❖ Autologous transplant

❖ Allogeneic transplant

❖ Umbilical cord blood transplant

❖ Parent Child transplant and haplotype mismatched transplant

NURSING RESPONSIBILITY
❏ PRE PROCEDURE

❏ INTRA PROCEDURE

❏ POST PROCEDURE
 Pretransplantation Care
1. Nutritional assessment physical examinations organ function test and
psychological evaluations are performed.
2. Blood works including assessing past exposure to any disease caused by
cytomegalovirus, hepatitis virus HIV, herpes simplex virus.
3. Patients social support system and other financial conditions are also evaluated.
4. Informed consent and patient teaching about the procedure and pre
transplantation and post transplantation care are vital
 During the treatment

➔ Monitoring Vital signs of the patient and oxygen Saturation.

➔ Assessing for any adverse effect such as fever, chest Pain, nausea,
vomiting, hypertension, tachycardia, etc.
➔ During transplant patient may get adverse reaction due to the
cryoprotectant dimethyl sulfoxide used to preserve harvested stem
cells so on going support and patient teaching is needed.
➔ During first 30 days following the transplant
➔ the patient is most at risk for developing reactivation of viral
infections including HPV, Epstein barr and cytomegalovirus.
➔ Nursing assessment for signs of these complications is essential for
early identification and treatment
 POST BMT CARE

1. A two to four week waiting period follows marrow transplant before its success can begin to be
judged.
2. The marrow recipient is kept in isolation during this time to minimise potential infection.
3. The recipient also receive intravenous antibiotic, antifungal, antiviral medications as well as blood
and platelet transfusions to help fight of infection and prevent excessive bleeding & blood tests are
performed.
4. Daily Monitoring patients kidney and liver functions as well as nutritional status.
5. Otherwise tests are performed as necessary.
6. For the side effect such as nausea and vomiting can be treated with other medications
7. Preventing infection –
A) patient Mein shower aur bath normally as long as he don’t submerge his Central
Venous catheter
underwater.
B) to help minimise infection and gum bleeding, daily oral care is necessary.
C) washing hands with antimicrobial or antibacterial soap and warm water before and
after any Central Venous catheter or intravenous infusion, before taking oral medicines
or after touching soiled linens or clothes.
D) preventing respiratory infections
- avoid close contact with people who have respiratory illnesses example of
cold and cough.
- avoid cried crowded Areas where you are unable to control the distance
between you and others.
- wear mask
- avoid tobacco and marijuana use as the use of the substances increase the risk
for bacterial viral and fungal infection
BIBLIOGRAPHY
THANKYOU