Date of Award

Spring 1991

Degree Type

Thesis - Restricted

Degree Name

Master of Science (MS)

Department

Nursing

Abstract

Advances in cellular immunology and recombinant DNA biotechnology have led to the development of adoptive immunotherapy, the transfer of immunologic cells with antitumor reactivity to the cancer patient (Rosenberg, 1984). The purpose of this essay is to review the current status of adoptive immunotherapy with interleukin-2 (IL-2) and to examine the nursing assessment of patients receiving this cancer treatment. The immune system maintains homeostasis through the destruction of invading microorganisms, the removal of cellular debri, and the surveillance of mutant cells (Bellanti, 1985 ) . IL-2 is a lymphocytotrophic hormone critical to the regulation of the immune system, including the transformation of lymphocytes into cells capable of killing tumor cells but not normal cells (Rosenberg, 1985 ). Adoptive immunotherapy with IL-2 is an effective way to activate the immune system to selectively destroy tumors (Rosenberg, Lotze, Yang, et al., 1989). IL-2 activates two lymphocyte populations to lyse tumors: Lymphokine activated killer cells (LAK cells), which are derived from null cell precursors and lyse all tumors, and tumor infiltrating lymphocytes (TIL cells), which are derived from T cell precursors that infiltrate tumors and exhibit specificity for autologous tumors (Lotze & Rosenberg, 1988). Adoptive immunotherapy with IL-2 offers hope for patients with cancer that standard therapy has failed to cure or for which no standard therapy exists. The side effects of IL-2 therapy can be attributed to three factors: Lymphocyte infiltration precipitates impaired organ function (Rosenberg, 1988b); capillary leak syndrome causes fluid retention and interstitial edema which compromise organ function (Ettinghausen & Rosenberg, 1987; Rosenstein, Ettinghausen, & Rosenberg, 1986); and IL-2 stimulates the release of other lymphokines with a wide scope of physiological effects (Rosenberg, 1988b). The multisystem toxicities associated with this therapy require complex nursing assessments, with an understanding of the hemodynamic interplay of organ systems. While in its infancy of development, adoptive immunotherapy with IL-2 is emerging as a promising approach for individuals with metastatic cancer. Through an application of the scientific principles of immunotherapy, oncology nurses must undertake a collaborative effort to meet the complex assessment needs of patients receiving this treatment. Opportunities exist for enhancing oncology nursing practice, in light of the exciting advances in cancer immunotherapy.

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