Podcast
The ONS Podcast
Hosted by Oncology Nursing Society · EN
Where ONS Voices Talk Cancer
Join oncology nurses on the Oncology Nursing Society's award-winning podcast as they sit down to discuss the topics important to nursing practice and treating patients with cancer.
ISSN 2998-2308
41episodes
Episodes
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Episode 407: Pharmacology 101: CAR T-Cell Immunotherapy
Mar 2000:48:31Tap to summarize"You want to try to act quickly and be able to know what the pathways are for appropriate escalating when a patient is having symptoms that are reflective of cytokine release syndrome (CRS) or neurotoxicity. These toxicities are very manageable and treatable when recognized early. To summarize, choosing the right patient, knowing the toxicity profile for each product, and acting early is really what helps to prevent severe outcomes with chimeric antigen receptor (CAR) T-cell therapy," Maribel Pereiras, PharmD, BCPS, BCOP, clinical pharmacy specialist at the John Theurer Cancer Center at Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about CAR T-cell immunotherapy. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by March 20, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to CAR T-Cell immunotherapy in the treatment of cancer. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 267: Side-Effect Management for CAR T-Cell Therapy for Hematologic Malignancies Episode 261: CAR T-Cell Therapy for Hematologic Malignancies Requires Education and Navigation Episode 176: Oncologic Emergencies 101: Cytokine Release Syndrome ONS Voice articles: A Body of Evidence Helps Nurses Manage CAR T-Cell Therapy Toxicities CAR T-Cell Therapy Programs Oncology Clinical Social Workers Add Layers of Support for Patients and Families During CAR T-Cell Therapy Studies Show Best Practices to Manage CAR T-Cell Therapies' irAEs and Improve Outcomes ONS Voice oncology drug reference sheet: Lisocabtagene Maraleucel Clinical Journal of Oncology Nursing articles: CAR T-Cell Therapy for Relapsed/Refractory Aggressive Large B-Cell Lymphoma CAR T-Cell Therapy: Updates in Nursing Management Nursing Considerations in Navigating Patients Receiving CAR T-Cell Therapy ONS book: Guide to Cancer Immunotherapy (second edition) ONS Huddle Cards: Chimeric Antigen Receptor T-Cell Therapy Cytokine Release Syndrome Immune Effector Cell–Associated Neurotoxicity Syndrome Immunotherapy Immuno-Oncology Learning Library American Society of Gene and Cell Therapy: Learning Center American Society for Transplantation and Cellular Therapy: Learning Center National Comprehensive Cancer Network home page To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "CAR T-cell therapy combines an adoptive cell transfer with genetic engineering. And what that really means is that we are harvesting a patient's own T cells and then we engineer them with a synthetic receptor that helps them recognize that cancer. And all of this work has evolved through many decades of stepwise advances in how we design and activate the T cells. That led us to several landmark trials and ultimately the first CAR T-cell therapy approved by the U.S. Food and Drug Administration in 2017, which was tisagenlecleucel for pediatric and young adult patients that had acute lymphoblastic leukemia." TS 3:34 "If a patient has higher disease burden or an inflammatory biology, that does tend to correlate with higher toxicity risk. And then that might influence the way we monitor the patients who are getting the CAR T therapy. And then finally, baseline neurologic examinations, because neurotoxicity can occur with these agents. It's very important that we as a whole healthcare team really understand what the patient looks like at baseline to be able to determine if they're having any altered changes or confusion. If I had to summarize it, we want to confirm the target and make sure that we have the right CAR T product for the patient. We want to confirm that the patient, physiologically and mentally, is ready for the CAR T therapy." TS 10:53 "I think the two [toxicities] that every nurse will hear about almost immediately when talking about CAR T therapy are CRS or ICANS, which stands for immune effector cell–associated neurotoxicity syndrome. ... ICANS can either follow or even occur alongside CRS. And this can present as something as simple as just being slightly confused or altered, leading into progressively more severe elements such as word-finding difficulties, tremors, or changes in handwriting. Or even more severe cases that lead to seizures or decreased levels of consciousness. So, in this setting, neurologic assessments and knowing and understanding what your patient's baseline neurologic status is is so important. Those are really the two largest side effects that cross the board when it comes to CAR T therapies." TS 16:02 "In terms of the more practical aspects of administration, this is not a typical medication infusion. CAR T cells are living cells. So the way they are handled and administered is very specific. The majority of CAR T products are given as a single IV infusion. The cells come to us frozen either from a cellular lab or they will come from the pharmacy department. So those cells are typically thawed, and timing is of the essence. You really need to coordinate the timing of [thawing] to when they get infused to your patient. They tend to have a short shelf life once they're not frozen anymore." TS 26:34 "Now that therapy has, in many places, transitioned to be administered in the outpatient setting, education becomes absolutely critical. The patient is coming for their daily visit to clinic and then they're going home. And it's really up to the caregiver, who is usually not a nurse, who has to recognize early signs of toxicity. They need to be educated about what a fever is, what number constitutes a fever, what does confusion look like, what does hypotension look like? ... Do they have access to a thermometer? If you are asking them to look at blood pressure, do they have access to a blood pressure monitor? And sometimes those can be subtle things th...
Transcribe →Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices
Mar 1300:24:04Tap to summarize"Our goal of precision oncology has been to shift to tailored therapies that can help to improve treatment efficacy and ultimately improve patient outcomes. Resistance biomarker testing can help the care team to detect these genomic changes that the tumor may have acquired during therapy that makes the cells resistant to therapy. This information can be extremely helpful when we're talking about making choices about second-line or subsequent-line therapy," ONS member Danielle Fournier, DNP, APRN, AGPCNP-BC, AOCNP®, advanced practice RN at the University of Texas MD Anderson Cancer Center in Houston, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about drug resistance biomarker testing. This podcast episode is sponsored by AstraZeneca. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Episode Notes This episode is not eligible for NCPD credit. ONS Podcast™ episodes: Episode 389: Biomarker Testing for Non-Small Cell Lung Cancer Episode 373: Biomarker Testing in Prostate Cancer Episode 169: How Biomarker Testing Drives the Use of Targeted Therapies ONS Voice articles: Help Your Patients Understand Biomarker Resistance Testing Key Patient Education Points for Biomarker Resistance Testing Quick Quiz: How Much Do You Know About Drug Resistance in Cancer? Quick Quiz: How Much Do You Know About Somatic Biomarker Resistance Testing? When Targeted Therapy Stops Working, What's Next? Discover How Biomarker Resistance Testing Opens New Doors ONS Biomarker Database Clinical Journal of Oncology Nursing article: Tumor-Agnostic Therapies Reshaping Cancer Care ONS book: Understanding Genomic and Hereditary Cancer Risk: A Handbook for Oncology Nurses ONS course: Genomic Foundations for Precision Oncology ONS Genomics and Precision Oncology Learning Library American Cancer Society Cancer Action Network: Access to Biomarker Testing page White paper: The Landscape of Biomarker Testing Coverage in the United States Find out which states are currently discussing biomarker testing bills and how you can advocate for them through ONS. To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "We know that biomarkers are playing an ever more important role in cancer care, and really, their use can range anywhere from helping us to confirm a given diagnosis, understand a patient's cancer susceptibility or risk, evaluate prognosis, as well as personalize treatment recommendations. … But in some cases, though, biomarkers can also help us to avoid therapies that are not likely to work. We also call these drug resistance biomarkers. These are those biomarkers that signify that a tumor is unlikely to respond to a given therapy." TS 1:50 "Resistance to cancer therapies is one of the most common issues that arises during cancer treatment. Because the populations of cancer cells within a tumor can be very diverse, when a given drug kills the cells that are sensitive to that therapy, it can also eventually leave behind resistant tumor cells, which can grow and multiply over time. So this can ultimately lead to a point where the treatment that was initially effective is no longer able to control the disease." TS 4:33 "While costs have come down, there can still be a cost associated with biomarker testing, and in some cases, this can be considered a barrier to care. What patients pay out of pocket can vary widely depending on their insurance coverage. So we have some data that was published from the American Cancer Society Cancer Action Network, and this was published a few years ago in 2023, which showed the average allowed unit cost to insurers per biomarker test ranged anywhere from about $79 for patients who were on Medicaid to about $224 for large-group, self-insured patients." TS 10:03 "There's research underway that's looking not only at genomic changes—so DNA changes that impact drug resistance—but how other substances such as RNA and proteins within the cell can also contribute to drug resistance. And this kind of falls into not just genomics but multiomics field. I have no doubt whatsoever that the use of artificial intelligence and machine learning is likely going to play a large role in drug resistance research. And really, these tools can help researchers to analyze complex data sets, identify novel resistance biomarkers...
Transcribe →Episode 405: Long-Term Multiple Myeloma Considerations for Oncology Nurses
Mar 600:34:01Tap to summarize"The disease is increasingly managed as a chronic condition rather than a diagnosis with an immediate terminal outcome. Particularly, with earlier and more effective and sustained treatment options, we can make this disease a very chronic, long-term, livable condition. I want to make sure that patients are aware that this is not a death sentence. This is something that patients can live with for the long term," Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about long-term multiple myeloma considerations for oncology nurses. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by March 6, 2027. Ann McNeill is on the speakers' bureau for Pfizer. This financial relationship has been mitigated. All other planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to management of long-term side effects related to multiple myeloma and treatment. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses Episode 398: An Overview of Multiple Myeloma for Oncology Nurses Episode 339: A Lesson on Labs: How to Monitor and Educate Patients With Cancer Episode 201: Which Survivorship Care Model Is Right for Your Patient? ONS Voice articles: Effective Care Transitions Are Essential for New Multiple Myeloma Treatments Infection Prevention for Oncology Nurses Multiple Myeloma Prevention, Screening, Treatment, and Survivorship Recommendations Nurse-Led Survivorship Programs Sexual Considerations for Patients With Cancer Oncology Nursing Forum articles: A Qualitative Study of the Experiences of Living With Multiple Myeloma Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study ONS book: Multiple Myeloma: A Textbook for Nurses (third edition) ONS Huddle Cards: Pain Management Sexuality Survivorship Care Plan ONS Learning Libraries: Hematology, Cellular Therapy, and Stem Cell Transplantation Survivorship ONS Symptom Intervention resources: Chronic Pain Fatigue Peripheral Neuropathy American Cancer Society: Living as a Multiple Myeloma Survivor Blood Cancer United: Resources for Healthcare Professionals International Myeloma Foundation: Resources and Support for the Myeloma Community Multiple Myeloma Research Foundation: Empower Patients and the Community To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "We do consider myeloma an incurable hematologic malignancy, even though we have had improvements in survival. But just like for any malignancy, our goal is to maximize survival. We want to eliminate as many myeloma cells as we possibly can. And subsequently, we want to improve the quality of life for these patients in the long term. So those are basically our treatment goals. That's what we think of when we're treating patients all throughout their treatment journey." TS 1:39 "It is very typical for patients along their journey to have received several lines of therapy. I think it's important to realize that the cells acquire new mutations, making them more resistant to these further subsequent lines of therapy. We see quicker, more aggressive relapses in those patients with multiple prior lines of therapy. We can see an increase in the CRAB symptoms, which are the calcium elevations, the renal dysfunction, profound anemia, and even bone disease. We can see a rapid rise in the monoclonal protein in the labs or even a very rapid rise in the involved light chain in that serum free light chain assay, so it's important to monitor these labs." TS 9:14 "All oncology nurses are focusing on these survivorship plans now. And I think that's a great thing when you think about a diagnosis of cancer and a survivorship plan, because it means these patients are living a longer time. We still look at long-term health maintenance guidelines depending on the patient's sex and their age. ... I think preventing infection is always going to be something absolutely on the forefront in our survivorship plan with myeloma. I mean, myeloma is an immune system malignancy. The treatments that we have given patients can sometimes, especially in later life therapies, further compromise the immune system. So, we're always looking to prevent serious infection." TS 12:46 "Patients get treatment, especially induction therapy. They may or may not get transplant. They may have been on a very minor maintenance schedule, depending on their age. And they feel really well. And then they decide not to return for their follow-up because they feel so good. I think nurses are critical in the communication aspect of the patient-provider aspect. So, nurses are really the key means of communication. The providers are absolutely important—the physicians, the nurse practitioners and every other member of the team—but I think the nurses have a really special rapport with patients. They're usually the ones providing the education on the treatment regimens. They're managing the toxicity profiles. They're doing all the coordination of care between visits. They are really going to be the ones telling the patient, 'Hey, you're going to feel good and that's a wonderful thing, but you still need to come once a month or once every six weeks or once every two months for your labs.'" TS 15:17 "It has been amazing. The science, the research, the treatments, the approvals from the U.S. Food and Drug Administration. Survivorship has improved dramatically. Let's take the first few years of the new century, right? The five-year survival rat...
Transcribe →Episode 404: Tailor Patient Treatment Education for Non-Oncology Indications
Feb 2700:38:57Tap to summarize"We print education sheets that we have, and we say, 'Just ignore this part that says cancer. You're getting this med but for a different indication.' And then you have to really point out what our goals of care are. You're using the information that, as oncology nurses, we like and love, but we're having to cross it out and say, 'Just read this portion and just do this here.' And that can be challenging for the nurse and probably confusing for the patient," ONS member Brandy Thornberry, RN, OCN®, outpatient infusion and VAD supervisor at Logan Health in Kalispell, MT, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about education for patients receiving antineoplastic drugs for non-oncology indications. Taylor also spoke with ONS members Lizzy McMahon, BSN, RN, OCN®, and Jennifer Lynch, BSN, RN, TCTCN™, about general antineoplastic treatment education and tailoring education in the stem cell transplantation setting. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 27, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge of best practices for educating patients receiving antineoplastic therapies across oncology, non‑oncology, and stem cell transplant settings. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 259: Patient Education for Health Literacy and Limited English Proficiency Episode 197: Patient Learning Needs and Educational Assessments Episode 183: How Oncology Nurses Find and Use Credible Patient Education Resources Episode 179: Learn How to Educate Patients During Immunotherapy Episode 173: Oncology Nurses' Role in Stem Cell Transplants for Pediatric Sickle Cell Disease ONS Voice articles: Online Tool Helps You Apply Health Literacy Principles to Written Patient Education Personalized Patient Education: Ensure Effective, Inclusive, and Equitable Patient Education With These Five Strategies Policies and Procedures for Written Patient-Facing Cancer Education Materials Oncology Nursing Forum article: An Integrative Review of Patient Education During Inpatient Hematopoietic Stem Cell Transplantation ONS Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library Patient Education Sheets: Cancer Care, Explained To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode McMahon: "A great question would be to ask the patient what they already know and what they're most concerned about or what their biggest questions are. This way, the nurse can tailor their education to make sure to focus on what the patient doesn't know yet and what they're most concerned about, while still touching on all the required education topics. … It's also important for nurses to continually be assessing the patient's readiness to learn throughout the education session, looking for nonverbal cues or verbal signs that the patient is overwhelmed or anxious because this is going to interfere with their ability to take in new information." TS 3:49 Thornberry: "A lot of the education sheets and the products for them explain it like, 'This is cancer,' and more of an oncology perspective, so occasionally [non-oncology patients] can show up and be confused by it. I do feel like they come a little bit less prepared than our oncology patients. Our rheumatologists and neurologists, they sure try, but they just don't have the support in that realm either. They're full of every question you can imagine. They've never been to an infusion room. They don't know what to bring. Can they drink water and have their meds beforehand? It's a full gamut of really preparing them to get these for autoimmune or rheumatology-type issues." TS 14:12 Lynch: "I really want to spend time with those patients to make sure that we are not assuming that they are coming to us with any knowledge or experience. I want them to be able to come to us with questions and trust their healthcare team and really sit down with them and say, 'Okay, you don't have cancer, but we're using the word chemotherapy where we're talking about cancer drugs.'… And we're going to probably spend more time going over some of the basics about blood stem cells, types of cells that they grow into, how your body fights infection, what they're going to be at risk for. The side effects can be pretty scary when you're talking about them, especially back to back. So making sure that we are delivering the information that doesn't put them in a panic mode… A lot of reassurance, as well, and just taking into consideration that, yes, this might have this whole other layer of anxiety to it because of the unknown." TS 32:22
Transcribe →Episode 403: Pharmacology 101: Checkpoint Inhibitors
Feb 2000:34:19Tap to summarize"Because the premise of immune checkpoint blockade centers around elevating the immune function, we should always take a great deal of caution around those patients who have high immune risks. Those include patients with autoimmune disorders. That's one of our biggest questions that we ask, usually every consult that we're seeing with solid tumor. 'Do you have any history of autoimmune disorders? Tell me a little bit more about it. Is it being treated? What are your symptoms like?' And then also patients who have undergone organ transplants. Now, interestingly, this does include stem cell transplants," Kelsey Finch, PharmD, BCOP, oncology pharmacist practitioner at Columbus Regional Health in Indiana, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about checkpoint inhibitors. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 20, 2027. Kelsey Finch has disclosed a speakers bureau relationship with AstraZeneca. This financial relationship has been mitigated. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to checkpoint inhibitors in the treatment of cancer. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 273: Updates in Chemotherapy and Immunotherapy Episode 174: Administer Pembrolizumab Immunotherapy With Confidence Episode 139: How CAR and Other T Cells Are Revolutionizing Cancer Treatment ONS Voice articles: Here's Why Oncology Nurses Are Pivotal in Managing Immune-Related Adverse Events Make Subcutaneous Administration More Comfortable for Your Patients Nursing Considerations for ICI-Related Myocarditis Oncology Nurses Navigate the Changing Landscape of Immuno-Oncology Postdischarge ICI Patient Education Eliminates Hospital Readmissions Shorter Administration Times Still Require High-Acuity Care ONS Voice oncology drug reference sheets: Dostarlimab-Gxly Nivolumab and Hyaluronidase-Nvhy Nivolumab and Relatlimab-Rmbw Pembrolizumab and Berahyaluronidase Alfa-Pmph Retifanlimab-Dlwr Toripalimab-Tpzi ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Guide to Cancer Immunotherapy (second edition) ONS course: ONS/ONCC® Chemotherapy Immunotherapy Certificate™ Clinical Journal of Oncology Nursing articles: Immune Checkpoint Inhibitor–Related Myocarditis: Recognition, Surveillance, and Management Immune Checkpoint Inhibitor Therapy: Key Principles When Educating Patients Triple M Syndrome: Implications for Hematology-Oncology Advanced Practice Providers ONS Huddle Cards: Checkpoint Inhibitors Immunotherapy ONS Learning Libraries: Genomics and Precision Oncology Learning Library Immuno-Oncology Learning Library Drugs@FDA package inserts National Comprehensive Cancer Network homepage OncoLink: All About Immunotherapy To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "Before immune checkpoint blockade, the two-year overall survival rate in metastatic melanoma was hovering around 10%. After these agents came to market, depending on the trial and the agents used, that number actually increased to about 50%–65%. So, five times the amount of patients were actually living at the two-year mark. Not surprisingly, studies then exploded across several tumor types, leading to approvals in all sorts of cancers, mostly in the solid tumor. But there are a couple hematologic as well. Lung cancer, kidney cancer, head and neck, Hodgkin lymphoma, hepatocellular, the list goes on. So, it's really just transforming the stage IV setting across all tumors, specifically from uniformly fatal prognosis to one where durable responses and long-term survival is also possible." TS 3:03 "There are four different mechanisms officially being used in therapies that are approved by the U.S. Food and Drug Administration (FDA). Those are cytotoxic T-lymphocyte–associated protein 4, programmed cell death protein 1, and programmed cell death ligand 1, which I'm counting as two different mechanisms, even though they somewhat work together. And lymphocyte-activation gene 3 is the fourth one that's in there. So, all these mechanisms impact the T cell in our immune system. The T cell is traditionally responsible for protecting our body from harmful things like bacteria, viruses, and cancer. When the tumor binds to cytotoxic T-lymphocyte–associated protein 4 receptors, that happens on the T cell itself. And that inhibits the activation of the T cells, essentially allowing that tumor to then live. So when developing medications that block this receptor, they noted an added benefit that it actually increased the T-cell proliferation as well as keeping that T cell active. So not only are we not blocking the T cells, we're making them more productive." TS 5:38 ...
Transcribe →Episode 402: Radiation Site-Specific Side Effects: Head and Neck Cancer
Feb 1300:25:24Tap to summarize"It's important to clarify that most patients will experience and at least some side effects—and often several. So prevention really means reducing severity, complications, and long-term impact rather than avoiding side effects altogether. This process starts before radiation begins and continues throughout the treatment and includes dental evaluation, baseline swallowing assessments, and thorough patient education," ONS member Astrid Amoresano, RN, OCN®, lead oncology nurse specialist at New York Proton Center in New York, NY, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about side effects of radiation for head and neck cancer. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 13, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to radiation side effects in people with head and neck cancer. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Cancer Symptom Management Basics series Episode 301: Radiation Oncology: Side Effect and Care Coordination Best Practices Episode 128: Manage Treatment-Related Radiodermatitis With ONS Guidelines™ ONS Voice articles: Highly Localized, Precision Radiation Therapies Require Nurses to Drive Care Coordination, Patient Education IMRT Shows Similar Quality-of-Life Outcomes to Proton Therapy in Head and Neck Cancer How to Handle Even the Worst Radiation Therapy Side Effects ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition) ONS courses: ONS/ONCC® Radiation Therapy Certificate™ ONS Oncology Symptom Management Clinical Journal of Oncology Nursing articles: The Role of Advanced Practice Providers in Radiation Oncology in 2025 Systematic Review of Malnutrition Risk Factors to Identify Nutritionally At-Risk Patients With Head and Neck Cancer Effects of a Nurse-Initiated Telephone Care Path for Pain Management in Patients With Head and Neck Cancer Receiving Radiation Therapy Radiation-Induced Skin Dermatitis: Treatment With CamWell® Herb to Soothe® Cream in Patients With Head and Neck Cancer Receiving Radiation Therapy ONS Radiation Learning Library ONS Symptom Intervention Resources ONCC: Radiation Oncology Certified Nurse (ROCN™) American Cancer Society CA: A Cancer Journal for Clinicians article: American Cancer Society Head and Neck Cancer Survivorship Care Guideline Cancer Survivors Network: Head and neck cancer Head and neck cancer resources Radiation therapy resources American Society of Radiation Oncology National Cancer Institute: Common Terminology Criteria for Adverse Events (CTCAE) National Comprehensive Cancer Network To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. ...
Transcribe →Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses
Feb 600:37:11Tap to summarize"You also want to deal with patient preferences. We do want to get their disease under control. We want to make them live a long, good quality of life. But do they want to come to the clinic once a week? Is it a far distance? Is geography a problem? Do they prefer not taking oral chemotherapies at home? We have to think about what the patient's preferences are to some degree and kind of incorporate that in our decision-making plan for treatments for relapsed and refractory myeloma," Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about multiple myeloma treatment considerations. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 6, 2027. Ann McNeill has disclosed a speakers bureau relationship with Pfizer. This financial relationship has been mitigated. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to the treatment of multiple myeloma. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 398: An Overview of Multiple Myeloma for Oncology Nurses Episode 395: Pharmacology 101: Monoclonal Antibodies Episode 372: Pharmacology 101: Proteasome Inhibitors ONS Voice articles: Effective Care Transitions Are Essential for New Multiple Myeloma Treatments New Multiple Myeloma Treatments Present New Challenges in Side Effect Management Reduce Racial Barriers and Care Inequities for Black and African American Patients With Multiple Myeloma ONS Voice FDA approval alerts ONS Voice oncology drug reference sheets: Belantamab mafodotin-blmf Daratumumab Motixafortide Selinexor Clinical Journal of Oncology Nursing articles: Journey of a Patient With Multiple Myeloma Undergoing Autologous Stem Cell Transplantation Optimizing Transitions of Care in Multiple Myeloma Immunotherapy: Nurse Roles Oncology Nursing Forum article: Facilitators of Multiple Myeloma Treatment: A Qualitative Study ONS books: Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice (third edition) Multiple Myeloma: A Textbook for Nurses (third edition) ONS course: ONS Hematopoietic Stem Cell Transplantation™ ONS Huddle Cards: Financial Toxicity Hematopoietic Stem Cell Transplantation (HSCT) Monoclonal Antibodies ONS Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library American Society of Clinical Oncology (ASCO)–Ontario Health: Treatment of Multiple Myeloma Living Guideline International Myeloma Foundation: Clinical Trials Fact Sheets Clinical Trial Support Resource Library Multiple Myeloma Research Foundation resource: Treatments for Multiple Myeloma To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "Typically for our first-line therapies, we use certain classes of drugs and some of them are proteasome inhibitors like bortezomib and carfilzomib. We also have IMiDs or immunomodulatory agents like thalidomide, lenalidomide, and pomalidomide. We have monoclonal antibodies, anti-CD38 monoclonal antibodies. Of course, we can never talk about treatment for myeloma without mentioning dexamethasone. It is an integral part of our treatment regimen. Most of our frontline therapies now are not just a single agent. They're not even doublets anymore. Typically, they're triplet therapies. And now in 2026, it's leaning more toward quadruplet therapies. By that, I mean you're taking a proteasome inhibitor, an immunomodulatory drug, dexamethasone, and an anti-CD38 monoclonal antibody all together to present patients with a good chance their induction therapy will lead to a good chance of them responding to treatment." TS 4:25 "[With] myeloma labs, there should be some indication after each cycle of therapy that the treatment is working. So, you don't have to do a whole myeloma panel, but maybe getting a monoclonal protein spike, maybe getting a free light chain assay, or maybe an immunoglobulin G or immunoglobulin A level, just to see if the treatment is working. So, those labs are crucial to determine whether the therapies are working. And again, the lab improvements usually correlate with the clinical presentation of the patient." TS 11:01 "There are active clinical trials ongoing with drugs like cell mods. Cell mods are the new oral anticancer agents for myeloma that have shown great promise with efficacy and safety profiles. And then there are other combinations that are showing a lot of promise. So, drugs that are already approved by the U.S. Food and Drug Administration (FDA). And I'm talking about pairing anti-CD38 monoclonal antibodies with bispecific T-cell engagers. If you do that, there has been some evidence that these combinations are very efficacious and responses are durable. And there are ongoing clinical trials and studies being done right now to see if these can be FDA-approved to pinpoint where they are as far as in comparison to other treatments." TS 20:10 "I always tell patients to try to participate in safe, and I want to stress safe, physical activity. So, I tell patients, the more you sit on the couch or you sit in the chair for most of the day, that unfortunately will make your pain worse. So, trying to get up and about and doing some physical activity, such as getting a physical therapy evaluation and a treatment program, no matter how passive or mild or gentle it is, can really help these patients with bo...
Transcribe →Episode 400: Pharmacology 101: Radioimmunoconjugates
Jan 3000:14:02Tap to summarize"Radioimmunoconjugates work through a dual mechanism that combines immunologic targeting with localized radiation delivery. The monoclonal antibody components bind to specific tumor-associated antigens such as CD20, expressed on malignant B cells. Once found, the attached radioisotope delivers beta radiation directly to the tumor, causing DNA damage and cell death," Sabrina Enoch, MSN, RN, OCN®, CNMT, NMTCB (CT), theranostics clinical specialist at Highlands Oncology in Rogers, AR, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about radioimmunoconjugates. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.25 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 30, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge in the history of, the mechanism of action of, and the use of radioimmunoconjugates in the treatment of cancer. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Pharmacology 101 series Episode 377: Creating and Implementing Radiopharmaceutical Policies and Procedures Episode 301: Radiation Oncology: Side Effect and Care Coordination Best Practices Episode 298: Radiation Oncology: Nursing's Essential Roles ONS Voice articles: Interprofessional Collaboration Reduces Time to Neutropenia Antibiotic Administration Radiopharmaceuticals and Theranostics Offer New Options for Oncology Nurses to Transform Cancer Care Radiopharmaceuticals Pack a One-Two Punch Against Cancer Safety Is Key in Use of Radiopharmaceuticals Telehealth Has Value During Radiotherapy, Patients Say ONS Voice oncology drug reference sheets: Lutetium Lu 177 dotatate Lutetium Lu 177 vipivotide tetraxetan Radium 223 dichloride Sodium iodide-131 Strontium chloride Sr-89 ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Manual for Radiation Oncology Nursing Practice and Education (fifth edition) ONS courses: ONS/ONCC® Chemotherapy Immunotherapy Certificate™ ONS/ONCC® Radiation Therapy Certificate™ Clinical Journal of Oncology Nursing articles: Radiopharmaceutical Safety: Making It Easy Targeted Radionuclide Therapy: A Theranostic Approach to Cancer Therapy ONS Huddle Cards: Radiobiology Radiopharmaceuticals ONS Learning Libraries: Immuno-Oncology Radiation ONS Symptom Interventions for Prevention of Bleeding Drugs@FDA package inserts To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "Radioimmunoconjugates are a specialized subset of radiopharmaceuticals designed to combine the specificity of monoclonal antibodies with the cytotoxic power of radiation. ... Early development focused on B-cell malignancies, particularly non-Hodgkin lymphoma." TS 1:51 "An important concept for nurses to understand is the crossfire effect, where radiation can affect nearby tumor cells, even though not every cell expressed has the target antigen. This helps explain why these agents can be effective even in heterogeneous tumors." TS 3:40 "At present, 90 Y-ibritumomab tiuxetan is the only radioimmunoconjugate approved by the U.S. Food and Drug Administration (FDA) in clinical use. Historically, iodine-131 tositumomab played a major role in establishing these therapy classes, but it's also useful to contrast radioimmunoconjugates with other radiopharmaceuticals, such as iodine-131 therapies, which a lot of places do at this time, used for thyroid diseases, or radium 223, used for metastatic prostate cancer. Unlike those agents, radioimmunoconjugates rely on antibody-mediated targeted rather than physiologic uptake or bone affinity." TS 4:55 "I just try to explain to [patients] that radiation exposure is like being next to a flame. The further you are away, the less heat you get, the less exposure you get. These patients can be radioactive for three days, seven days—it just depends on how fast they excrete it through their bodies with half-life exposure." TS 9:33 "While only one agent is currently approved, the principles established by radioimmunoconjugates continue to guide development for newer targeted radiopharmaceuticals. Emerging agents aim to improve targeting, reduce toxicity, and expand indications beyond hematologic malignancies. This evolution underscores the importance of nursing education in this rapidly changing field." TS 10:41 "Radioimmunoconjugates represent an important bridge between traditional oncology treatments and the future of targeted therapies. Oncology nurses play a vital role in ensuring safe delivery, patient understanding, and collaboration between multidisciplinary teams. So, it's very important to educate and also stay up to date on evidence-based practices." TS 13:12
Transcribe →Episode 399: National Hazardous Drug Exposure Registry
Jan 2300:39:39Tap to summarize"The United States does not have a national cancer registry. We have a bunch of state registries. Some of those registries do collaborate and share information, but the issue is the registries that do exist typically do not report cancer by occupation. So, we cannot get our arms around the potential work-relatedness of the health outcome given the current way the state registries collect information. What we're trying to set up, is a way to make what is currently an invisible risk, visible," ONS member Melissa McDiarmid, MD, MPH, DABT, professor of medicine and epidemiology and public health director of the division of occupational and environmental medicine at the University of Maryland School of Medicine in Baltimore, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about the University of Maryland School of Medicine Hazardous Drug Safety Center Exposure Registry. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 23, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge in the incidence of hazardous drug exposure and the tracking and reporting of healthcare worker exposures. Episode Notes Complete this evaluation for free NCPD. University of Maryland School of Medicine Hazardous Drug Safety Center Exposure Registry information sheet ONS Podcast™ episodes: Episode 330: Stay Up to Date on Safe Handling of Hazardous Drugs Episode 308: Hazardous Drugs and Hazardous Waste: Personal, Patient, and Environmental Safety Episode 209: Updates in Chemo PPE and Safe Handling ONS Voice articles: Hazardous Drug Surface Contamination Prevails, Despite More Diligent PPE National Hazardous Drug Exposure Registry Safeguards Oncology Professionals NIOSH Releases Its 2024 List of Hazardous Drugs Safe Handling—We've Come a Long Way, Baby! Strategies to Promote Safe Medication Administration Practices Surfaces in Patient Bathrooms Often Contaminated With HDs, Despite Use of Plastic-Backed Pads ONS books: Safe Handling of Hazardous Drugs (fourth edition) Safe Handling of Hazardous Drugs Quick Guide™ ONS course: Safe Handling Basics Clinical Journal of Oncology Nursing articles: Hazardous Drug Exposure: Case Report Analysis From a Prospective, Multisite Study of Oncology Nurses' Exposure in Ambulatory Settings Personal Protective Equipment Use and Surface Contamination With Antineoplastic Drugs: The Impact of the COVID-19 Pandemic Sequential Wipe Testing for Hazardous Drugs: A Quality Improvement Project The Use of Plastic-Backed Pads to Reduce Hazardous Drug Contamination Oncology Nursing Forum articles: Ensuring Healthcare Worker Safety When Handling Hazardous Drugs Factors Influencing Nurses' Use of Hazardous Drug Safe Handling Precautions Other ONS resources: ONS Safe Handling of Hazardous Drugs Quick Guide Introduction to Safe Handling Huddle Card Safe Handling of Hazardous Drugs Learning Library Hematology/Oncology Pharmacy Association (HOPA) course: Safe Handling of Hazardous Drugs National Institute for Occupational Safety and Health (NIOSH) List of Hazardous Drugs in Healthcare Settings, 2024 To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "We thought that in order to answer some of the unclear questions about health risk, we would set up an exposure registry, in this case, for oncology personnel who handle the drugs. This would then create a cohort that we could ask questions to. For example, we could try to characterize whether there is a cancer excess in this group. Or characterize the reproductive abnormalities in excess that people are experiencing." TS 6:21 "It's sort of counterintuitive that the healthcare industry, whose mission itself is care of the sick, is a high-hazard industry. We typically think about the risk as being from infectious diseases, and certainly we've all lived in our practice lifetime through some examples of that. Even before COVID-19, some of us were doing preparation for Ebola and that sort of thing. So, we're kind of used to that. But the hazards that you kind of grew up with, we've routinized or normalized handling group one, human carcinogens, which a number of these drugs are—it's just something we do every day. Well, it is, but we have to do it with respect and with care every day. And I think sometimes in that routineness of it, we have sort of lost sight of the vigilance that we need to maintain." TS 11:19 "It's very easy in the life cycle of a drug in an organization to do something that doesn't just impact you, but unknowingly, you've contaminated a surface for somebody who comes behind you. Who maybe doesn't have plastic protective equipment on because something that got contaminated shouldn't have been contaminated in the first place. If we could all be thinking of it as more of a team sport, especially in terms of safe handling, that our disposition and drug handling affects not just us and our health, but those of our colleagues." TS 24:47 "For the job history pieces, we ask what year you started, what year you stopped, and we ask about estimations of handling. So we'll be able to come up with either a duration or some kind of metric for the intensity and duration of your handling history, which will then permit us to sort the population who completed the survey into sort of low, medium, high. And we'll see whether the health outcomes that are being reported are influenced by that drug handling history." TS 27:45 <p...
Transcribe →Episode 398: An Overview of Multiple Myeloma for Oncology Nurses
Jan 1600:43:36Tap to summarize"[Multiple myeloma] is very treatable, very manageable, but right now it is still considered an incurable disease. So, patients are on this journey with myeloma for the long term. It's very important for us to realize that during their journey, we will see them repeatedly. They are going to be part of our work family. They will be with us for a while. I think it's our job to be their advocate. To be really focused on not just the disease, but periodically assessing that financial burden and psychosocial aspect," Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about multiple myeloma. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by January 16, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to the pathophysiology and diagnosis of multiple myeloma. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 332: Best Nursing Practices for Pain Management in Patients With Cancer Episode 256: Cancer Symptom Management Basics: Hematologic Complications Episode 192: Oncologic Emergencies 101: Hypercalcemia of Malignancy ONS Voice articles: AI Multiple Myeloma Model Predicts Individual Risk, Outcomes, and Genomic Implications Cancer Mortality Declines Among Black Patients but Remains Disproportionately High Financial Navigation During Hematologic Cancer Saves Patients and Caregivers $2,500 Multiple Myeloma: Detecting Genetic Changes Through Bone Marrow Biopsy and the Influence on Care Multiple Myeloma Prevention, Screening, Treatment, and Survivorship Recommendations Nurse-Led Bone Marrow Biopsy Clinics Truncate Time for Testing, Treatment Diagnose and Treat Hypercalcemia of Malignancy ONS books: BMTCN® Certification Review Manual (second edition) Multiple Myeloma: A Textbook for Nurses (third edition) Clinical Journal of Oncology Nursing articles: African American Patients With Multiple Myeloma: Optimizing Care to Decrease Racial Disparities Music Intervention: Nonpharmacologic Method to Reduce Pain and Anxiety in Adult Patients Undergoing Bone Marrow Procedures Other ONS resources: Financial Toxicity Huddle Card Hypercalcemia of Malignancy Huddle Card Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library American Cancer Society article: What Is Multiple Myeloma? Blood Cancer United educational resources page International Myeloma Foundation homepage Myeloma University homepage Multiple Myeloma Research Foundation (MMRF) article: Understanding Multiple Myeloma To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "Epidemiologically, myeloma is a cancer of older adults. The median age is about 69. It is more common in men than women. It's a ratio of about three men to two women that are diagnosed. It is much more common in people of African American descent with increasing global incidence linked to aging populations. Although, the highest rates are in high-income countries. So, if we look at some of the risk factors, and several have been identified, including MGUS. MGUS is a benign precursor of myeloma, and it stands for monoclonal gammopathy of undetermined significance. Older age is also a risk factor, although we do see patients that are younger who are diagnosed with myeloma." TS 1:54 "Bone pain, specifically in the back, and fatigue, are very common symptoms that relate to things that are going on behind the scenes with myeloma. But also, patients can be bothered by frequent and long-lasting infections. So, they find that they get sick more frequently than their family and friends, and they take a longer time to recover. That could also be a presenting sign. I think there can be some presenting signs and symptoms related to electrolyte abnormalities, especially in later stages. They might be nauseated, vomiting, or constipated. Also, signs and symptoms related to cytopenias. You have to remember that this is a bone marrow cancer. So, we do have some problem with development of normal blood cells. So, we can see not only infections, but bleeding issues related to thrombocytopenia and factors related to anemia from low red blood cell counts." TS 7:15 "About 20%–25% of our patients who are diagnosed are asymptomatic. They have no symptoms. They're living their lives, they're going to work or they're traveling, playing golf on the weekends, taking care of their children or grandchildren. They are just living their lives. And at times, they go to the primary care physician and then they're referred to a hematologist-oncologist, and they're pretty surprised when they're sent to a cancer center. The way they are diagnosed in this matter is that their routine lab work, the complete blood cell count may be normal, there may be some slight differences in their hemoglobin. But what we see in the chemistry, the complete metabolic panel, is an elevation in their total protein and or an elevation of the total globulins." TS 9:22 "The bone marrow biopsy serves many purposes. You want to determine the percentage of bone marrow plasma cells. So, you want to get the degree of plasmacytosis. And then you want to do really specific tests on those plasma cells. So, you want to isolate the malignant plasma cells and determine, via analysis. So, we do the karyotype, chromosomal studies, fluorescence in situ hybridization (FISH) studies, immunohistochemistry studies, and molecular studies. All of these studies are looking for specific genetic changes in the myeloma cells—looking for translocations or deletions. And it's very important to get that information because we c...
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