Reader comments on patient-specific vaccine therapy for non-Hodgkin lymphoma.

We have read your excellent article, “Patient-Specific Vaccine Therapy for NonHodgkin Lymphoma” (Vol. 9, pp. 85–90), and thank you for this major contribution to the nursing literature. We had a few questions relative to nursing care. The authors stated that clinical evidence suggests that dendritic cell stimulation may cause stimulation of autoimmune disease in patients with a history of autoimmune disease and that these patients should be observed for potential autoimmune adverse effects or excluded from this type of therapy (Bondanza et al., 2003). We note that the clinical evidence cited is from the murine model. The fear of stimulating disease using recombinant growth factors is reminiscent of early fears that colony-stimulating factors (CSFs) would cause stimulation of cancer or other diseases. We are interested to know if these cases have been documented in the human model. What action would you take if white blood cells (WBCs) climbed to an abnormal level because of granulocyte-macrophage–CSF (GM-CSF)? What would be the patient consequences in this event, and how would you manage patients with higher than normal WBCs? Also, how would you manage side effects such as pruritis from vaccine administration techniques? Thanks for your help.