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42 Cards in this Set

  • Front
  • Back
The general term used to describe a group of malignancies affecting blood and blood forming tissues including:
Bone marrow
Lymphatic system
Based on:
Cell type
-Lymphocytic (lymphoid line)
-Myelocytic (myeloid line - bone marrow)
Acuity or Chronicity
-Acute leukemia-rapid onset, aggressive
-Chronic leukemia-gradual onset, indolent
Acute lymphocytic leukemia (ALL)
Acute myelogenous leukemia (AML)
Chronic lymphocytic leukemia (CLL)
Chronic myelogenous leukemia (CML)
**cell maturity refers to acute or chronic**
Hairy cell leukemia (highly treated with interferon)
Cutaneous t-cell leukemia
Unclassified leukemias - subtype can't be identified, or combination of myeloid and lymphoid
Causative Factors
? Genetic Predisposition
? Viral implications
Not a single causative agent
Most likely combination of factors
Anemia may be a precursor
Potential Risk Factors
Radiation Exposure
Genetic factors: Down's Syndrome and Philadelphia Chromosome
Clinical Presentation
Elevated white count
Enlarged liver/spleen
Increased metabolism
Severe infections
(patient reports last week they were fine and 1 week later present very sick, look sick and feel lousy).
Clinical Presentation
CNS symptoms: headache, mental status changes
Renal Insufficiency
Bone pain (very common complaint)
Potential Risk Factors
Exposure to benzenes
Diagnostic Studies
History and Physical Exam
CBC with differential
Serum electrolytes
Bone marrow biopsy - definitive diagnosis
Lumbar puncture - evaluate if CNS disease
Biopsy of skin lesions
Cancer in the Marrow: Acute Leukemia
Acute Leukemia
-More common in children than adults
-Progresses rapidly
-Ineffective, immature WBC's crowd the bone marrow (large number of diseased cells)
Signs: Increasing immature may effect all lines
Bone Pain
Cancer in the Marrow: Chronic Leukemia
Chronic Leukemia
-Rarely affect people under the age of 20
-Affect men > women typically age 40-50
-Progress slowly
-Allows development of normal cells
Acute Lymphocytic Leukemia (ALL)
Rapidly developing immature lymphocytes crowd out normal cells
Presence of the Philadelphia chromosome
Poor prognostic factors:
WBC > 25,000/mm3
Age over 50
First remission later than 3 weeks
Acute Lymphocytic Leukemia (ALL)
Four treatment phases: (chemotherapy)
Induction-"induce" a remission
Consider bone marrow transplant if relapse at any point
Goal: Complete remission with restoration of hematopoiesis
Acute Lymphocytic Leukemia (ALL)
Induction Phase:
Aggressive, intensive chemotherapy
Goal is to eradicate leukemia
Prolonged hospitalization with potentially life threatening complications
Requires CNS prophylaxis
Infection prevention and treatment
Nausea management
6 weeks of hospitalization
Wait for blood counts to come back up.
Acute Lymphocytic Leukemia (ALL)
Intensification phase:
Several courses of same or different chemotherapy drugs (never single agents)
Goal is to continue destruction of leukemic cells (residual cells)
Usually briefer hospitalization, recovery before beginning new cycle
Acute Lymphocytic Leukemia (ALL)
Consolidation phase:
Begun after remission achieved
Goal: eliminate undetectable disease
Less aggressive, spaced out over weeks
Usually same drugs used for remission
Acute Lymphocytic Leukemia (ALL)
Maintenance phase:
Goal is to maintain remission, prevent recurrence of leukemic cells
Lower doses, same drugs every 3-4 weeks
Less toxicity, out-patient, oral and IV
May continue for 3-4 years
Acute Lymphocytic Leukemia (ALL)
The role of Bone Marrow Transplant:
Remains controversial
Unclear if improves survival period if in remission
Many clinical trials currently ongoing
Goal is to eradicate the diseased cells
Acute Myelogenous Leukemia (AML)
Represents 25% of all leukemia in adults
85% of acute leukemias in adults
Abrupt onset
Uncontrolled proliferation of myeloblasts
Acute Myelogenous Leukemia (AML)
Induction therapy:
Induce a remission like ALL
Prolonged hospitalization
Goal is <5% blasts 10 days after treatment started
No routine CNS prophylaxis
Prognostic Factors
Age under 60 years is favorable
Spontaneous cause
Remission within one cycle of chemo=good prognosis
WBC <10,000/mm3
Acute Myelogenous Leukemia (AML)
Post Remission Therapy: is required
No further treatment-relapse in 6-8 months
Conflicting data re: appropriate treatment
Preference is allogeneic BMT
If no match, may involve intensive chemo
Clients should enroll in clinical trial
Acute Myelogenous Leukemia (AML)
Remission Rates 25-35%
Role of transplant
-Allogeneic transplant from matched donors has increased the cure rate to 50-60%
-Autologous stem cell transplant benefit is unclear at this time
Chronic Lymphocytic Leukemia (CLL)
Second most common leukemia, often found in routine exam (discovered with CBC)
Difficult decision re: if or when to treat
Early disease: may survive >10 years with no treatment
Late disease: aggressive, treatment resistant, death in <2
Chronic Lymphocytic Leukemia (CLL)
Indolent disease
-Recurrent infections
Chronic Lymphocytic Leukemia (CLL)
The goal is not cure and is usually delayed
Median survival when treatment begins: 19 months
Radiation therapy
Biologic therapy
Chromic Myelogenous Leukemia (CML)
Hallmark: presence of Philadelphia chromosome - diagnostic of CML
Has 3 phases:
Chronic Phase: may last 3-5 years, treated with single agent to control WBC count
Accelerated Phase: all clients convert, resistant to treatment, death <6 months
Blast Phase
Chromic Myelogenous Leukemia (CML)
Chronic Phase: mild symptoms contolled with single agents designed to keep WBC down. Blasts <105
Accelerated Phase: Spleen enlargement, fevers, night sweats, weight loss
10-30% blasts
-lasts 6-12 months
-less responsive to therapy
Chromic Myelogenous Leukemia (CML)
Blast Phase: transformation to aggressive leukemia >30% blasts
-Interferon hydoxurea
-Allogeneic stem cell transplant (must be done early)
Bone Marrow Transplant (BMT)
Cure rates increasing with BMT
Even if no cure, some period of remission
Allows for very high dose chemotherapy
Type of transplant depends on whose marrow is infused
Over 15,000 transplants done in US in 2004 and number is growing
Disorders treated with Bone Marrow Transplant
Malignant Diseases:
Hodgekin's Disease
Non-Hodgekin's Lymphomas
Multiple myeloma
Mylodysplastic syndrome (MDS)
Sickle cell disease
Aplastic anemia
Immunodeficiency diseases
Types of Transplant
Allogeneic Bone Marrow Transplant:
Related, usually sibling
Unrelated, matched unrelated donor (MUD) from marrow registry
Infused marrow from donor who is HLA matched to recipient
Autologous Bone Marrow Transplant:
Clients receive own bone marrow back
Harvested and stored, can use bone marrow or peripherally harvested cells
More of a "rescue" than a true transplant
Syngeneic Bone Marrow Transplant:
Donor is identical twin
Has identical HLA typing and is a perfect match
Peripheral Stem Cell Transplant (PSCT)
Peripheral Stem Cell Transplant (PSCT):
Harvest of peripheral stem cells via pheresis
Donor is given colony stimulating factor
May require several days to obtain adequate number of stem cells
Recovery quicker, fewer side effects
Bone Marrow Transplant (BMT)
Proceeded by harsh chemotherapy regimens:
Dental exam
Suppress menstruation pharmacologically
Permanent vascular device, with multiple lumens(tunneled permanent central venous access)
Preferably no/minimal disease
BMT Donation
Done in OR, general anesthesia
Multiple aspirations from iliac crest
Takes 1-2 hours
Client discharged home with iron supplements and pain medications
Marrow replaced in 1-2 weeks
Stem Cells
Cord Blood Stem Cells
Umbilical cord blood is rich in stem cells
Disadvantage: low number of stem cells
Data: cord blood has been stored for 15 years with no decrease in effectiveness
Still new technology; processing fee: $1800 and annual storage fee: $100
Nursing Considerations BMT
Same for all bone marrow transplants
Countdown Days: Conditioning
Day "0": Transplant Day
Plus days: Recovery
The Course of BMT
Early: First 100 or so days:
Bacterial, viral, fungal infections
Anemia, neutropenia, thrombocytopenia
Mucous membrane breakdown: mucocytis, esophogitis, stomatitis, rectal fissures
Electrolyte imbalances
Rejection - Graft vs Host Disease (GVHD)
Late: Chronic rejection (GVHD)
Respiratory problems: Bronchiolitis obliterans organizing pneumonia (BOOP)
Decreased maturation (in children and teens)
Secondary cancers and infertility