Nu 246 (Exam 2)-Leukemia

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LEUKEMIA

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WHITE BLOOD
-UNREGULATED PROLIFERATION OF WBC'S IN BM AND OTHER TISSUES

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CAUSE OF LEUKEMIA

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MAYBE DEFECT IN STEM CELL
LEUKEMIA ACCOUNTS FOR 5 PERCENT OF ALL CANCERS
MORE ADULTS HAVE LEUKEMIA>CHILDREN

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CELL LINE

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MYELOID-MYELOCYTIC
MYELOGENOUS
LYMPHOID-LYMPHOCYTIC

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MATURITY OF CELL

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ACUTE=IMMATURE CELLS (RAPID GROWING "BLASTS")
CHRONIC=MORE DIFFERENTIATED (SLOWER GROWING)

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ETIOLOGY

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UNKNOWN
VIRAL?GENETIC?ENVIRONMENTAL?

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ASSSESSMENT

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HISTORY:
1.ACUTE-S/S COMMON INFECTIOUS ILLNESS
2.CHRONIC-MORE SUBTLE
S/S:FATIGUE,NIGHT SWEATS
3.LATER-SYMPTOMS DUE TO CROWDING OUT OF NORMAL B.M.

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WHAT HAPPENS IF SYMPTOMS CROWD OUT DUE TO NORMAL B.M.?

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THE RBC'S DECREASE,THE PLATELETS DECREASE,AND THE WBC'S DECREASE
-ANEMIA=FATIGUE
-PLATELETS=THROMBOCYTOPENIA
-ABNORMAL WBC=PRONE TO INFECTION

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WHAT OTHER S/S SEEN

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PAIN=INCRESES INFILTRATION,ELARGEMENT OF ORGANS,LEADS TO:INCREASED INTRACRANIAL PRESSURE
-ANOREXIA
-CNS INFILTRATION
-ANXIETY
-HYPERURICEMIA=INCREASED URIC ACID

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CLINICAL DATA:

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INCLUDES PLATELET AND CBC COUNT
-LOW Hgb
-NORMAL
-HIGH OR LOW WBC
-LOW PLATELETS
2.BONE MARROW ASPIRATION
3.LYMPHNODE BIOPSY
4.LUMBAR PUNCTURE
5.CAT SCAN

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ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

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ACUTE=IMMATURE CELLS
AKA=CHILDHOOD LEUKEMIA
PEAK AGE=4
**BEST PROGNOSIS**
THIS CANCER INFILTRATES TO OTHER ORGANS(ESP.BRAIN AND SPINAL CORD)
-CHILDREN (80% SURVIVE >5YRS)
-ADULTS (60%)

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TXT FOR ACUTE LYMPHOCYTIC LEUKEMIA

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1.CHEMO
2.RADIATION AND CHEMO TO CNS
3.HOW DO YOU GET CHEMO TO BRAIN AND SPINAL CORD? **INTRATHECAL PROCEDURE***
A.INDUCTION
B.CONSOLIDATION
C.MAINTENANCE

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INDUCTION

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ERADICATE THE LEUKEMIC CELLS
-IV CHEMO:LASTS 4 WKS
GIVEN-***PREDNISONE,ASPARAGINASE,VINCRISTINE
-NEUTROPENIA
-THROMBOCYTOPENIA
-ANEMIA

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CONSOLIDATION

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POST REMISSION
TO ELIMINATE ANY RESIDUAL CELLS
-LASTS 6 MONTHS:INTENSE
-MAY NEED HOSPITALIZATION
-INTRATHECAL MEDS:RT TO CNS

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MAINTENANCE

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2-3 YRS MEDICAL TXT
-MOST PO,SOME IV

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CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

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MILD DISORDER
-AGE >40 2/3>60 YRS OLD
-ASYMPTOMATIC
-LYMPHOCYTOSIS (HIGH WBC)ALWAYS PRESENT
-PROGRESSION UP TO 15 YRS

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TXT FOR CLL

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MILD=NONE
SEVERE=**CYTOXAN,LEUKERAN
ORGAN DRUG:(SPECIFIC FOR LYMPHOCYTIC LEUKEMIA)CALLED"A

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ACUTE MYELOGENOUS LEUKEMIA (AML)
(ANLL=ACUTE NON LYMPHOCYTIC LEUKEMIA)

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-ALL AGE GROUPS (INCREASE W/AGE)
-INSIDUOUS ONSET=1-6 MONTHS
-PRESENCE OF AUER RODS IN CYTOPLASM

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TREATMENT FOR AML

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1.CHEMO->REMISSION 1 YR OR GREATER
2.BONE MARROW TRANSPLANT ON 1ST REMISSION
AML IS RESISTANT TO TXT !
70% RELAPSE AFTER CHEMO-**BEST IF GIVEN BONE MARROW TRANSPLANT
PROGNOSIS:PT USUALLY DIES W/IN 2-5 MOS

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CHRONIC MYELOGENOUS LEUKEMIA (CML)

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MORE NORMAL CELLS PRESENT THAN W/ ACUTE DISEASE=MILDER
-AGE=40
-LEUKOCYTOSIS IS ALWAYS PRESENT
(WBC'S CAN INCREASE TO 500,000)
-PHILADELPHIA CHROMOSOME FOUND IN 90-95% OF PTS

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TXT FOR CML

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1.**GLEEVAC-P.O.(IMATINILOMESYLATE)
2.ONLY CURE IS BONE MARROW TRANSPLANT

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PROGNOSIS FOR CML

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LIFE EXPECTANCY IS 3-5 YRS

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WHAT ARE THE 3 PHRASES OF CML?

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1.CHRONIC
2.ACCELERATED
3.BLAST CRISIS

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WHAT IS GIVEN DURING ACCELERATED PHASE OF CML?

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1.INTERFERON
2.ALLOGENIC BMT

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NSG DIAGNOSIS

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SAME AS FOR APLASTIC ANEMIA
-RISK FOR INJURY/BLEEDING
-ANXIETY
-GRIEVING
-POWERLESSNESS

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GOAL FOR CML

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INCREASE STRENGTH AND ENDURANCE
WANT ABSENCE OF INFECTION,BLEEDING,PAIN
HELP COPE W/DIAGNOSIS,TXT,PROGNOSIS

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REMISSION

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A HEALTHY STATE IN WHICH ALL
ABNORMAL,IMMATURE, USELESS CELLS DISAPPEAR FROM B.M. AND BLOOD STREAM

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NSG CARE FOR LEUKEMIA IS RELATED TO __

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BONE MARROW SUPPRESSION
**PREVENT AND CONTROL INFECTION**-MAJOR CAUSE OF DEATH

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NSG MEASURES FOR LEUKEMIA

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-CULTURE,ANTIBIOTIC
-CHECK LOC,CHECK RESPIRATORY
-SOMATITIS(NORMAL SALINE)
-ASEPTIC TECH
-NO RECAL TEMP-ABSESSES COMMON
-NO TYLENOL-WILL MASK THE TEMP
-REVERSE ISOLATION CONTROVERSIAL
-NO ASPIRIN

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NSG TXT FOR CHEMO

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-GOOD NUTRITION (ANTIEMETICS,DO NOT GIVE FAVORITE FOOD)
-RENAL STONES (ALLOPURINOL)
-HYDRATION (ELECTROLYTE SUPPLEMENTS)
-TUMORLYSIS SYNDROME

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WHAT NEW DRUG GIVEN TO LOWER URIC ACID LEVELS?

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RASBURICASE (ELITEK) IV-PEDIATRIC POPULATION

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PT IS MORE PRONE TO __ IF PT GETS LEUKEMIA

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HODGKINS