LEUKEMIA

• Leukemia

  Uncontrolled production of immature WBCs in the bone marrow
• Classification of leukemia

  • Acute vs. chronic
  • Lymphocytic vs. myeloid
• Etiology & Risk factors for leukemia

  • Genetic and environmental factors
  • Damage to genes that control cell growth
  • Ionizing radiation
  • Viral infection
  • Exposure to chemicals and drugs
• Most common leukemia types:

  Children: acute lymphocytic leukemia (ALL)

  Adult: acute myeloid leukemia (AML) & chronic lymphocytic leukemia (CLL)
• Pediatric leukemias

  • 31% of all cancers in children (USA)
  • ALL 70%
  • More common in boys/ 2-3 years of age
  • 90% survive beyond 5 years after diagnosis
  • 15-20% of children relapse - associated with poorer outcomes
• Diagnostic tests for leukemia

  • Bone marrow examination
  • Chest x-ray
  • Skeletal x-ray
  • CBC with differential (H & H, WBCs)
  • Platelets
  • Clotting times
  • Chromosome analysis
• Bone Marrow Transplant (BMT)


  • Treatment of choice for some types
  • Often in conjunction with chemotherapy
  • Allogeneic BMT: bone marrow cells from donor with closely matched tissue antigens
  • Autologous BMT: patient's own bone marrow taken during period of remission
• Stem Cell Transplant (SCT)


  • Alternative to BMT
  • Complete, sustained replacement of blood cell lines with cells from donor stem cells (RBCs, WBCs, and platelets)
  • Donors must have tissue closely matched to recipient's
  • Hematopoietic growth factor administered to donor before harvesting to increase concentration of stem cells in peripheral blood
• Graft versus host disease (GVHD)


  • Allogeneic BMT or SCT may precipitate
  • Immune cells identify body tissue as foreign
  • Acute: Develops within 3 months after transplant, Pruritic, maculopapular rash begins palms/feet, jaundice nausea, vomiting, diarrhea and dry eyes
  • Chronic: Develops >3 months after transplant, May follow acute GVHD or may develop in patients with no previous symptoms, Chronic pain, fatigue, weakness, sob
  • Treatment: steroids & antibiotics & immunosuppressants
• Chemotherapy drugs


  • Vincristine (VCR) - ALL in children. Does not suppress bone marrow
  • Bleomycin - AML. more effective against dividing rather than resting cells. Pulmonary toxicity.
  • Methotrexate - ALL. interferes with cell division
  • Cisplatin - interferes with cell growth
• Supportive chemotherapy drugs

  • Filgrastim (Neupogen) - ↑ WBCs
  • Oprelvekin (Interleukin 2) - ↑ platelets (no longer sold in USA)
  • Epoetin Alpha (Erythropoietin) - ↑ RBCs
• Tumor Lysis Syndrome (TLS)

  • Risk with initial treatment
  • Results from dissolving or decomposing of tumor cells
  • Leads to release of intracellular contents into circulation
  • Can result in cardiac arrhythmias, renal failure or death
• Radiation therapy

  • damages cellular DNA so it cannot multiply
  • cells that divide rapidly (bone marrow/cancer cells) respond quickly
  • normal cells affected but can recover
• Biologic agents

  • Cytokine modify body's response to cancer cells
  • Colony stimulating factors "rescue" bone marrow after induction of chemotherapy
• Nursing care

  • Prevent infection due to reduced immunity & chemotherapy
  • infection: the major cause of death in patients with leukemia
  • mucous membranes especially susceptible
  • handwashing
  • strict aseptic technique
  • changes in WBC function impair immune, inflammatory responses
  • chemo, radiation therapy further depress bone marrow function, increasing risk for infection
  • neutropenia - reverse isolation
• Nursing care plan


  • Meet development milestones
  • Express emotions related to diagnosis
  • Receive sufficient dietary intake to maintain growth and/or weight
  • Report symptoms of complication
  • Obtain daily weight measurements
• Immature Lymphocytes

  infiltrate spleen, lymph nodes, CNS
• Myeloid

  stem cells interfering with maturation of all blood cell granulocytes, RBCs, and thrombocytes
• Assessment

  A) ecchymoses

  B) lesions

  C) pallor

  D) liver/spleen

  E) hematuria

  F) joint

  G) tachy

  H) dyspnea

  I) fatigue

  
• Nursing care plan: prevent & manage adverse medication effects

  • obtain daily weight measurements
  • evaluate infusion site frequently
  • monitor patient's intake, output
  • carefully monitor renal function in patients receiving Cycophosphamide
  • may require infusion of platelets or packed RBCs
• Nursing Care

  A) clotting

  B) bleeding

  C) avoid

  D) uric

  E) creatinine

  F) 4

  G) 3-5

  H) 15-20