Acute lymphoblastic leukemia Flashcards
What is acute lymphoblastic leukemia?
Bone marrow is replaced with malignant clone of immature blast cell.
Panocytopenia as a result of bone marrows reduced ability to produce normal blood cells.
Signs and symptoms
Bone marrow suppression
- Neutropenia (more infections)
- Anaemia (fatigue and pallor)
- Thrombocytopenia (bruising)
Induction drugs
Vincristine
PEG asparage IM
Intrathecal methotrexate
High dose dexamethason
Vincristine
Inhibits microtuble formation
Disrupts formation of mitiotic spindle
Arrests cell in metaphase
PEG asparase IM
Asparaginase enzyme hydrolyses L-asparaginase to ammonia and aspartic acid.
Intrathecal methotrexate
Injected into intrathecal space
Unwanted side effects of dexamethasone
- Increased appetite
- Hyperglycaemia
- Mood swings
- Insomnia
Counting carbs approach
Having 7 small meals witch each meal having up to 25 grams of carb
Consolidation drugs
Cyclophosphamide
6-mercatopurine
Cytarabine
Cyclophosphamide
Alkylates DNA
Inhibits protein synthesis
Stops cancer cell growth
Suppresses immune systen
6-mercatopurine
Inhibits de novo purine synthesis
Interferes with DNA, RNA and protein synthesis
Promotes apoptosis
Fast metabolic reaction produces xanthine oxidase - drug interaction with dairy products
Cytarabine
Pyrimidine analogue
Competes with cytidine
Incorporates itself into DNA
Causes direct DNA damage during the S-phase
Interim maintenance
IV methotrexate
Intensification
Doxorubicin
Forms complex with DNA
Intercalates between base pairs
Inhibits tropoisomerase II
Maintenance
Carried out for 20 months.
- Mercatopurine daily
- Methotrexate weekly
Pulses of dexamethasone and vincristine monthly
