ALL Flashcards
difference between bone marrow biopsy and lumbar puncture tap
bone marrow - examines size and # of leukemic cells; also finds out type of lymphocytes involved (B/T)
lumbar tap - test to see if CSF is involved
which type has better prognosis B or T type
B
Sanctuary sites?
testes, retina/optic nerve
define sanctuary sites
an area of the body that is poorly penetrated by pharmacological agents and therefore is a place in which tumor can escape the effects of drug therapy.
steps of chemo
induction -consolidation - maintenance - (CNS prophylaxis)
induction
immediately after diagnosis
1 month
consolidation
given after remission achieved
4-8 months
Maintenance
kills of residual disease, or recurrence
when is CNS prophylaxis given
high risk pts
t-cell diagnosis
high initial WBC
dose for CNS prophylaxis
1200/24 or 20
cranial field borders
sup - fall off, flash
ing - include cribriform plate, temporal fossa; to level of c2 posteriorly, includes retina and optic nerve
post- fall off, flash
ant - fall off, flash
when is RT done for ALL
prep for bone marrow transplant CSI testicular irradiation large mediastinal mass palliation
difference between autologous and allogeneic stem cell transplant
auto-from transplant from same person (after conditioning regimen)
transplant healthy from donor
dose for a TBI?
1200-200cGy given BID for 3 days
when do we treat a pt with TBI
prep for a bone marrow transplant,
wipe out all bad bone marrow so new one can take over
were is TBI dose prescribed?
umbilicus
dose given for testicular relapse?
boost when?
2400cGy-2600cGy/150-200cGy/fx
after TBI might boost with 400cGy
for ALL when do we do CSI
what dose?
when there are positive cells in CSF
helmet field: 2400/150cGy
Spine field: 1500cGy/150cGy
spine field borders for CNS?
sup - junction of inf cranial field
inf - below s2
lat - width should cover the entire vertebral bodies in all areas
acute side effects of CSI
hematopoietic - decrease in blood counts
somnolence syndrome - characterized by drowsiness and malaise
l’hermitte’s syndrome
GI effects - NV, diarrhea
late effects of CSI
motor-sensory loss
growth delays - hypothalmic-pituitary dysfunctions - irradiation to the CNS
myelopathy
secondary tumours
acute side effects TBI
NV, diarrhea, anorexia
effect mucosa of: mouth, pharynx, bladder
skin rxns: itch, tingling, bruise, dry/ineleastic skin (cracks easy)
alopecia
interstitial pneumonitis
malaise (discomfort)
chronic side effects TBI
permanent sterility
cataracts
hepatic fibrosis
radio-necrosis of genital tissue, muscle, or kidney
where might TLDs be placed for TBI
knees umbilicus neck head armpits pelvis shoulders
