Chapter 30: Leukemia

Question 1

Describe the general term leukemia and what body structures/organs/systems are affected by leukemia.

Answer 1

used to describe a group of cancers affecting the blood and blood-forming tissues of the bone marrow, lymph system, and spleen.

Question 2

Cite common causes of leukemia. 11

Answer 2

*No single cause
*mutation in the DNA of certain cells
*combo of factors: genetic and environmental
*abnormal genes (oncogenes)
*chemical agents
*viruses
*radiation
*immunologic deficiencies
*pesticides
*smoking
*obesity

Question 3

Compare the terms acute and chronic when classifying the 2 major types leukemia.

Answer 3

*Acute: Characterized by the clonal proliferation of immature hematopoietic cells. The leukemia develops after malignant transformation of a single type of immature hematopoietic cell, followed by cellular replication and expansion of that malignant clone.

*Chronic: Involves more mature forms of the WBC. The disease onset is more gradual.

Question 4

Compare the terms myelogenous and lymphocytic when classifying leukemia by cell type.

Answer 4

Myelogenous: Cancer develops in granulocytes or monocytes (myeloid cells)

Lymphocytic: Cancer develops in lymphocytes (lymphoid cells)

Question 5

List the 4 major types of leukemia and common clinical manifestations as displayed in Table 30.24 on page 636.

Answer 5

*Acute myelogenous leukemia
*Acute lymphocytic leukemia
*Chronic myelogenous leukemia
*Chronic lymphocytic leukemia

Question 6

Acute Myelogenous Leukemia

who has (kids vs adults) s/s (11)

Answer 6

15%-20% of leukemia in kids, 80% of leukemia in adults. Increase in incidence with advancing age after 60 years.

Fatigue and weakness, headache, mouth sores, anemia, bleeding, fever, infection, sternal tenderness, gingival hyperplasia, mild hepatosplenomegaly (⅓ of patients)

Question 7

Acute LYmphocytic Leukemia (ALL)

age: young vs. old, s/s lots

Answer 7

Median dx is 15 years with 57.2% diagnosed at younger than 20 years old. ~27% of cases are dx at age 4 or older and only 11% at age 65 or older.

Fever, pallor, bleeding, anorexia, fatigue, and weakness. Bone, joint, and abdominal pain. Generalized lymphadenopathy, infections, weight loss, hepatosplenomegaly, headache, mouth sores, neurologic manifestations: CNS involvement, increased intracranial pressure (N/V, lethargy, cranial nerve dysfunction) from meningeal infiltration. Men may have painless enlargement of the scrotum.

Question 8

Chronic Myelogenous Leukemia (CML):

age, s/s 9 (similar to AML)

Answer 8

*Increase in incidence with advancing age, with median age at dx of 67. RARE IN CHILDREN..

*No symptoms early in disease. Fatigue and weakness, fever, sternal tenderness, weight loss, joint pain, bone pain, massive splenomegaly, increase in sweating

Question 9

Chronic Lymphocytic Leukemia (CLL):

age and gender, s/s (sympotomatic? 10)

Answer 9

Increase in incidence with advancing age after 65 years, with PREDOMINANCE IN MEN.

Frequently no symptoms. Detection of disease often during examination for unrelated condition, chronic fatigue, anorexia, splenomegaly and lymphadenopathy, hepatomegaly. May progress to fever, night sweats, weight loss, fatigue, and frequent infections.

Question 10

Cite the which type leukemia makes up about 80% of acute leukemias in adults.

Answer 10

Acute Myelogenous Leukemia (AML)

Question 11

Cite the most common form of leukemia in children.

Answer 11

Acute Lymphocytic Leukemia (ALL)

Question 12

Cite the most common form of leukemia in adults of Western countries.

Answer 12

Chronic Lymphocytic Leukemia (CLL)

Question 13

Describe the Philadelphia chromosome and its occurrence in chronic myelogenous leukemia.

Answer 13

*The Philadelphia chromosome originates from the translocation between the BCR gene on chromosome 22 and the ABL gene on chromosome 9.

*interferes with normal cell cycle events, such as the regulation of cell proliferation.

Question 14

Explain what causes bone marrow failure and the 3 conditions that can develop due to this bone marrow failure, refer to Figure 30.13

Answer 14

*Bone marrow failure results from (1) bone marrow overcrowding by abnormal cells and (2) inadequate production of normal marrow elements.

*The patient is predisposed to:
1. Anemia
2. Thrombocytopenia ( <150,000 platelets)
3. Decreased number and function of WBCs

Question 15

Cite the common locations of where leukemic cells infiltrate outside of the bone marrow. 4

Answer 15

Lymph nodes
Liver
Spleen
joints

Question 16

Define the terms chloromas and leukostasis.

Answer 16

Chloromas → Solid mass resulting from a collection of leukemic cells

Leukostasis → When there is a high leukemic white count in the peripheral blood (more than 100,000 cells/𝝻L) and causes the blood to thicken and potentially block circulatory pathways

Question 17

List diagnostic studies used for diagnosing and classifying type of leukemia. 9

Answer 17

• Peripheral blood evaluation
• Bone marrow exam
  Morphologic
  Histochemical
  Immunologic
  Cytogenetic
  Lumbar puncture
  PET
  CT

Question 18

List 2 diagnostic test that can detect leukemic cells outside of the blood and blood marrow.

Answer 18

Lumbar puncture and PET/CT scans

Question 19

Cite the initial goal of leukemia treatment.

Answer 19

Remission

Question 20

Compare the 3 types of remission: complete, partial, and molecular.

Answer 20

Complete:
There is no evidence of overt disease on physical examination, and the bone marrow and peripheral blood appear normal.

Partial:
Characterized by a lack of symptoms and a normal peripheral blood smear, but there is still evidence of disease in the bone marrow.

Molecular:
All molecular studies are negative for residual leukemia.

Question 21

Describe induction chemotherapy and the actions of this phase in treatment. 6

Answer 21

*The first stage of chemotherapy. *This is the attempt to bring about a remission.
*Induction is an aggressive treatment that seeks to destroy leukemic cells in the tissues, peripheral blood, and bone marrow to eventually restore normal hematopoiesis in bone marrow recovery.
*During induction therapy, a patient may become critically ill because the bone marrow is severely depressed by the chemotherapeutic agents
*After 1 course of induction therapy, around 70% of newly diagnosed patients younger than 60 years old achieve complete remission.
*It is assumed that leukemic cells persist undetected after induction therapy. This could lead to relapse within a few months without further therapy.

Question 22

RN interventions during induction

Answer 22

focus on neutropenia, thrombocytopenia, and anemia

Question 23

Describe postinduction or post remission chemotherapy and the goal of this phase of leukemia treatment.

Answer 23

*This stage of chemotherapy includes intensification and consolidation.
*Intensification therapy, or high-dose therapy, may be given immediately after induction therapy for several months.
*Other drugs that target the cell in a different way than those given during induction may be added.
*Consolidation therapy is started after remission is achieved. It may consist of 1 or 2 more courses of the same drugs given during induction or involve high-dose therapy (intensive consolidation).
*The purpose of consolidation therapy is to eliminate remaining leukemic cells that may not be clinically or pathologically evident.

Question 24

Describe maintenance therapy and the goal and duration of this leukemia treatment.

Answer 24

*may be used and involves treatment with lower doses of the same drugs used in induction or other drugs given every few weeks for a prolonged period
*goal: keep the body free of leukemic cells. This is often used with ALL and extends for several years.

Question 25

Cite the 3 purposes of using multiple drugs to treat leukemia.

Answer 25

Decrease drug resistance

Minimize the drug toxicity by using multiple drugs with varying toxicities

Interrupt cell growth at multiple points in the cell cycle

Question 26

Describe how radiation therapy may be used even with the absence of solid tumors. 3

Answer 26

*Total body radiation may be used to prepare a patient for bone marrow transplantation.
*Radiation may be restricted to certain areas (fields) such as the liver and spleen, or other organs affected by infiltrates.
*In ALL, prophylactic intrathecal methotrexate or cytarabine is given to decrease the chance of CNS involvement, which is common in this type of leukemia.

Question 27

Discuss what to monitor for when caring for patients that have received treatment for leukemia.

Answer 27

signs and symptoms of disease control or relapse.

Question 28

Identify what is important to understand about long-term survivors of leukemia. 3

Answer 28

*The goals of rehabilitation for long-term survivors of leukemia are to manage the physical, psychologic, social, and spiritual consequences and delayed effects from the disease and its treatment.
*Assistance may be needed to reestablish the various relationships that are a part of the patient’s life.
*Involving the patient in survivor networks and support groups or services may help the patient adapt to living after a life-threatening illness.