Chapter 33: Acute Lymphocytic Leukemia (ALL) (Children) Flashcards
Acute Lymphocytic Leukemia (ALL)
most common type of cancer in children
- a type of blood and bone marrow cancer which mainly affects the white blood cells
- peak between 2 to 5 years of age
- during infancy, boys are more likely to develop
- the leukemic cells are usually acquired versus inherited
- increased risk among children with certain genetic disorders such as Down Syndrome
Signs and Symptoms
- fever (in 50% of cases)
- fatigue and lethargy
- have anemia and therefore are pale
- anorexia
- bone or joint pain may be present
- parents may notice a limp or the child may refuse to walk
Less Common Symptoms
- headache, vomiting, difficulty in breathing, and low urine output
- bleeding under the skin, in the mouth, or sometimes in the eyes may be present
- petechiae can also be noted
- abdominal distention caused by an enlarged spleen
- enlarged lymph nodes
- hepatomegaly
Diagnosis
-CBC and other blood tests to evaluate the WBC count, platelets, and liver and kidney function
-bone marrow aspirate is required to make the diagnosis of ALL
>a finding of more than 25% abnormal lymphoblast cells in the bone marrow is diagnostic
-other samples in the bone marrow are sent for further testing and show chromosomal changes and better identify the specifics of the leukemia
-the child’s WBC count and age at diagnosis are important prognosis signs in ALL
Best Prognosis is Associated with?
-a WBC less than 5000/mm3 and an age 2 to 9 years
Worst Prognosis is Associated with?
- an initial WBC count of 50,000/mm3 and an age older than 10
- infants younger than 1 year of age at time of diagnosis
Lumbar Puncture (LP)
“spinal tap”
is the introduction of a needle into the subarachnoid space of the lumbar spinal cord; the needle is inserted with a stylet into the interspace between the third and fourth lumbar vertebrae under strict sterile technique
-test is usually done to remove a sample of cerebrospinal fluid (CSF) to test for infection
>for cancer patients, this procedure is used to introduce chemotherapeutic agents into the CSF space; this is known as giving chemotherapy intrathecally (through the theca of the spinal cord into the subarachnoid space)
-b/c some medications cannot cross the blood-brain barrier easily, physicians have obtained better results by introducing chemotherapeutic agents into the CSF space to kill cancer cells so they cannot “hide” behind the blood-brain barrier
Nursing Care
without effective therapy and nursing care, ALL is fatal
-leukemia is treated with chemotherapy and includes three phases: remission-induction, consolidation, and maintenance
-in the remission-induction phase, the tumor burden is reduced to an undetectable level; 95% of children with ALL achieve remission during induction, which usually lasts 4 weeks
>once remission is achieved, most children relapse within a few months if treatment is stopped
Remission
the partial or complete disappearance of signs and symptoms of the disease
- does not mean “cancer free”
- there could still be cancer cells that are undetectable in the body; treatment will continue
Induction
chemotherapy given to achieve remission
Consolidation
chemotherapy given after the induction to control microscopic disease
Maintenance
chemotherapy given on a long-term basis to maintain remission
Complementary Care: Visualization and Distraction
the child may experience anticipatory anxiety before a procedure; visualization and distraction can be helpful
- Visualization: be creative; have child imagine a trip to his/her favorite place; have the child close their eyes while the nurse plays tour guide; ask questions about their favorite place and encourage the child to be apart of the the story/trip
- Distraction: depending on child’s developmental level; blowing bubbles, performing a magical light show, or simply reading a story
Medical Care
-Chemotherapy agents used for remission-induction: vincristine (Oncovorin), L-asparaginase (Elspar), and prednisone (Deltasone) or dexamethasone (Decadron)
>children who have worse prognosis are also given a anthracycline drug (chemotherapy drug that is known to affect and damage the heat, such as doxorubicin (Adriamycin))
-children with ALL also receive CNS prophylaxis; the prophylactic chemotherapy agent is injected intrathecally into the CSF during an LP
-once child is stable, the chemotherapy can be given in an outpatient setting
The goal of the second phase (consolidation)
is to destroy any residual leukemic cells
- this phase starts immediately after remission and is achieved and lasts about 6 months
- chemotherapy in this phase is frequently administered in high doses
- children not usually hospitalized for this stage unless a complication arises
- this phase may also require radiation
What is the goal of the third phase? (maintenance)
controls the leukemia
-can last for 2 to 3 years after diagnosis
Bone Marrow Transplant
is the treatment option for children who have a second remission after relapse
-involves giving the child high doses of chemotherapy and/or radiation to eradicate disease or cancer and then rescuing the patient with a source of stem cells that allows for recovery of healthy bone marrow
>two types of transplants: autologous and allogenic
-autologous= the patient’s own peripheral blood or bone marrow is given back
-allogenic= can be from matched sibling, a relative, or an unrelated donor accessed through the National Marrow Donor Program
Biological Therapy
consists of high doses of hormones or other proteins that are normally made by the human body
- pharmaceutical companies can make these substances
- made to prevent or treat damage to other systems of the body that may be caused by other leukemia treatments
Education/Discharge
- made aware of the importance of these children avoiding falls and “being careful” during play
- monitor for signs of red dots called petechiae that are described as small (1 to 2 mm), red or purple spots on the body caused by broken capillaries that do not blanch or fade when pressed by the finger
- with a low WBC count, tell parents to keep the child away from people who are ill and avoid crowded places, such as shopping malls
Chemotherapy Agents Used for Remission-Induction
- vincristine (Oncovorin)
- L-asparaginase (Elspar)
- prednisone (Deltasone)
- dexamethasone (Decadron)
Doxorubicin (Adriamycin)
- anthracycline drug (chemotherapy drug that is known to affect and damage the heart)
- for children who have a worse prognosis
