Leukaemia Management Flashcards
Who is ALL more common in?
- Paediatric patients
- 0-4 years
How is ALL managed?
- Course 1 = 4 week chemo
- Course 2 = 4 week chemo
- Methotrexate weekly for 3 weeks
- Either 4 cycles of chemo followed by maintenance chemo
OR - Stem cell transplant
- Decision based on each individual patient, and their repsonse to treatment
- Treatment lasts between about 3 and 5 years
What are the stages of chemotherapy in leukaemia?
- Induction: clear blood of leukaemia cells, reduce number of blast cells in the bone marrow to normal
- Consolidation: Given after induction recovery, kills remaining (undetectable leukaemia cells)
- Maintenance: long term and low dose, not used for all leaukaemia types, common in ALL
What Chemo drugs are used in AML?
- Cytarabine (cytosine arabinoside or ara-C)
- Anthracycline Drugs
- Daunorubivin (daunomycin), idarubicin, mitoxantrone
What Chemo drugs are used in ALL?
Vincristine
Dexamethasone or prednisone
Anthracycline drugs
Doxorubicin (Adriamycin) or daunorubicin etc.
What Chemo drugs are used in maintenance?
Methotrexate
6-mercaptopurine (6-MP)
Possibly additional vincristine and prednisone
What is Pegaspargase?
- Used as combination therapy
- recommended for use in children, young people and adults
- enzyme derived from e-coli, an asparaginase
- asparagine = amino acid which synthesises proteins, malignant cells cannot produce it.
- Asparagine is essential for cell growth and survival
What are the types of stem cell transplant?
-Autologous stem cell transplant
Stem cells harvested from the patient are given back after conditioning regimen of high dose chemotherapy and/or RT
-Allogeneic stem cell transplant:
Same procedure but uses matching donor (relative, unrelated individual, or saved umbilical cord blood)
Needs a successful human leukocyte antigens (HLA) test
Preferable as donor cells non-malignant but hard to match to donors
What is TBI?
- Total body irradiation
- can help reduce chance of a transplant rejection
- can kill cancer cells in the body
- Side effects: nausea, diarrhoea, fatigue, mouth sores, skin changes and IMMUNOSUPPRESSION
- Lungs can be shielded to reduce long term issues and to even out the dose
What infection control methods are important for TBI treatment?
- protective isolation
- room sterilisation
- clean air
- clean food
- purified water
- removal of plants
- hand washing
- masks to be worn
- Sealed room
- 1 visitor a day, written instructions, stay 1m apart, face mask and a gown
How is acute leukaemia Palliation managed?
- Low dose chemo, based on previous responses
- Outpatient based care
- Supportive care, blood transfusions and symptom management
What is CLL?
- Chronic leukaemia
- Age related, 40% in 70+ year olds
- 3800 new CLL cases in the UK per day
How is CLL staged?
- Binet system
- Stage A, fewer than 3 groups of enlarged lymph nodes and a high WBC count
- Stage B - more than 3 groups of enlarged lymph nodes and a high WBC count
- Stage C - enlarged lymph nodes or spleen, high WBC count, low RBC or platelet count
How is CLL managed?
- watchful waiting
- fast developing disease (chemo)
- lymphandenopathy (RT)
- Splenomegaly (surgery or RT)
- Bone marrow transplant is rare but is sometimes used as an intensive option, in low risk, younger patients
How is splenomegaly treated with RT?
- Low dose
- 0.5Gy daily fractions to total dose of 6-10Gy
- Dose can be repeated if needed
- Indicated if unsuitable for surgery
