Leukemia EXAM I Flashcards
- young, undifferentiated immature cells known as blast cells.
- rapid onset
- rapid disease progression
- requires immediate aggressive treatment
acute leukemia
- more mature cells, well differentiated (still function and look like parent cell)
- onset more gradual
- prolonged course
- although cells look mature, cannot fight infection as well as normal WBCs
chronic leukemia
- diagnosed 10 times more often in adults
- men affected more often than women
- genetic disorders
- environmental risks: smoking, being exposed to gas
- previous cancer treatment (assess the duration, start and age of the start of chemo especially cyclophosphiamuab)
risk factors for leukemia
- issues with bleeding and bruising
- bone pain
- fever, headache
- oxygenation low or troubles
- anemia (fatigue, pallor, ShoB, general malaise)
- splenomegaly
clinical manifestations of leukemia
primarily affects children and young adults. leukemic cells may infiltrate the CNS. uncontrolled proliferation of lymphoblasts and hyperplasia of bone marrow/spleen. B cell ALL is better to have rather than T cell ALL. T cell stabilize and maintains the immune system. Children 1-9 have the best outcome as well as those who respond rapidly to the treatment. manifests with recurrent infections, bleeding, pallor, low grade fever, bone and joint pain, weight loss, sore throat, fatigue, night sweats, weakness, live and spleen enlargement. Treated with chemotherapy (sometimes upward to 2 years), bone marrow transplant, or stem cell transplant. treatment is based on the risk for the child.
acute lymphocytic (lymphoblastic) leukemia
primarily affects older adults. insidious onset and slow chronic course. manifests with fatigue, exercise intolerance, lymphadenopathy, and splenomegaly, recurrent infections, pallor, edema, thrombophlebitis. often requires no treatment but if there is a treatment process it would include chemotherapy and/or bone marrow transplant. alemtuzumab given for 12 weeks via IV. Rituximab (monoclonal antibody) and bendamustine (alkylating agent).
WBC >100,000 : considered crisis
WBC > 30,000 : considered
chronic lymphocytic leukemia (CLL)
common in older adults, may affect children and younger adults. strongly associated with toxins, genetic disorders, and treatment of other cancers. defined by greater than 30% blasts (normal blast count is <5%). manifested by fatigue, weakness, fever, anemia, headache, bone and joint pain, abnormal bleeding and bruising, recurrent infection, thrombocytopenia (petechiae), epistaxis (nose bleeds), lymphadenopathy, splenomegaly, and hepatomegaly. treated with chemotherapy and stem cell transplant.
Acute myeloid leukemia ( AML )
primarily affects adults. early course slow and stable, progressing to aggressive phase in 3 to 4 years. manifested by weakness, fatigue, dyspnea on exertion, possible splenomegaly. later manifestations are fever, weight loss, night sweats. treated typically treat with PO medications. with Interferon - a chemotherapy with imatinib mesylate (Gleevac) and stem cell transplant. PO medications are an indefinite treatment.
chronic myeloid leukemia (CML)
induction therapies goals it to ___ as many blastic cells as they can
kill
induction therapies goals it to ___ as many blastic cells as they can
kill
Hemoglobin less than ____ - ____ one should expect to administer blood.
7 - 8
- Antimetabolite (inhibit DNA synthesis)
- Cell-cycle specific (S phase)
- Bone marrow suppression, stomatitis, N/V, alopecia
- toxic effects: CNS, corneal, hepatotoxic
nursing care:
- teach the client about body image changes
- educate the importance of mouth care: mouthwash without alcohol, no acidic food, soft toothbrush, etc
- frequent cerebellar checks (assess and monitor speech, eyes, gait, presence of tremors, issues with fine motor skills?)
- the drug itself penetrates body fluids and it is excreted in the tears. typically artificial tears and steroid eye drops are given. imperative to be on time with eye drops.
- report blurred vision, discomfort in eyes, photosensitivity
Cytarabine (ARA - C)
given continuously for 7 days
-used to treat AML
- Cell cycle nonspecific (inhibit protein and RNA synthesis)
- Bone marrow suppression, stomatitis, N/V, alopecia
- Extravasation:
- Given for 3 days (piggyback)
- mimics doxorubicin (red urine and tears)
- toxic effects: cardiotoxicity and hepatotoxic
Daunorubicin or Idarubicin
- used to treat AML
if relapse occurs then ________ happens and then a bone marrow transplant will take place.
reinduction
Three Drug Induction
- Vincristine ( can cause peripheral neuropathy, hepatotoxic)
- Corticosteroid (Prednisone or Dexamethasone)
- L-asparaginase (can be given IV ; concern is allergic reaction to the medication)
Intrathecal Methotrexate (chemo is placed directly into the spinal space. interferes with folic acid metabolism and inhibits the cancer cell from synthesizing and reproducing.) Urine should be alkaline when taking methotrexate. often given Leukovorin as a rescue drug in conjunction with methotrexate. Can interact with NSAIDs (increases absorption), tetracyclolines (decreases absorption)
Drugs used for low risk (ALL) patients
low risk is characterized by 1-9 years old and the WBC is less than 50,000
