CLL and AML in Older Adults
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Questions and Answers

What is the median age of onset for Chronic Lymphocytic Leukemia (CLL)?

  • 65 years
  • 70 years (correct)
  • 60 years
  • 75 years
  • Acute Myeloid Leukemia (AML) has a higher 5-year survival rate compared to Chronic Lymphocytic Leukemia (CLL).

    False

    What initial treatment is commonly used for Chronic Lymphocytic Leukemia (CLL)?

    Ibrutinib

    Older adults diagnosed with __________ should undergo a Comprehensive Geriatric Assessment for personalized care.

    <p>Chronic Lymphocytic Leukemia (CLL)</p> Signup and view all the answers

    Match the following leukemia types with their prevalent median onset age:

    <p>Chronic Lymphocytic Leukemia (CLL) = 70 years Acute Myeloid Leukemia (AML) = 67 years Individual ≥ 75 years = 1/3 of AML cases Overall diagnosis = Can be asymptomatic for years</p> Signup and view all the answers

    Which of the following key symptoms might indicate a serious condition requiring further assessment?

    <p>Frequent infections</p> Signup and view all the answers

    A physical examination should include an assessment of vital signs and heart/lung sounds.

    <p>True</p> Signup and view all the answers

    Name one environmental exposure that could be concerning for a patient.

    <p>Ionizing radiation</p> Signup and view all the answers

    Symptoms such as __________, weakness, and dyspnea on exertion may require immediate medical attention.

    <p>fatigue</p> Signup and view all the answers

    Match the following symptoms or findings with their descriptions:

    <p>Bruising = A sign of potential clotting issues Night sweats = Possible indicator of infection or malignancy Pallor = May indicate anemia Occult blood = Suggests bleeding in the gastrointestinal tract</p> Signup and view all the answers

    What is the primary purpose of daily weight monitoring during treatment?

    <p>To monitor hydration and nutritional status</p> Signup and view all the answers

    Fluid monitoring is only necessary during the inpatient phase of treatment.

    <p>False</p> Signup and view all the answers

    What medication is prescribed to prevent uric acid crystallization during treatment?

    <p>Allopurinol</p> Signup and view all the answers

    Cyclophosphamide precautions include ensuring __________ mL/day fluid intake to prevent hemorrhagic cystitis.

    <p>3000</p> Signup and view all the answers

    Match the following components of multidisciplinary care with their descriptions:

    <p>Induction Therapy = Hospitalization for 3-4 weeks Consolidation Therapy = Can be administered at home Family Education = Teach safe drug administration Medication Monitoring = Track weight and infusion site</p> Signup and view all the answers

    Study Notes

    Chronic Lymphocytic Leukemia (CLL) in Older Adults

    • CLL typically affects individuals around the age of 70.
    • Diagnosis often occurs early, yet the disease can remain dormant for extended periods.
    • A Comprehensive Geriatric Assessment (CGA) is crucial for older patients (65 years or older) to tailor treatment plans.
    • Treatment commences only when symptoms of active CLL become apparent.
    • Ibrutinib, a Bruton's tyrosine kinase inhibitor, is the preferred first-line treatment.
    • Research is actively exploring combination therapeutic strategies to enhance survival rates.

    Acute Myeloid Leukemia (AML) in Older Adults

    • AML has a median onset age of 67, with roughly one-third of cases affecting individuals aged 75 and above.
    • The 5-year survival rate for AML is approximately 5% due to limited treatment options.
    • Older patients face challenges in responding to induction chemotherapy due to underlying health conditions, organ function limitations, and overall health status.
    • Venetoclax, a targeted therapy, combined with lower-dose chemotherapy has emerged as a safer and effective treatment option for older individuals with AML.

    Assessment for Potential Blood Disorders

    • Observation and Patient Interview:
      • Physical Appearance: Observe for pallor (pale skin) and visible bruising.
      • Key Symptoms: Inquire about fatigue, weakness, shortness of breath during exertion, frequent infections, sore throat, night sweats, bleeding gums, nosebleeds, and recent weight loss.
      • Environmental Exposure: Consider history of exposure to ionizing radiation (e.g., X-rays) or chemical exposures (occupational).
      • Medical History: Review prior cancer treatment and history of immune disorders.

    Physical Examination

    • Skin and Mucous Membranes: Inspect for:
      • Color changes
      • Bruising, purpura (purple spots), and petechiae (tiny red spots)
      • Ulcers, lesions, and pallor (paleness)
    • Vital Signs: Monitor vital signs including orthostatic vitals (blood pressure taken while lying down and then standing up).
    • Heart and Lung Sounds: Assess for abnormalities like murmurs, wheezes, or crackles.
    • Abdominal Examination: Look for discomfort or signs of organ enlargement.
    • Stool: Test for occult (hidden) blood.

    Multidisciplinary Care

    • Monitor and support psychosocial and emotional well-being of the patient and family.

    Induction Therapy

    • Begins in the hospital, lasting 3 to 4 weeks.
    • During hospitalization, evaluate the patient's capability to manage aspects like nutrition, sleep, medication administration, and access to psychosocial support.

    Consolidation Therapy

    • Can be administered at home using oral medications.

    Family Education

    • Instruct patients and families on safe medication administration and address identified issues.

    Medication Monitoring

    Daily Weight

    • Assess hydration and nutritional status.
    • Adjust treatment if necessary.

    Infusion Site Monitoring

    • Evaluate the site before treatment initiation and frequently during infusion.
    • Inspect for extravasation, especially with toxic agents.

    Fluid Monitoring

    • Track fluid intake and output, as well as urine specific gravity.
    • Continued negative fluid balance, reduced output, and concentrated urine can indicate dehydration and require fluid replacement.

    Cyclophosphamide Precautions

    • Monitor renal function due to potential for hemorrhagic cystitis, a side effect of this drug.
    • Administer fluids prior to infusion.
    • Ensure a daily intake of 3000 mL to prevent hemorrhagic cystitis and promote uric acid excretion.

    Allopurinol Administration

    • Prescribed to prevent uric acid crystallization.

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    Description

    This quiz covers the key aspects of Chronic Lymphocytic Leukemia (CLL) and Acute Myeloid Leukemia (AML) in older adults. Learn about the age-related onset, diagnostic considerations, treatment options, and challenges faced by this patient population. Understand the importance of tailored treatment plans and ongoing research in improving survival rates.

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