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.

Chronic Lymphocytic Leukemia (CLL) Signup and view all the answers

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

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 Signup and view all the answers

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

Frequent infections Signup and view all the answers

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

True Signup and view all the answers

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

Ionizing radiation Signup and view all the answers

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

fatigue Signup and view all the answers

Match the following symptoms or findings with their descriptions:

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 Signup and view all the answers

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

To monitor hydration and nutritional status Signup and view all the answers

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

False Signup and view all the answers

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

Allopurinol Signup and view all the answers

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

3000 Signup and view all the answers

Match the following components of multidisciplinary care with their descriptions:

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 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.