CLL and AML in Older Adults

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.