Leukemia Overview and Types

Leukemia Overview

• Leukemia is characterized by unregulated proliferation of leukocytes (white blood cells) in the bone marrow.
• This proliferation can impact normal cell production, and also result in the presence of cells in the liver and spleen. In acute forms, infiltration of other organs (meninges, lymph nodes, gums, skin) can occur.
• The cause is not fully understood, but risk factors include radiation exposure, chemicals, genetic disorders, and viral infections.
• Leukemia can be classified as acute or chronic, and also as lymphoid (lymphocyte-related) or myeloid (non-lymphocyte-related). The time course of symptom development and the affected cell stage help determine the acute vs chronic classification.

Acute Leukemia

• Symptoms appear abruptly within weeks.
• Leukocyte development halts at a blast phase, meaning most cells are immature and undifferentiated.
• Progression is rapid, potentially leading to death in weeks to months without treatment.
• Types include Acute Myeloid Leukemia (AML) and Acute Lymphocytic Leukemia (ALL).

Chronic Leukemia

• Symptoms develop over months to years.
• Majority of leukocytes produced are mature.
• Progression is slower, potentially lasting for years.
• Types include Chronic Myeloid Leukemia (CML) and Chronic Lymphocytic Leukemia (CLL).

Acute Myeloid Leukemia (AML)

• Arise from defects in hematopoietic stem cells differentiating into myeloid cells (monocytes, granulocytes, erythrocytes, platelets).
• Most common non-lymphocytic leukemia.
• Affects all ages infrequently before 45, with incidence peaking at age 67.
• Clinical manifestations include insufficient normal blood cell production, potentially resulting in fever, infection, weakness, fatigue, dyspnea, pallor, bleeding tendencies, bone pain, gum hyperplasia, lymphadenopathy, and/or splenomegaly (less common).
• Diagnosis uses a CBC showing decreased erythrocytes and platelets, along with a bone marrow analysis revealing >20% immature leukocytes (blasts).

Chronic Myeloid Leukemia (CML)

• Originates from a mutation in the myeloid stem cell.
• Results in an increase of blast cells, along with a wide array of cell types (from blast forms to mature neutrophils) in the blood.
• Marked proliferation leads to bone marrow expansion and extramedullary hematopoiesis (cells in organs like liver and spleen).
• Often linked to a chromosomal translocation between chromosomes 9 and 22 (Philadelphia chromosome).
• Common age at diagnosis is 64, rare in children.
• Manifestations can be asymptomatic or involve nonspecific symptoms like shortness of breath, slight confusion (due to leukostasis), tender enlarged spleen/liver, malaise, anorexia, and weight loss.
• Treated with oral tyrosine kinase inhibitors to block leukemia cell growth.

Acute Lymphocytic Leukemia (ALL)

• Originates from uncontrolled proliferation of lymphoblasts (immature lymphoid cells).
• Most prevalent in young children (peak incidence 4 years old).
• Boys affected more frequently than girls.
• Highly responsive to treatment, with high remission rates (98% in children; 85% in adults)
• Manifestation can include pain related to organ enlargement, neurological symptoms, or abdominal pain.
• Treatment involves corticosteroids, chemotherapy, and sometimes hematopoietic stem cell transplantation (HSCT).

Chronic Lymphocytic Leukemia (CLL)

• Originates from a malignant clone of B lymphocytes.
• Common in older adults (average age 72).
• Sometimes has a familial predisposition.
• Characterized by lymphocytosis (elevated lymphocyte count).
• Erythrocyte and platelet counts may be normal or low, especially in advanced stages.
• Often asymptomatic, diagnosis can be incidental.
• Manifestations can include enlarged lymph nodes (lymphadenopathy), an enlarged spleen (splenomegaly), or nonspecific symptoms like fever, night sweats and weight loss.

Nursing Considerations - Leukemia

• Risk for infection and bleeding: Crucial monitoring and intervention are vital.
• Impaired oral mucous membranes: Frequent gentle oral hygiene, saline rinses, and meticulous care are needed.
• Imbalanced nutrition: Small, frequent feedings, soft foods, and pain relief before eating aids in nutrition.
• Acute pain and discomfort: Addressing mucositis and other sources of pain is essential.
• Fatigue and activity intolerance: Addressing anemia, infection and deconditioning needs to be considered.

Complications

• Infections, bleeding, renal dysfunction, tumor lysis syndrome, nutritional depletion, mucositis, anxiety/depression are possible complications of leukemias. These require specific patient management.