Leukemia Treatment and Multisystem Effects
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Which of the following is NOT a treatment method for leukemia?

  • Targeted therapy
  • Chemotherapy
  • Bone marrow transplantation
  • Radiofrequency ablation (correct)

    • Long-term remission is more often achieved in adults with acute leukemia compared to children.

    False

    What is the purpose of induction chemotherapy?

    To induce a remission

    Consolidation chemotherapy is used to sustain the ______.

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

    Match the leukemia treatment with its purpose:

    <p>Chemotherapy = Relieving symptoms and inducing remission Targeted therapy = Targeting specific cancer cells Radiation therapy = Reducing tumor size Stem cell transplantation = Providing healthy cells for recovery</p> Signup and view all the answers

    What commonly develops within days to 6 months following a transplant?

    <p>Acute GVHD</p> Signup and view all the answers

    GVHD can only develop in patients who receive allogeneic BMT or SCT.

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

    Name one common symptom of acute GVHD.

    <p>Pruritic rash</p> Signup and view all the answers

    Chronic GVHD develops more than ______ months after a transplant.

    <p>3</p> Signup and view all the answers

    Which agent is used as a BCL-2 inhibitor in the treatment of acute myeloid leukemia?

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

    Antibiotics and corticosteroids are used as initial treatments for GVHD.

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

    What does AML stand for in the context of leukemia?

    <p>Acute Myeloid Leukemia</p> Signup and view all the answers

    In chronic lymphocytic leukemia (CLL), the monoclonal antibody used is ______.

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

    Which of the following is a targeted therapy in chronic myeloid leukemia (CML)?

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

    Chronic GVHD is marked by symptoms that can persist throughout a patient's life.

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

    What type of agent is Cytarabine considered in the context of leukemia treatment?

    <p>Antimetabolite agent</p> Signup and view all the answers

    Match each type of leukemia with its primary treatment agents:

    <p>Acute Myeloid Leukemia = Cyclophosphamide, Cytarabine, Daunorubicin Chronic Myeloid Leukemia = Imatinib, Nilotinib Acute Lymphocytic Leukemia = Vincristine, Asparaginase Chronic Lymphocytic Leukemia = Rituximab, Fludarabine</p> Signup and view all the answers

    Vincristine is classified as a ______ alkaloid.

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

    Which type of leukemia is characterized by the presence of myeloblasts?

    <p>Acute Myeloid Leukemia</p> Signup and view all the answers

    Platelet count is typically high in acute lymphocytic leukemia.

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

    What are the two types of bone marrow transplant mentioned?

    <p>Allogeneic and Autologous</p> Signup and view all the answers

    In leukemia, patients may experience ___________ due to a low platelet count.

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

    Match the forms of leukemia with their key characteristics:

    <p>Acute Myeloid Leukemia = Low platelets, myeloblasts present Chronic Myeloid Leukemia = Increased WBCs, low platelets late Acute Lymphocytic Leukemia = Lymphoblasts present Chronic Lymphocytic Leukemia = Increased lymphocytes, normal neutrophils</p> Signup and view all the answers

    What potential complication arises from renal issues in leukemia patients?

    <p>Renal insufficiency or failure</p> Signup and view all the answers

    Bone marrow transplantation is not recommended after chemotherapy.

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

    What is a common respiratory symptom associated with leukemia?

    <p>Dyspnea on exertion</p> Signup and view all the answers

    The ___________ is a common diagnostic test used to evaluate blood cell counts in leukemia.

    <p>CBC with differential</p> Signup and view all the answers

    Which of the following is a gastrointestinal symptom associated with leukemia?

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

    Chronic Lymphocytic Leukemia typically presents with low levels of lymphocytes.

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

    What is a potential complication of autologous bone marrow transplant?

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

    Patients with leukemia may experience __________ due to metabolic processes.

    <p>weight loss</p> Signup and view all the answers

    Which type of transplant involves the patient's own bone marrow?

    <p>Autologous bone marrow transplant</p> Signup and view all the answers

    What is the primary purpose of the induction phase in chemotherapy for leukemia?

    <p>To eradicate leukemic cells from the bone marrow</p> Signup and view all the answers

    Tumor lysis syndrome is a risk associated with initial treatment for leukemia.

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

    What does postremission chemotherapy aim to achieve?

    <p>Eradicate remaining leukemic cells, prevent relapse, and prolong survival.</p> Signup and view all the answers

    Interferons are known to moderate the body's response to ______ cells.

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

    Match the following biological therapies with their mechanisms of action:

    <p>Filgrastim = Stimulates immature neutrophil division Blinatumomab = Targets CD19 on malignant cells Interferon alfa = Inhibits abnormal cell proliferation Tisagenlecleucel = Targets CD19 on T cells</p> Signup and view all the answers

    Which of the following effects is NOT commonly associated with interferon therapy?

    <p>Enhanced physical strength</p> Signup and view all the answers

    The degree of bone marrow suppression is unaffected by drug dose.

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

    What is the role of colony-stimulating factors like filgrastim during induction chemotherapy?

    <p>They stimulate the production and activation of neutrophils.</p> Signup and view all the answers

    Cytokine release syndrome is a potential reaction to ______ during treatment.

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

    Match the following side effects with the corresponding biological therapy:

    <p>Filgrastim = Respiratory distress Sargramostim = First-dose reactions Interferon alfa = Neuropsychiatric disorders Blinatumomab = Cytokine release syndrome</p> Signup and view all the answers

    Which of the following factors can influence the degree of bone marrow suppression?

    <p>All of the above</p> Signup and view all the answers

    Interferons are primarily used to stimulate red blood cell production.

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

    What complication should be monitored in patients receiving blinatumomab?

    <p>Symptoms of cytokine release syndrome.</p> Signup and view all the answers

    Increased risk of infection is associated with the use of ______.

    <p>colony-stimulating factors</p> Signup and view all the answers

    Which agent is known for targeting CD19 in leukemia treatment?

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

    Which drug is used to target the CD22 antigen in Acute Lymphoblastic Leukemia (ALL)?

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

    Gemtuzumab is used for treating Chronic Lymphocytic Leukemia (CLL).

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

    What is a key symptom to monitor for when using FLT3 inhibitors?

    <p>Pulmonary toxicity</p> Signup and view all the answers

    Alemtuzumab binds to the ______ antigen on the surface of B and T cells.

    <p>CD52</p> Signup and view all the answers

    Match the drug to its associated effect:

    <p>Obinutuzumab = Anti-CD20 monoclonal antibody Rituximab = Prevents activation of lymphoma cells FLT3 inhibitors = Induces cell death in leukemic cells Colony-stimulating factors = Supports neutrophil maturation</p> Signup and view all the answers

    Which symptom is associated with veno-occlusive disease?

    <p>Rapid weight gain</p> Signup and view all the answers

    Radiation therapy damages cellular DNA but does not prevent cell division.

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

    What is a common side effect of therapy with colony-stimulating factors?

    <p>Bone pain</p> Signup and view all the answers

    Rituximab binds to the CD20 antigen on the surface of ______ cells.

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

    Which FLT3 inhibitor is used to treat Acute Myeloid Leukemia (AML)?

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

    Patients receiving alemtuzumab should be monitored for symptoms of hypokalemia.

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

    What should patients receiving obinutuzumab notify their healthcare provider about?

    <p>Neurologic symptoms</p> Signup and view all the answers

    GM-CSF and G-CSF are types of ______ used to rescue the bone marrow.

    <p>colony-stimulating factors</p> Signup and view all the answers

    Match the condition with its relevant symptoms:

    <p>Hypersensitivity reaction = Difficulty breathing Tumor lysis syndrome = Acute renal failure Progressive multifocal leukoencephalopathy (PML) = Visual disturbances Infusion reaction = Fever and chills</p> Signup and view all the answers

    Study Notes

    Leukemia Treatment

    • Treatment focuses on symptom relief and achieving remission or cure.
    • Common treatment methods include chemotherapy, targeted therapy, radiation therapy, and bone marrow/stem cell transplantation.
    • Induction chemotherapy aims to induce remission, while consolidation chemotherapy sustains it
    • Children with acute leukemia have a higher cure rate compared to adults, though long-term remission is achievable for both.

    Multisystem Effects

    • Neurologic
      • Headache, altered level of consciousness (LOC), cranial nerve impairment, potential complications: subarachnoid and retinal hemorrhages, seizures, coma
    • Respiratory
      • Dyspnea on exertion, pharyngitis, sore throat, frequent respiratory infections, potential complication: pulmonary bleeding
    • Gastrointestinal
      • Anorexia, nausea, oral ulcerations/infections, bleeding gums, gingival hyperplasia, abdominal pain, hepatomegaly, occult GI bleeding
    • Urinary
      • Urinary tract infection, hematuria, potential complication: renal insufficiency or failure
    • Musculoskeletal
      • Weakness, bone tenderness/pain, joint pain
    • Metabolic Processes
      • Malaise, lethargy, heat intolerance, diaphoresis, chills, fever, night sweats, weight loss
    • Cardiovascular
      • Tachycardia, palpitations, orthostatic hypotension, heart murmurs, hematomas, edema, potential complications: hemorrhage, thrombophlebitis
    • Hematologic
      • Anemia, thrombocytopenia, leukopenia, bleeding (epistaxis), splenomegaly, potential complication: disseminated intravascular coagulation (DIC)
    • Immunologic
      • Frequent or recurrent infections, lymphadenopathy, potential complications: abscesses, septicemia
    • Integumentary
      • Skin and mucous membrane pallor, petechiae, bruising/purpura, ulcerations, chloromas (skin infiltrations near bony prominences)

    Diagnostic Tests

    • Complete blood count with differential (CBC with diff): evaluates cell counts (RBCs, WBCs, platelets), hemoglobin and hematocrit levels, and morphology of WBCs.
    • Platelet count: identifies possible thrombocytopenia and bleeding risk.
    • Bone marrow examination: provides information about marrow cells, erythropoiesis, and maturity of erythro- and leukopoietic cells.

    Surgical Procedures

    • Bone marrow transplant (BMT)
      • Treatment of choice for certain leukemia types.
      • Often used with or after chemotherapy or radiation.
      • Allogeneic BMT uses donor bone marrow, ideally from a sibling with closely matched tissue antigens or an unrelated donor.
      • Requires high-dose chemotherapy and potentially total body irradiation to destroy leukemic cells.
      • Donor bone marrow is aspirated and infused through a central venous line.
      • Post BMT, the patient is critically ill and at high risk for infections and bleeding due to WBC and platelet depletion.
      • Autologous BMT utilizes the patient's own bone marrow, often stored during remission, to restore bone marrow function after treatment.
      • Involves aspirating and freezing bone marrow, then thawing it and infusing it intravenously with antibiotics and steroids after high-dose chemotherapy or radiation.
    • Stem Cell Transplant (SCT)
      • Alternative to BMT, resulting in complete replacement of the recipient's blood cell lines with donor stem cell-derived cells.
      • Similar treatment as BMT beforehand.
      • Donors must have closely matched tissue antigens.
      • Hematopoietic growth factors (GM-CSF, G-CSF) are administered to the donor to increase stem cell concentration in their peripheral blood, allowing for stem cell harvesting and transplantation.
      • Peripheral blood is collected, WBCs are separated, and infused via a central venous catheter.
      • Umbilical cord blood can also be used as a source of stem cells.

    Graft-Versus-Host Disease (GVHD)

    • A potential complication of allogeneic BMT or SCT, occurs when donor T lymphocytes attack the recipient's liver, skin, and GI tract.
    • Acute GVHD: develops within days to 6 months after transplant, characterized by a pruritic maculopapular rash and other symptoms like jaundice, nausea, vomiting, diarrhea, and dry eyes.
    • Chronic GVHD: develops over 3 months after transplant and can persist for life, accompanied by chronic pain, fatigue, weakness, and shortness of breath.
    • Treated with antibiotics and corticosteroids.

    Pharmacologic Therapy

    • Two main approaches: killing cancerous cells and altering the body's response to cancer cells.
    • Chemotherapy: cytotoxic medications given in induction and postremission phases.
    • Induction chemotherapy: high doses to eradicate leukemic cells, but can also harm stem cells and affect normal blood cell production.
    • Postremission chemotherapy: lower doses, aimed at eradicating remaining leukemic cells, preventing relapse, and prolonging survival.
    • Biological therapy: uses cytokines like interferons and interleukins, modifying the body's response to cancer cells and potentially having cytotoxic effects.
    • Interferons: proteins normally produced in response to antigens, modulating immune function and inhibiting abnormal cell proliferation.
    • Interferon alfa: used for certain leukemias, particularly chronic myeloid leukemia (CML), with common side effects like flu-like symptoms, fatigue, weight loss, muscle and joint pain.

    Medications

    • Colony-Stimulating Factors: stimulate the production and differentiation of neutrophils, aiding in recovery after chemotherapy.
    • Cytokines: modify the body's response to cancer cells, potentially causing cell lysis.
    • Drug Antibody Conjugates: target specific antigens on tumor cells, delivering cytotoxic agents to cause cell death.
    • FLT3 Inhibitors: target the FLT3 protein involved in cell proliferation, inhibiting signaling and inducing cell death in leukemic cells.

    Monoclonal Antibodies

    • Alemtuzumab: Targets CD52 antigen on B and T cells, leading to cell death in chronic lymphocytic leukemia (CLL).
    • Obinutuzumab: Targets CD20 antigen on premature and mature B cells, resulting in cell death and depletion in CLL.
    • Ofatumumab: Binds to CD20 to cause cell death in CLL.
    • Rituximab: Binds to CD20 antigen on lymphoma cells, preventing cell cycle activation and resulting in cell death in CLL.

    Monitoring

    • General: CBC, liver and renal function tests, infusion reactions, cardiovascular status
    • Alemtuzumab: Stroke symptoms (neck pain, weakness, facial droop), infection, immune thrombocytopenia, progressive multifocal leukoencephalopathy (PML), depression, suicide ideation
    • Obinutuzumab: Tumor lysis syndrome, infection, hepatitis, new neurologic symptoms
    • Rituximab: Stroke symptoms, infection, neutropenia, tumor lysis syndrome, PML, hypersensitivity reactions

    Patient Advice

    • Alemtuzumab: Report neutropenia (bleeding, easy bruising), infusion reactions, infection, thyroid disorder, stroke, PML, depression, suicide ideation
    • Obinutuzumab: Report infusion reaction, tumor lysis syndrome, infection, hepatitis, new neurologic symptoms
    • Rituximab: Report infection, neutropenia, tumor lysis syndrome, PML, hypersensitivity reactions

    Biological Response Modifiers (Colony-Stimulating Factors)

    • Stimulate bone marrow recovery following chemotherapy
    • Examples: granulocyte-macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF)
    • Side effects: bone pain, fever, chills, anorexia, muscle aches, lethargy

    Radiation Therapy

    • Uses high doses of x-rays or other energy to damage cellular DNA, preventing cell division and multiplication.
    • Targets rapidly dividing cells (e.g., bone marrow, cancer cells).
    • Normal cells recover better from radiation damage than cancer cells.

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    Description

    This quiz covers the treatment strategies for leukemia including chemotherapy, targeted therapy, and stem cell transplantation. It also explores the multisystem effects of leukemia on neurologic, respiratory, gastrointestinal, and urinary functions. Test your knowledge on symptom management and the complexities of leukemia treatments.

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