Leukemia Management PDF

**Chapter 30: Management of Patients with Hematologic Neoplasms** **Leukemia,** pg 2607 figure 30-1 - **Acute Myeloid Leukemia (AML)**, pg 2609 - Acute myeloid leukemia (AML) originates due to a series of genetic mutations in the myeloid HSC leading to clonal development o...

**Chapter 30: Management of Patients with Hematologic Neoplasms** **Leukemia,** pg 2607 figure 30-1 - **Acute Myeloid Leukemia (AML)**, pg 2609 - Acute myeloid leukemia (AML) originates due to a series of genetic mutations in the myeloid HSC leading to clonal development of abnormal blast cells - AML affects the blood and bone marrow. It is characterized by the rapid proliferation of abnormal myeloid cells, which are a type of WBC that normally help fight infection - **As these blast cells (immature leukocytes) continue to proliferate, they crowd out the normal bone marrow production leading to anemia, thrombocytopenic and either low or elevated WBC counts** - Patho: Defect in stem cell that differentiate into all myeloid cells: monocytes, granulocytes, erythrocytes, & platelets i. Most common is nonlymphocytic leukemia - Prognosis highly variable - Symptoms from abnormal blood cell counts ii. s/s: fever, weight loss, neutropenia, petechiae, weakness, fatigue, bleeding tendencies, pain from enlarged liver or spleen, hyperplasia/overgrowth of gums, & bone pain - Labs: CBC and bone marrow analysis (which shows an excess number of blast cells) - **Tx: Induction, consolidation, supportive therapies, aggressive chemotherapy, hematopoietic stem cell transplantation (HSCT)** iii. Supportive care may be the only option, antimicrobial therapy & transfusion, death occurs w/in months - Complications: bleeding and infection (which are the major causes of death in these pts) - **Chronic Myeloid Leukemia (CML)** pg. 2617 - Patho: Mutation in myeloid stem cell w/ uncontrolled proliferation of cells (Philadelphia chromosome) - CML affects the blood and bone marrow. It is characterized by the rapid proliferation of abnormal myeloid cells, which are a type of WBC that normally help fight infection but unlike AML, CML progresses more slowly and is divided into three stages iv. Stages: 1. Chronic phase: few s/s & not be affected by disease 2. Transformational phase: slow or very rapid; marks evolution into acute stage 3. Blast crisis: most advanced; show s/s of acute myeloid then chronic - S/sx: weight loss, malaise, confusion or shortness of breath, enlarged/tender spleen or enlarged liver - **Medical management:** v. Goal is to keep dz in acute remission or keeping pt in chronic phase for as long as possible vi. Oral tyrosine kinase inhibitors (TKIs): the use of tyrosine kinase inhibitors (TKIs) has significantly improved treatment and long-term survival for patients with CML - **Nursing management**: it is extremely important for the nurse to educate the patient about the medication regimen, how to manage side effects, drug interactions, and safe handling - **Treatment: imatinib mesylate (Gleevec)** which blocks signals in leukemic cells that express BCR-ABL protein, chemo & HSCT - **Acute Lymphocytic Leukemia (ALL)** - Uncontrolled proliferation of immature cells/lymphoblasts from lymphoid stem cell - Most common in young children, boys more often than girls, & peaks @ 4 years old - Prognosis is good for children; 85% for 3-year event-free survival but drops w/ increased age \< 45% adults - **S/sx:** anemia, pallor, fatigue, weakness, DOE, pain from enlarged liver/spleen, dizziness, petechiae, ecchymosis, lymphadenopathy, and splenomegaly is rare - Tx: chemotherapy, HSCT, monoclonal antibody therapy, corticosteroids - **Chronic Lymphocytic Leukemia (CLL) (MC leukemia in adults) "A-accumulation, B-symptoms, C-chronic"** - **Patho: Accumulation of abnormal B lymphocytes in the bone, blood, and lymph nodes** - **Slow progression** - **KNOW Chart 30-1 risk factors:** vii. - - - - - - - Tx varies depending on pt and stage viii. Early: watch weight ix. Late: IVIG, chemo agents, HSCT **Nursing Process for Acute Leukemia** - Assessment: family hx, weight loss, bleeding, loss of appetite - Interventions: Managing infection and bleeding - Managing mucositis x. Artificial saliva, mouth moisturizer - Improving nutritional intake. Easing pain - Labs: cultures as needed before antibiotics - Interventions - Decreasing fatigue and activity intolerance. Maintaining F&E balance - Improving self-care. Managing anxiety and grief. Encourage spiritual well-being **Malignant lymphomas:** **Hodgkin's Lymphoma pg. 2656** - - - xi. Stage 1: localized, single lymph node region xii. Stage 2: 2 or more lymph node regions on same side of diaphragm xiii. Stage 3: 2 or more lymph node regions above & below diaphragm xiv. Stage 4: widespread dz; multiple organs w/ or w/out lymph node involvement - - - - - - - xv. Lymphadenopathy and B symptoms, weight loss, fatigue, weakness, fever - - - xvi. It is extremely important for the nurse to know the specific disease type, stage of disease, treatment history, and current treatment plan - - Pancytopenia w/ radiation therapy and/or chemo - N/V w/ RT and/or chemo. Skin problems w/ RT - Constipation or diarrhea w/ RT adn/or chemo - Impaired liver function w/ mets - Sterility for males - Secondary cancer development **Multiple Myeloma** - - - - xvii. Age: rarely occurs in those less than 35 years of age; risks increase with increasing age xviii. African Americans have twice the risk of Whites xix. Exposure to radiation, petroleum products, benzenes, and Agent Orange xx. Family history, particularly among first-degree relatives (e.g., siblings, parents) xxi. Men have slightly higher risks than women xxii. Overweight or obesity - xxiii. **HyperCalcemia (\>11.5 mg/dL):** (which can cause Thirst, Constipation, Confusion and can lead to coma) xxiv. **Renal insufficiency** (creatinine \>2 mg/dL or creatinine clearance of less than 40 mL/min) xxv. **Anemia** (hemoglobin less than 10 g/dL or 2 g/dL less than normal) xxvi. The presence of **Bony lesions/bone destruction**. xxvii. Other s/s: Bone pain, Spinal fractures/compression, Leukopenia, Thrombocytopenia, Kidney Damage, death xxviii. **Nursing note: Any older adult whose chief complaint is back pain and who has an elevated total protein level should be evaluated for possible multiple myeloma.** - - - - - -