Term
| What tissues are likely to be affected by leukemia? |
|
Definition
| Highly vascularized organs: liver, spleen, lymph, bone marrow |
|
|
Term
| What are some S/S of leukemia? |
|
Definition
profound anemia
infection with left shift (increase in
immature neutrophils)
bleeding (petechiae anywhere that clothing
tight) |
|
|
Term
| What is the pathophysiology of leukemia? |
|
Definition
| Unrestricted proliferation of immature WBCs that act like a "circulating tumor" and can send out "fingers" into different organ systems and then compete for metabolic elements causing destruction to tissue around it. |
|
|
Term
| With leukemia, what would you see in a complete WBC count? |
|
Definition
| Leukocytosis (increased WBC count >10,000) with very low percentage of mature WBCs |
|
|
Term
| What is the end result of leukemic invasion of spleen, liver, and lypmph glands? |
|
Definition
| hepatosplenomegaly and fibrosis |
|
|
Term
What is a possible cause of pathological fractures?
How? |
|
Definition
Leukemia
Invading leukemic cells into bone marrow causes weakening |
|
|
Term
What is the chemotherapy Tx for acute lymphoid leukemia?
What is the goal? |
|
Definition
4-6 weeks
corticosteroids, vincristine, L-aspariginase and maybe doxorubicin
goal: remission or decrease cells to 5% |
|
|
Term
| What is the chemotherapy Tx for AML (ANLL)? |
|
Definition
|
|
Term
| What are 3 Tx's for leukemia? |
|
Definition
chemotherapy
steroids
hematopoietic stem cell transplantation (bone marrow transplant) |
|
|
Term
| What are the 3-5 phases of chemotherapy for leukemia? |
|
Definition
1)Induction therapy lasts 4-6 wks. Goal is to put into remission or decrease cells to 5%
2)Intesification therapy: after remission, Tx is intensified to eradicate remaining leukemic cells
3)Maintenance: daily and weekly IV,IM, and intrathecal meds for 2 yrs
4)Possible CNS prophylactic therapy
5)Possible relapse induction |
|
|
Term
| Why are steroids part of Leukemia Tx? |
|
Definition
stop bone marrow from producing WBCs
counteract inflammation from chemo |
|
|
Term
| What therapy is only for high risk leukemia Pts? Explain. |
|
Definition
CNS prophylactic therapy:
intrathecal methotraxate and cytarabine
*injected into spinal column so X's blood-brain barrier for pts who have plaques in CSF or brain
*it can kill Pts, so needs lots of checks |
|
|
Term
| Who must be in the room during CNS prophylactic therapy for leukemia Pts? |
|
Definition
| If the parent cannot handle being in the room, a play therapist or someone the child trusts must be there to help/hold hand/distract child |
|
|
Term
| What factors would indicate a better prognosis in a leukemia Pt? |
|
Definition
*Normal or low initial WBC count
*Onset at 2-9 yrs rather than before 2 or after 10
*female
*DNA index >1.16 and translocation of chromosomes 4 and 10 |
|
|
Term
| What are chemotherapy drugs? |
|
Definition
| antimetabolites that affect fast proliferating cells such as hair, nail, GI, bone marrow cells |
|
|
Term
| What are some relatively immediate side effects of chemotherapy? |
|
Definition
| alopecia, sores in GI tract from mouth to anus, GI bleeds, gastric pain, vomiting blood, lines on nails |
|
|
Term
| What pain medication is needed to deal with the side effects of chemotherapy? |
|
Definition
|
|
Term
|
Definition
| Period of 7-12 days after chemotherapy when there is pancytopenia (wiped-out bone marrow) and sometimes no WBCs which means the chemo is working. |
|
|
Term
| What are some late side-effects of cancer Tx? |
|
Definition
*anthracycline causes *chemo and radiation effect all organs negatively (e.g. brain growth effected and interferes in cognitive development)
*secondary malignancy-lymphoma
*cranial radiation before 5:risk malignant brain tumor cardiomyopathy
*intrathecal chemo->cognitive delays |
|
|
Term
| What do parents need to be aware of during chemotherapy? |
|
Definition
*pathology
*S/S of sepsis - if worried bring in, especially duing nadar
*drugs and side effects
*when to seek emergency medical help
*how to optimize growth and development |
|
|
