Term
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Definition
| No disease can be detected |
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Term
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Definition
| combination chemotherapy of chemotherapy drug regime started @ beginning of diagnosis |
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Term
| Benefits of combination chemotherapy |
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Definition
Decreases drug resistance
Decreases drug toxicity (less drug/safer)
Interrupts cellular growth @ different phases by using different mech. of action in each drug. |
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Term
| Goal of drug therapy in Phase 1? |
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Definition
| To achieve rapid and complete remission |
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Term
| What is the name of Phase 2 in treatment of AML? When does it start and what is the goal? |
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Definition
| Consolidation is the name of Phase 2. It begins early in remission and the intent is to CURE! It can be a single course of treatment or repeated courses. |
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Term
| What is the goal of consolidation? When does this phase of treatment begin? |
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Definition
| It starts early in remission and is necessary to eliminate non-detected disease and prevent relapse...to achieve a cure! |
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Term
| What is Phase 3 of AML therapy called? What is the goal and when is it prescribed? |
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Definition
| Phase 3 is called Maintenance Therapy. The goal=maintain remission. It can be prescribe months to years after successful induction and consolidation. |
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Term
| What are the names of all three phases of AML treatment? |
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Definition
Phase 1-Induction Phase 2-Consolidation
Phase 3-Maintenance |
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Term
| What is the percentage of relapse of AML? |
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Definition
| 70-80% of patients experience relapse. Only 20-30% enjoy long-term disease-free survival. |
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Term
| What is the next step if relapse of AML occurs? |
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Definition
| The only curative therapy is Bone Marrow transplant and the last option is clinical trials. |
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Term
| What lab data would you expect to see if someone has AML? |
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Definition
| low H & H, too high WBC, low platelets |
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Term
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Definition
| It is the first malignancy to have a clear link to a genetic abnormality - Philadelphia Chromosome |
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Term
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Definition
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Term
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Definition
| CML is diagnosed through the detection of the Philadelphia chromosome. NOT ENOUGH to just do bone marrow biopsy. |
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Term
| Myeloid cells produce what kind of cells? |
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Definition
| Myeloid cells produce white blood cells. |
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Term
| Where is bone marrow usually harvested? |
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Definition
| sternum, anterior or more commonly posterior iliac crest. |
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Term
| Where can a bone marrow biopsy be done? Is it in the OR, outpatient...? |
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Definition
| It can be done bedside or in a doctor's office. Need to pre-medicate for pain. |
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Term
| What age is most common to find CML? |
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Definition
| Most common among middle aged and elderly adults. |
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Term
| How is CML usually discovered. What are symptoms that lead to discovery? |
|
Definition
| Often asymptomatic. Usually suspected with elevated WBC's on a routine CBC lab. |
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Term
| What is the prognosis rate for CML? |
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Definition
| 37% 5 year prognosis rate |
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Term
| What are the 3 phases of CML? |
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Definition
| 1) Chronic phase, 2) Accelerated phase 3) Blast crisis phase |
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Term
| Details about 1)Chronic phase of CML |
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Definition
| Approx 85% of patients with CML are in this phase at the time of diagnosis. It is usually asymptomatic (mild symptoms possible include mild fatigue or abdominal fullness) Duration of phase is varied and depends on time of diagnosis & therapies used. |
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Term
| Details of Accelerated phase of CML (per World Health Organization) |
|
Definition
10-19% myeloblasts in blood or marrow. >20% basophils in blood or marrow
Plt count <100,000 unrelated to therapy
Plt count >1,000,000 unresponsive to therapy NEW abnormalities in ADDITION to the Philadelphia chromosome. Increasing splenomegaly or WBC count, unresponsive to therapy. |
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Term
| Blast crisis phase of CML info |
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Definition
| Final phase of CML. Acts like acute leuk. w/rapid progression & short survival. Very high mortality rate "croaking zone" |
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Term
|
Definition
Treated with inhibitors of tyrosine kinease. First one=GLEEVEC, another=Hydrea
another=Interferon alpha |
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Term
| What is the first drug of choice to use with CML? |
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Definition
| GLEEVEC (tyrosine kinease) turns off Philadelphia chromosome, tolerated well. Take w/lots of water, few side effects. |
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Term
| How does Hydrea work to treat CML? |
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Definition
| Hydrea (hydroxyurea) inhibits DNA synthesis. It TEMPORARILY reduces the WBC count. |
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Term
| Details about Interferon Alpha in treatment for CML? |
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Definition
| reduces the growth and division of leukemic cells. Limited use d/t side effect. Feels like you have BAD FLU constantly The mech. of action is unknown. |
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Term
| Nursing assessment for leukemic patients details (re: tendency to bleed) What would you see? |
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Definition
| Petechiae, nose bleed, gums bleeding spontaneously, ecchymosis |
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Term
| Nursing assessment for leukemic patients r/t anemia |
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Definition
| -non-healing skin abrasions, fatigue, pallor, headache, dyspnea, pain in joints |
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Term
| Nursing assessment for leukemic patients infection. |
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Definition
| Fever, tachycardia, poor healing, swollen lymph nodes, night sweats. |
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Term
| Nursing assessment for leukemic patients r/t GI distress |
|
Definition
| diarrhea, abdominal pain, anorexia, oral lesions, thrush, hepatomegaly & splenomegaly |
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Term
| What point to you need to remember concerning fever and leukemia? |
|
Definition
| Fever is not always present with infection so be sure to do a thorough assessment. |
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Term
| When is a bone marrow transplantation done? What is the goal? |
|
Definition
| It is done for pt. in remission after induction therapy. The goal - get rid of pt. marrow and replace with healthy marrow w/o leukemic cells. |
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Term
| What is the site of production of leukemic cells? |
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Definition
| Bone marrow is the actual site of production of leukemic cells. |
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Term
| Besides leukemis, when else is bone marrow transplantation used? |
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Definition
| It is also used to treat lymphoma, aplastic anemia, sickle cell disease, and many solid tumors. |
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Term
| What is the name of the antigen that must match for a bone marrow transplant to be successful? |
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Definition
| HLA = human leukocyte antigen. This is a collection of antigens and are specific to each person. |
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Term
| If there is not a match of HLA, what happens to the recipient of the bone marrow? |
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Definition
| The body will attack the cells. The transplant will fail and w/o another good transplant, the patient dies. |
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Term
| What are the 5 phases of the allogenic transplant process? |
|
Definition
| 1) collection 2) processing 3) crypreservation 4)chemotherapy 5) Infusion |
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Term
| Explain the Collection phase of the allogenic transplant process |
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Definition
| Stem cells are collected from the patient's bone marrow or blood. |
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Term
| Explain the processing phase of the allogenic transplant process. |
|
Definition
| BM or periferal blood to lab, concentrated and prepped for freezing phase. |
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Term
| Explain the cryopreservation phase of the allogenic transplant process. |
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Definition
| BM or blood is frozen (cyropreservation) to keep stem cells alive until they are infused into the pts. bloodstream. |
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Term
| Explain the chemotherapy phase of the allogenic transplant process. |
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Definition
| High dose chemotherapy and/or radiation therapy is given to the patient. |
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Term
| Explain the infusion phase of the allogenic transplant process. |
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Definition
| Thawed stem cells are infused into the patient. |
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Term
|
Definition
| CML related triad of symptoms...elevated calcium levels, renal failure, anemia & bone lesions. |
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|
Term
|
Definition
| GHI Gleevec as it targets Philadelphia chomosome & stops it Hydrea as it inhibits DNA synthesis Interferon Alpha as it inhibits growth and division of leukemic cells. |
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|
Term
| defining characteristic of AML |
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Definition
| Acute myeloid leukemia...most common leuk. in adults, highest remission rate of cancers, immature and high # of WBC (blast cells) |
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