Lecture Leukemia 2

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LeukemiaLeukemia

DR Ibraheem Bashayreh, RN, PhD

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Leukemia Leukemia

A group of malignant disorders affecting A group of malignant disorders affecting the blood and blood-forming tissues of the blood and blood-forming tissues of – Bone marrowBone marrow– Lymph systemLymph system– SpleenSpleen

Occurs in all age groupsOccurs in all age groups

A group of malignant disorders affecting A group of malignant disorders affecting the blood and blood-forming tissues of the blood and blood-forming tissues of – Bone marrowBone marrow– Lymph systemLymph system– SpleenSpleen

Occurs in all age groupsOccurs in all age groups

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Leukemia Leukemia

Results in an accumulation of Results in an accumulation of dysfunctional cells because of a loss of dysfunctional cells because of a loss of regulation in cell divisionregulation in cell division

Fatal if untreatedFatal if untreated

– ProgressiveProgressive

Results in an accumulation of Results in an accumulation of dysfunctional cells because of a loss of dysfunctional cells because of a loss of regulation in cell divisionregulation in cell division

Fatal if untreatedFatal if untreated

– ProgressiveProgressive

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Leukemia Leukemia

Often thought of as a childhood diseaseOften thought of as a childhood disease The number of adults affected with The number of adults affected with

leukemia is 10 times that of children leukemia is 10 times that of children

Often thought of as a childhood diseaseOften thought of as a childhood disease The number of adults affected with The number of adults affected with

leukemia is 10 times that of children leukemia is 10 times that of children

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Leukemia Leukemia Etiology and PathophysiologyEtiology and Pathophysiology No single causative agent No single causative agent Most from a combination of factorsMost from a combination of factors

– Genetic and environmental influencesGenetic and environmental influences

No single causative agent No single causative agent Most from a combination of factorsMost from a combination of factors

– Genetic and environmental influencesGenetic and environmental influences

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Leukemia Leukemia Etiology and PathophysiologyEtiology and Pathophysiology Associated with the development of leukemia Associated with the development of leukemia

– Chemical agentsChemical agents

– Chemotherapeutic agentsChemotherapeutic agents

– VirusesViruses

– Radiation Radiation

– Immunologic deficiencies Immunologic deficiencies

Associated with the development of leukemia Associated with the development of leukemia

– Chemical agentsChemical agents

– Chemotherapeutic agentsChemotherapeutic agents

– VirusesViruses

– Radiation Radiation

– Immunologic deficiencies Immunologic deficiencies

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Leukemia Leukemia ClassificationClassification Acute versus chronicAcute versus chronic

– Cell maturityCell maturity• Acute: clonal proliferation of immature Acute: clonal proliferation of immature

hematopoietic cells (hematopoietic cells (the formation of the formation of blood or blood cells )blood or blood cells )• Chronic: mature forms of WBC; onset is Chronic: mature forms of WBC; onset is

more gradual more gradual

– Nature of disease onsetNature of disease onset

Acute versus chronicAcute versus chronic

– Cell maturityCell maturity• Acute: clonal proliferation of immature Acute: clonal proliferation of immature

hematopoietic cells (hematopoietic cells (the formation of the formation of blood or blood cells )blood or blood cells )• Chronic: mature forms of WBC; onset is Chronic: mature forms of WBC; onset is

more gradual more gradual

– Nature of disease onsetNature of disease onset

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Leukemia Leukemia ClassificationClassification Type of white blood cell (WBC)Type of white blood cell (WBC)

– Acute lymphocytic leukemia (ALL)Acute lymphocytic leukemia (ALL)

– Acute myelogenous leukemia (AML)Acute myelogenous leukemia (AML)• Also called acute nonlymphoblastic Also called acute nonlymphoblastic

leukemia (ANLL)leukemia (ANLL)

– Chronic myelogenous leukemia (CML)Chronic myelogenous leukemia (CML)

– Chronic lymphocytic leukemia (CLL)Chronic lymphocytic leukemia (CLL)

Type of white blood cell (WBC)Type of white blood cell (WBC)

– Acute lymphocytic leukemia (ALL)Acute lymphocytic leukemia (ALL)

– Acute myelogenous leukemia (AML)Acute myelogenous leukemia (AML)• Also called acute nonlymphoblastic Also called acute nonlymphoblastic

leukemia (ANLL)leukemia (ANLL)

– Chronic myelogenous leukemia (CML)Chronic myelogenous leukemia (CML)

– Chronic lymphocytic leukemia (CLL)Chronic lymphocytic leukemia (CLL)

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Myelogenous Leukemia Myelogenous Leukemia

Leukemia characterized by proliferation Leukemia characterized by proliferation of myeloid tissue (as of the bone marrow of myeloid tissue (as of the bone marrow and spleen) and an abnormal increase in and spleen) and an abnormal increase in the number of granulocytes, myelocytes, the number of granulocytes, myelocytes, and myeloblasts in the circulating bloodand myeloblasts in the circulating blood

Leukemia characterized by proliferation Leukemia characterized by proliferation of myeloid tissue (as of the bone marrow of myeloid tissue (as of the bone marrow and spleen) and an abnormal increase in and spleen) and an abnormal increase in the number of granulocytes, myelocytes, the number of granulocytes, myelocytes, and myeloblasts in the circulating bloodand myeloblasts in the circulating blood

Myeloid tissue is a Myeloid tissue is a biologic tissue with the with the ability to perform ability to perform hematopoiesis. It is mainly . It is mainly found as the found as the red bone marrow in in bones, and is , and is often synonymous with this. However, myeloid often synonymous with this. However, myeloid can also be present in the can also be present in the liver and and spleen . .

A myelocyte is a young A myelocyte is a young cell of the of the granulocytic series, occurring normally in series, occurring normally in bone marrow, but , but not in circulating not in circulating blood (except when caused by (except when caused by certain diseases).certain diseases).

Myeloid tissue is a Myeloid tissue is a biologic tissue with the with the ability to perform ability to perform hematopoiesis. It is mainly . It is mainly found as the found as the red bone marrow in in bones, and is , and is often synonymous with this. However, myeloid often synonymous with this. However, myeloid can also be present in the can also be present in the liver and and spleen . .

A myelocyte is a young A myelocyte is a young cell of the of the granulocytic series, occurring normally in series, occurring normally in bone marrow, but , but not in circulating not in circulating blood (except when caused by (except when caused by certain diseases).certain diseases).

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Granulocytes are a category of Granulocytes are a category of white blood cells characterized by the characterized by the presence of granules in their cytoplasm.presence of granules in their cytoplasm.[1][1] They are also called polymorphonuclear They are also called polymorphonuclear leukocytes (PMN or PML) because of the leukocytes (PMN or PML) because of the varying shapes of the nucleus, which is varying shapes of the nucleus, which is usually lobed into three segments.usually lobed into three segments.

The myeloblast is a unipotent stem cell, The myeloblast is a unipotent stem cell, which will differentiate into one of the which will differentiate into one of the actors of the granular series.actors of the granular series.

Granulocytes are a category of Granulocytes are a category of white blood cells characterized by the characterized by the presence of granules in their cytoplasm.presence of granules in their cytoplasm.[1][1] They are also called polymorphonuclear They are also called polymorphonuclear leukocytes (PMN or PML) because of the leukocytes (PMN or PML) because of the varying shapes of the nucleus, which is varying shapes of the nucleus, which is usually lobed into three segments.usually lobed into three segments.

The myeloblast is a unipotent stem cell, The myeloblast is a unipotent stem cell, which will differentiate into one of the which will differentiate into one of the actors of the granular series.actors of the granular series.8/12/20098/12/2009 1111

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Acute Myelogenous Leukemia Acute Myelogenous Leukemia (AML)(AML) Leukemia characterized by proliferation of myeloid Leukemia characterized by proliferation of myeloid

tissue (as of the bone marrow and spleen) and an tissue (as of the bone marrow and spleen) and an abnormal increase in the number of granulocytes, abnormal increase in the number of granulocytes, myelocytes, and myeloblasts in the circulating bloodmyelocytes, and myeloblasts in the circulating blood

One fourth of all leukemiasOne fourth of all leukemias– 85% of the acute leukemias in adults85% of the acute leukemias in adults

Abrupt, dramatic onsetAbrupt, dramatic onset– Serious infections, abnormal bleedingSerious infections, abnormal bleeding

Uncontrolled proliferation of myeloblastsUncontrolled proliferation of myeloblasts– Hyperplasia of bone marrow and spleenHyperplasia of bone marrow and spleen

Leukemia characterized by proliferation of myeloid Leukemia characterized by proliferation of myeloid tissue (as of the bone marrow and spleen) and an tissue (as of the bone marrow and spleen) and an abnormal increase in the number of granulocytes, abnormal increase in the number of granulocytes, myelocytes, and myeloblasts in the circulating bloodmyelocytes, and myeloblasts in the circulating blood

One fourth of all leukemiasOne fourth of all leukemias– 85% of the acute leukemias in adults85% of the acute leukemias in adults

Abrupt, dramatic onsetAbrupt, dramatic onset– Serious infections, abnormal bleedingSerious infections, abnormal bleeding

Uncontrolled proliferation of myeloblastsUncontrolled proliferation of myeloblasts– Hyperplasia of bone marrow and spleenHyperplasia of bone marrow and spleen

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Acute Lymphocytic Leukemia Acute Lymphocytic Leukemia (ALL)(ALL) Most common type of leukemia in Most common type of leukemia in

childrenchildren 15% of acute leukemia in adults15% of acute leukemia in adults Immature lymphocytes proliferate in the Immature lymphocytes proliferate in the

bone marrowbone marrow

Most common type of leukemia in Most common type of leukemia in childrenchildren

15% of acute leukemia in adults15% of acute leukemia in adults Immature lymphocytes proliferate in the Immature lymphocytes proliferate in the

bone marrowbone marrow

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Acute Lymphocytic LeukemiaAcute Lymphocytic Leukemia

Signs and symptoms may appear Signs and symptoms may appear abruptlyabruptly

– Fever, bleedingFever, bleeding Insidious with progressiveInsidious with progressive

–Weakness, fatigue Weakness, fatigue Central nervous system manifestations Central nervous system manifestations

Signs and symptoms may appear Signs and symptoms may appear abruptlyabruptly

– Fever, bleedingFever, bleeding Insidious with progressiveInsidious with progressive

–Weakness, fatigue Weakness, fatigue Central nervous system manifestations Central nervous system manifestations

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Chronic Myelogenous Leukemia Chronic Myelogenous Leukemia (CML)(CML) Excessive development of mature Excessive development of mature

neoplastic granulocytes in the bone neoplastic granulocytes in the bone marrowmarrow

–Move into the peripheral blood in Move into the peripheral blood in massive numbersmassive numbers

– Ultimately infiltrate the liver and Ultimately infiltrate the liver and spleen spleen

Excessive development of mature Excessive development of mature neoplastic granulocytes in the bone neoplastic granulocytes in the bone marrowmarrow

–Move into the peripheral blood in Move into the peripheral blood in massive numbersmassive numbers

– Ultimately infiltrate the liver and Ultimately infiltrate the liver and spleen spleen

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Chronic Myelogenous LeukemiaChronic Myelogenous Leukemia

Philadelphia chromosomePhiladelphia chromosome

– The chromosome abnormality that The chromosome abnormality that causes chronic myeloid leukemia causes chronic myeloid leukemia (CML) (9 &22)(CML) (9 &22)

– Genetic markerGenetic marker Chronic, stable phase followed by acute, Chronic, stable phase followed by acute,

aggressive (blastic) phaseaggressive (blastic) phase

Philadelphia chromosomePhiladelphia chromosome

– The chromosome abnormality that The chromosome abnormality that causes chronic myeloid leukemia causes chronic myeloid leukemia (CML) (9 &22)(CML) (9 &22)

– Genetic markerGenetic marker Chronic, stable phase followed by acute, Chronic, stable phase followed by acute,

aggressive (blastic) phaseaggressive (blastic) phase

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Chronic Lymphocytic Leukemia Chronic Lymphocytic Leukemia (CLL)(CLL) Production and accumulation of Production and accumulation of

functionally inactive but long-lived, functionally inactive but long-lived, mature-appearing lymphocytes mature-appearing lymphocytes

B cell involvementB cell involvement Lymph node enlargement is noticeable Lymph node enlargement is noticeable

throughout the bodythroughout the body

– ↑ ↑ incidence of infection incidence of infection

Production and accumulation of Production and accumulation of functionally inactive but long-lived, functionally inactive but long-lived, mature-appearing lymphocytes mature-appearing lymphocytes

B cell involvementB cell involvement Lymph node enlargement is noticeable Lymph node enlargement is noticeable

throughout the bodythroughout the body

– ↑ ↑ incidence of infection incidence of infection

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Chronic Lymphocytic LeukemiaChronic Lymphocytic Leukemia

Complications from early-stage CLL is Complications from early-stage CLL is rarerare

–May develop as the disease advancesMay develop as the disease advances

– Pain, paralysis from enlarged lymph Pain, paralysis from enlarged lymph nodes causing pressurenodes causing pressure

Complications from early-stage CLL is Complications from early-stage CLL is rarerare

–May develop as the disease advancesMay develop as the disease advances

– Pain, paralysis from enlarged lymph Pain, paralysis from enlarged lymph nodes causing pressurenodes causing pressure

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Hairy Cell LeukemiaHairy Cell Leukemia

2% of all adult leukemias2% of all adult leukemias Usually in males > 40 years oldUsually in males > 40 years old Chronic disease of lymphoproliferation Chronic disease of lymphoproliferation

– B lymphocytes that infiltrate the bone B lymphocytes that infiltrate the bone marrow and livermarrow and liver

2% of all adult leukemias2% of all adult leukemias Usually in males > 40 years oldUsually in males > 40 years old Chronic disease of lymphoproliferation Chronic disease of lymphoproliferation

– B lymphocytes that infiltrate the bone B lymphocytes that infiltrate the bone marrow and livermarrow and liver

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Hairy Cell LeukemiaHairy Cell Leukemia

Cells have a “hairy” appearanceCells have a “hairy” appearance Symptoms fromSymptoms from– Splenomegaly, pancytopenia, infection, Splenomegaly, pancytopenia, infection,

vasculitis vasculitis TreatmentTreatment– alpha-interferon, pentostatin, alpha-interferon, pentostatin,

cladribine cladribine

Cells have a “hairy” appearanceCells have a “hairy” appearance Symptoms fromSymptoms from– Splenomegaly, pancytopenia, infection, Splenomegaly, pancytopenia, infection,

vasculitis vasculitis TreatmentTreatment– alpha-interferon, pentostatin, alpha-interferon, pentostatin,

cladribine cladribine

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Unclassified LeukemiasUnclassified Leukemias

Subtype cannot be identifiedSubtype cannot be identified Malignant leukemic cells may haveMalignant leukemic cells may have– Lymphoid, myeloid, or mixed Lymphoid, myeloid, or mixed

characteristicscharacteristics Frequently these patients do not respond Frequently these patients do not respond

well to treatmentwell to treatment– Poor prognosis Poor prognosis

Subtype cannot be identifiedSubtype cannot be identified Malignant leukemic cells may haveMalignant leukemic cells may have– Lymphoid, myeloid, or mixed Lymphoid, myeloid, or mixed

characteristicscharacteristics Frequently these patients do not respond Frequently these patients do not respond

well to treatmentwell to treatment– Poor prognosis Poor prognosis

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Leukemia Leukemia Clinical ManifestationsClinical Manifestations Relate to problems caused byRelate to problems caused by

– Bone marrow failureBone marrow failure• Overcrowding by abnormal cellsOvercrowding by abnormal cells• Inadequate production of normal marrow Inadequate production of normal marrow

elementselements• Anemia, thrombocytopenia, Anemia, thrombocytopenia, ↓ number ↓ number

and function of WBCsand function of WBCs

Relate to problems caused byRelate to problems caused by

– Bone marrow failureBone marrow failure• Overcrowding by abnormal cellsOvercrowding by abnormal cells• Inadequate production of normal marrow Inadequate production of normal marrow

elementselements• Anemia, thrombocytopenia, Anemia, thrombocytopenia, ↓ number ↓ number

and function of WBCsand function of WBCs

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Leukemia Leukemia Clinical ManifestationsClinical Manifestations Relate to problems caused byRelate to problems caused by– Leukemic cells infiltrate patient’s Leukemic cells infiltrate patient’s

organsorgans• SplenomegalySplenomegaly• HepatomegalyHepatomegaly• LymphadenopathyLymphadenopathy• Bone pain, meningeal irritation, oral Bone pain, meningeal irritation, oral

lesions (chloromas)lesions (chloromas)

Relate to problems caused byRelate to problems caused by– Leukemic cells infiltrate patient’s Leukemic cells infiltrate patient’s

organsorgans• SplenomegalySplenomegaly• HepatomegalyHepatomegaly• LymphadenopathyLymphadenopathy• Bone pain, meningeal irritation, oral Bone pain, meningeal irritation, oral

lesions (chloromas)lesions (chloromas)

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Leukemia Leukemia Diagnostic StudiesDiagnostic Studies

To diagnose and classifyTo diagnose and classify

– Peripheral blood evaluation (Peripheral blood evaluation (CBC and CBC and blood smearblood smear))

– Bone marrow evaluationBone marrow evaluation To identify cell subtype and stageTo identify cell subtype and stage

–Morphologic, histochemical, Morphologic, histochemical, immunologic, and cytogenic methodsimmunologic, and cytogenic methods

To diagnose and classifyTo diagnose and classify

– Peripheral blood evaluation (Peripheral blood evaluation (CBC and CBC and blood smearblood smear))

– Bone marrow evaluationBone marrow evaluation To identify cell subtype and stageTo identify cell subtype and stage

–Morphologic, histochemical, Morphologic, histochemical, immunologic, and cytogenic methodsimmunologic, and cytogenic methods

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Leukemia Leukemia Collaborative CareCollaborative Care Goal is to attain remissionGoal is to attain remission (when there is (when there is

no longer evidence of cancer cells in the no longer evidence of cancer cells in the body)body)

Chemotherapeutic treatmentChemotherapeutic treatment– Induction therapyInduction therapy• Attempt to induce or bring remissionAttempt to induce or bring remission• Seeks to destroy leukemic cells in the Seeks to destroy leukemic cells in the

tissues, peripheral blood, bone marrowtissues, peripheral blood, bone marrow• Patient may become critically illPatient may become critically ill– Provide psychological support as wellProvide psychological support as well

Goal is to attain remissionGoal is to attain remission (when there is (when there is no longer evidence of cancer cells in the no longer evidence of cancer cells in the body)body)

Chemotherapeutic treatmentChemotherapeutic treatment– Induction therapyInduction therapy• Attempt to induce or bring remissionAttempt to induce or bring remission• Seeks to destroy leukemic cells in the Seeks to destroy leukemic cells in the

tissues, peripheral blood, bone marrowtissues, peripheral blood, bone marrow• Patient may become critically illPatient may become critically ill– Provide psychological support as wellProvide psychological support as well

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What is remissionWhat is remission??

The main aim of treatment for acute lymphoblastic leukaemia is to The main aim of treatment for acute lymphoblastic leukaemia is to give a remission. This means that the abnormal, immature white give a remission. This means that the abnormal, immature white cells or blasts can no longer be detected in your blood or bone cells or blasts can no longer be detected in your blood or bone marrow, and normal bone marrow has developed again. marrow, and normal bone marrow has developed again.

However, once you are in remission there may still be a very small However, once you are in remission there may still be a very small number of abnormal lymphoblasts left. To destroy these, your number of abnormal lymphoblasts left. To destroy these, your doctor may prescribe maintenance or continuation chemotherapy doctor may prescribe maintenance or continuation chemotherapy which may last for several years. These drugs are mainly taken as which may last for several years. These drugs are mainly taken as tablets and you will need to have regular check-ups to monitor tablets and you will need to have regular check-ups to monitor their effect. Very specialised blood tests to find particular proteins their effect. Very specialised blood tests to find particular proteins present on the surface of the leukaemia cells can show if any present on the surface of the leukaemia cells can show if any leukaemia cells are still present in the body. leukaemia cells are still present in the body.

For many people with acute lymphoblastic leukaemia the For many people with acute lymphoblastic leukaemia the remission lasts indefinitely and the person is said to be cured. remission lasts indefinitely and the person is said to be cured.

The main aim of treatment for acute lymphoblastic leukaemia is to The main aim of treatment for acute lymphoblastic leukaemia is to give a remission. This means that the abnormal, immature white give a remission. This means that the abnormal, immature white cells or blasts can no longer be detected in your blood or bone cells or blasts can no longer be detected in your blood or bone marrow, and normal bone marrow has developed again. marrow, and normal bone marrow has developed again.

However, once you are in remission there may still be a very small However, once you are in remission there may still be a very small number of abnormal lymphoblasts left. To destroy these, your number of abnormal lymphoblasts left. To destroy these, your doctor may prescribe maintenance or continuation chemotherapy doctor may prescribe maintenance or continuation chemotherapy which may last for several years. These drugs are mainly taken as which may last for several years. These drugs are mainly taken as tablets and you will need to have regular check-ups to monitor tablets and you will need to have regular check-ups to monitor their effect. Very specialised blood tests to find particular proteins their effect. Very specialised blood tests to find particular proteins present on the surface of the leukaemia cells can show if any present on the surface of the leukaemia cells can show if any leukaemia cells are still present in the body. leukaemia cells are still present in the body.

For many people with acute lymphoblastic leukaemia the For many people with acute lymphoblastic leukaemia the remission lasts indefinitely and the person is said to be cured. remission lasts indefinitely and the person is said to be cured.

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Leukemia Leukemia Collaborative CareCollaborative Care

Chemotherapeutic treatment (cont.)Chemotherapeutic treatment (cont.)

– Intensification therapyIntensification therapy• High-dose therapyHigh-dose therapy• May be given after induction therapyMay be given after induction therapy• Same drugs at higher doses and/or other Same drugs at higher doses and/or other

drugsdrugs


– Intensification therapyIntensification therapy• High-dose therapyHigh-dose therapy• May be given after induction therapyMay be given after induction therapy• Same drugs at higher doses and/or other Same drugs at higher doses and/or other

drugsdrugs

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Leukemia Leukemia Collaborative CareCollaborative Care


– Consolidation therapyConsolidation therapy• Started after remission is achievedStarted after remission is achieved• Purpose is to eliminate remaining Purpose is to eliminate remaining

leukemic cells that may not be evidentleukemic cells that may not be evident

–Maintenance therapy Maintenance therapy • Lower doses of the same drugLower doses of the same drug


– Consolidation therapyConsolidation therapy• Started after remission is achievedStarted after remission is achieved• Purpose is to eliminate remaining Purpose is to eliminate remaining

leukemic cells that may not be evidentleukemic cells that may not be evident

–Maintenance therapy Maintenance therapy • Lower doses of the same drugLower doses of the same drug

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Leukemia Leukemia Chemotherapy RegimensChemotherapy Regimens

Combination chemotherapyCombination chemotherapy–Mainstay treatment Mainstay treatment – 3 purposes3 purposes• ↓ ↓ drug resistancedrug resistance• ↓ ↓ drug toxicity to the patient by using drug toxicity to the patient by using

multiple drugs with varying toxicities multiple drugs with varying toxicities • Interrupt cell growth at multiple points in Interrupt cell growth at multiple points in

the cell cycle the cell cycle

Combination chemotherapyCombination chemotherapy–Mainstay treatment Mainstay treatment – 3 purposes3 purposes• ↓ ↓ drug resistancedrug resistance• ↓ ↓ drug toxicity to the patient by using drug toxicity to the patient by using

multiple drugs with varying toxicities multiple drugs with varying toxicities • Interrupt cell growth at multiple points in Interrupt cell growth at multiple points in

the cell cycle the cell cycle

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Leukemia - Leukemia - Bone Marrow and Stem Bone Marrow and Stem Cell TransplantationCell Transplantation

GoalGoal

– Totally eliminate leukemic cells from Totally eliminate leukemic cells from the body using combinations of the body using combinations of chemotherapy with or without total chemotherapy with or without total body irradiation body irradiation

GoalGoal

– Totally eliminate leukemic cells from Totally eliminate leukemic cells from the body using combinations of the body using combinations of chemotherapy with or without total chemotherapy with or without total body irradiation body irradiation

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Leukemia - Leukemia - Bone Marrow and Stem Bone Marrow and Stem Cell TransplantationCell Transplantation Eradicates patient’s hematopoietic stem cellsEradicates patient’s hematopoietic stem cells Replaced with those of an HLA-matched Replaced with those of an HLA-matched

(H(Human Leukocyte Antigen)uman Leukocyte Antigen)• Sibling (Sibling (is a brother or a sister; that is, any is a brother or a sister; that is, any

person who shares at least one of the same person who shares at least one of the same parents )parents )

• VolunteerVolunteer

• Identical twinIdentical twin

• Patient’s own stem cells removed before Patient’s own stem cells removed before

Eradicates patient’s hematopoietic stem cellsEradicates patient’s hematopoietic stem cells Replaced with those of an HLA-matched Replaced with those of an HLA-matched

(H(Human Leukocyte Antigen)uman Leukocyte Antigen)• Sibling (Sibling (is a brother or a sister; that is, any is a brother or a sister; that is, any

person who shares at least one of the same person who shares at least one of the same parents )parents )

• VolunteerVolunteer

• Identical twinIdentical twin

• Patient’s own stem cells removed before Patient’s own stem cells removed before

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Nursing Management Nursing Management PlanningPlanning

Overall goalsOverall goals– Understand and cooperate with the Understand and cooperate with the

treatment plantreatment plan– Experience minimal side effects and Experience minimal side effects and

complications of disease and treatmentcomplications of disease and treatment– Feel hopeful and supported during the Feel hopeful and supported during the

periods of treatment, relapse, and periods of treatment, relapse, and remission remission

Overall goalsOverall goals– Understand and cooperate with the Understand and cooperate with the

treatment plantreatment plan– Experience minimal side effects and Experience minimal side effects and

complications of disease and treatmentcomplications of disease and treatment– Feel hopeful and supported during the Feel hopeful and supported during the

periods of treatment, relapse, and periods of treatment, relapse, and remission remission

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Nursing ManagementNursing Management

Many physical and psychological needsMany physical and psychological needs

– Evokes great fearEvokes great fear• Family also needs help Family also needs help

Balance demanding technical needs with Balance demanding technical needs with a humanistic, caring approacha humanistic, caring approach

Many physical and psychological needsMany physical and psychological needs

– Evokes great fearEvokes great fear• Family also needs help Family also needs help

Balance demanding technical needs with Balance demanding technical needs with a humanistic, caring approacha humanistic, caring approach

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Patient empowered by knowledge of the Patient empowered by knowledge of the disease and treatment can have a more disease and treatment can have a more positive outlook and improved quality of positive outlook and improved quality of lifelife

Nurses face special challenges when Nurses face special challenges when meeting the intense psychosocial needs of meeting the intense psychosocial needs of a patient with leukemia a patient with leukemia

Patient empowered by knowledge of the Patient empowered by knowledge of the disease and treatment can have a more disease and treatment can have a more positive outlook and improved quality of positive outlook and improved quality of lifelife

Nurses face special challenges when Nurses face special challenges when meeting the intense psychosocial needs of meeting the intense psychosocial needs of a patient with leukemia a patient with leukemia


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Ongoing care is necessary to monitor for Ongoing care is necessary to monitor for signs and symptoms of disease control or signs and symptoms of disease control or relapserelapse

Teach patient and significant otherTeach patient and significant other– Diligence in disease managementDiligence in disease management– Need for follow-up careNeed for follow-up care–When to seek medical attention When to seek medical attention

Ongoing care is necessary to monitor for Ongoing care is necessary to monitor for signs and symptoms of disease control or signs and symptoms of disease control or relapserelapse

Teach patient and significant otherTeach patient and significant other– Diligence in disease managementDiligence in disease management– Need for follow-up careNeed for follow-up care–When to seek medical attention When to seek medical attention

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Goals of rehabilitation Goals of rehabilitation –ManageManage• PhysicalPhysical• PsychosocialPsychosocial• Social Social • SpiritualSpiritual• Delayed effects Delayed effects

– Support groups Support groups

Goals of rehabilitation Goals of rehabilitation –ManageManage• PhysicalPhysical• PsychosocialPsychosocial• Social Social • SpiritualSpiritual• Delayed effects Delayed effects

– Support groups Support groups

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Nursing Management Nursing Management Evaluation

Cope effectively with diagnosis, Cope effectively with diagnosis, treatment regimen, and prognosis treatment regimen, and prognosis

Attain and maintain adequate nutrition Attain and maintain adequate nutrition Experience no complications Experience no complications Feel comfortable and supported Feel comfortable and supported

Cope effectively with diagnosis, Cope effectively with diagnosis, treatment regimen, and prognosis treatment regimen, and prognosis

Attain and maintain adequate nutrition Attain and maintain adequate nutrition Experience no complications Experience no complications Feel comfortable and supported Feel comfortable and supported

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Lecture Leukemia 2