Ocn Chapter 31 Leukemia

Front 1

Cerebral Toxicity and acral erythema are possible side/adverse effects of

Back 1

Cytarabine

Front 2

# of new cases of leukemia diagnosed annually in 2014

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52380

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Treatment option for CD 33+ AML first relapse

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Gemtuzumab

Front 4

Initial treatment of APL

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ATRA (all-trans retinoic acid)

Front 5

Treatment of AML

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Cytosine arabinoside

Front 6

Main treatment of NHL (biologic)

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Rituximab

Front 7

This kind of leukemia has three distinct phases

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CML

Front 8

Chronic phase, accelerated phase, and blast crisis are three phrases of this type of leukemia

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CML

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In ALL, the _____ is the sanctuary for leukemic cell

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CNS

Front 10

Intrathecal chemo &/or high dose systemic chemo & cranial radiation are used as treatment/prophylaxis for ________ in ALL

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CNS involvement

Front 11

Graft vs. host disease plays an intended effect for this kind of treatment in leukemia.

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Nonmyeloablative transplant.

Front 12

95% of CML patients has positive test for this kind of chromasone.

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Positive Philadelphia chromasone

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These two sites are the sanctuary sites for ALL

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CNS and testes

Front 14

Induction therapy for AML includes

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Cytarabine + anthracycline

Front 15

Diagnostic procedure for AML

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Bone marrow biopsy and aspirate with special stain => + Auer rods

Front 16

The staging system used for Chronic Lymphocytic Leukemia

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Rai and Binet

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The staging system used for Acute Leukemia

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French American British (FAB)

Front 18

What are the blood-forming organs?

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Bone marrow, liver, and spleen.

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B and T lymphocytes are part of __________ stem cell

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Lymphoid

Front 20

White blood cells, RBC's, and platelets are parts of ___________ stem cell.

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Myeloid.

Front 21

T/F:

Leukemia cells are capable of infiltrating and accumulating in other organs (e.g. CNS, eyes, testes, skin)

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True

Front 22

Organ involvement is most common in this type of leukemia: __________.

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Acute Leukemia.

Front 23

These abnormal labs are usually associated with this type of leukemia:

* WBC: myeloblasts, Low/normal/high, & neutropenia (ANC< 1000 cells/mm^3)

* Low platelet

* Low RBC

* Other: hyperuricemia, elevated LDH.

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AML

Front 24

These abnormal labs are usually associated with this type of leukemia:

* WBC: Lymphoblasts, low/normal/high, Neutropenia (ANC <1000 cells/mm^3)

* Low Platelet

* Low RBC

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ALL

Front 25

These abnormal labs are usually associated with this type of leukemia:

* Mature meylocytes (>100,000 cells/mm^2)

* Normal or high platelet

* Low RBC

* Other: High serum B12 level, Low LAP level

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CML

Front 26

These abnormal labs are usually associated with this type of leukemia:

* WBC: small mature or immature lymphocytes,

B cells, >20,000 cells/mm^3 in early disease,

> 100,000 cells/mm^3 in advanced disease

* Low platelet

* Low RBC

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CLL

Front 27

Lymphadenopathy occurs with these two types of leukemia

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ALL & CLL

Front 28

Splenomegaly occurs with these types of leukemia

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ALL, CML, & CLL

Front 29

Hepatomegaly occurs with these types of leukemia

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AML, CML, & CLL

Front 30

This kind of leukemia has the same signs as AML plus lymphadenopathy and splenomegaly.

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ALL

Front 31

Peripheral blood leukocytosis is one of the signs of __________ leukemia

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CML

Front 32

Hypogammaglobulinemia & rashes are signs (of all signs) of this kind of leukemia

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CLL

Front 33

The most common forms of leukemia in adults are...

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AML and CLL

Front 34

This kind of type of chemotherapy is considered a risk factor for leukemia: ___________ ____________.

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Alkylating agents

Front 35

drug tx for relapsed/refractory APL (previously treated with ATRA & athracycline-based)

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Aresenic Trioxide

Front 36

Please choose the correct answer

Treatment for CNS leukemia includes:

A. Intrathecal cytarabine

B. Intrathecal methotrexate

C. IV methotrexate

D. IV cytarabine

E. A & C

F. A & B

Back 36

Correct Answer:

F. Intrathecal cytarabine and intrathecal methotrexate are used for CNS

IV is not effective for CNS invovlement.

Front 37

For AML:

Post remission therapy to reduce leukemic cell population and achieve long-term, disease-free survival (DFS) includes: .....

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1. Consolidation

2. Intensification

3. Maintenance

4. Bone marrow transplantation.

Front 38

For acute myeloid leukemia: What is....

"one or two cycles of the same chemotherapy agents used in the induction therapy. Usually given after remission occurs"

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Consolidation therapy

Front 39

For acute myeloid leukemia: What is...

"High-dose chemotherapy given immediately or within several months of induction therapy. Same chemotherapy agents may be used at higher doses, or different drugs thought to be cross resistant with induction therapy drugs may be used."

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Intensification therapy

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For AML: What is...

Lower doses of the same drugs used for induction therapy or different drugs given monthly for a prolonged time period to 'maintain' a disease-free state. This therapy not currently recommended in treatment of AML."

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Maintenance therapy

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For AML:

This drug is used to treat clients 60 y.o. or older in first relapse with CD33+ AML and who are not candidates for cytotoxic chemotherapy.

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Gemtuzumab ozogamicin

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For AML:

___________ may be offered to clients who are elderly or clients with high-risk factors causing them to be ineligible for myeloablative transplantation.

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Nonmyeloablative transplantation

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For acute leukemia:

This therapy has graft-versus-host disease with graft-versus-tumor effect as intended to eradicate disease

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Nonmyeloablative transplantation

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Cell morphology, age, WBC count at presentation, success of initial induction therapy, chromosomal abnormalities are prognostic factors of _____________ ___________ leukemia.

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Acute lymphocytic leukemia (ALL)

Front 45

Initial treatment of ______________ includes: Vincristine, Prednisone, anthracycline, cyclophosphamide, with or without asparaginase.

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ALL

Front 46

Post-remission therapy for _________ includes short-term, relatively intensive chemotherapy followed by longer-term therapy at lower doses. Multiple drugs not previously administered may be given.

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ALL

Front 47

When to use the following treatment for ALL:

Allogeneic BMT from histocompatible leukocyte sibling human leukocyte antigen (HLA) donor

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For clients younger than age 50 in first CR with high-risk ALL.

Front 48

The two agents that are used for chronic phase CML to control leukocytosis (but do not eradicate disease or induce cytogenetic remission) include: 1. ___________________ & 2. _____________________

The other agent that is used for chronic phase include: 3. ____________________________

Back 48

1. Hydroxyrea

2. Busulfan (Myleran)

3. Alpha-2a interferon

Front 49

During blastic crisis for CML, ______ _______ is used for lytic bone lesions.

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Radiation Therapy (RT).

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____________ can be used during blastic crisis in CML for palliation.

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Hydroxuria

Front 51

After alpha-2a interferon failure, what medication is approved for treating CML (chronic phase, accelerated phase, or blast crisis)

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Imatinib mesylate (Gleevec)

Front 52

T/F

Client who is asymptomatic in CLL should be treated ASAP.

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False

Rationale: Treatment should be delayed until patient is symptomatic, e.g. exhibiting signs of hemolytic anemia, cytopenia, lymphadenopathy that is painful and/or disfiguring, or symptomatic organomegaly.

Front 53

The lab value is used to monitor CLL

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Lymphocyte count

Front 54

In CLL:

_________ chemo is used to suppress production of well-differentiated, small lymphocytes

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Chlorambucil (Leukeran)

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In CLL:

This chemo is used to inhibit growth of less mature lymphocytes (with limited effect on neutrophils and platelets).

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Cyclophosphamide

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In CLL:

What drug can be used to control leukocytosis and immune-mediated cytopenias?

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Corticosteroids.

Front 57

In CLL:

What procedure can be used to relieve symptom of leukocytosis and immune-mediated cytopenias when steroids are no longer effective?

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Splenectomy

Front 58

In CLL:

What's an effective treatment for painful lymphadenopathy and/or splenomegaly?

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Radiation Therapy (RT)

Front 59

What's the approved treatment for B-Cell CLL?

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Fludarabine (Fludara)

Front 60

In CLL:

Treatment for CD+ lymphocytes

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Rituximab and alemtuzumab (Campath-1H)

Front 61

10% of patients never require treatment for this kind of leukemia

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Hairy Cell Leukemia

Front 62

When to treat hairy cell leukemia?

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* When cytopenias is symtomatic

* When there's massive splenomegaly

* or when there're other complications.

Front 63

The following are treatment options for ______________:

1. 2-Chlorodeoxyadenosine (2-CdA)

2. Pentostatin (Nipent)

3. Alpha-interferon

4. Splenectomy

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Hairy Cell Leukemia

Front 64

When is splenectomy indicated in Hair Cell Leukemia?

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When client has low WBC count, splenomegaly, and minimal bone marrow involvement.

Front 65

Name the two viruses that are associated with leukemia (risk factors for leukemia)

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1. HIV

2. Epstein-Barr virus

Front 66

What previous chemo agents are known to be risk factors for leukemia?

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1. Alkylating agents

2. Etoposide

Front 67

What medications previously used by patients identified as risk factors for leukemia?

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1. Chloramphenicol (antibiotic)

2. Phenylbutazone (NSAID for animals)

Front 68

What genetic abnormalities are known to be risk factors for leukemia?

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1. Down syndrome

2. Turner's Syndrome

3. Bloom's Syndrome

4. Klinefelter's Syndrome

5. Fanconi's anemia

6. Neurofibromatosis

7. Ataxia telangiectasia

Front 69

What abnormal values of cerebrospinal studies would be associated with leukemia?

Back 69

1. Increased protein

2. Decreased glucose

3. Leukemic cells presence

Front 70

What are the most common sites of leukostasis?

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1. Brain/CNS

2. Lung

3. Other organs may be involved

Front 71

What clients are at risk for leukostasis?

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Clients that have diagnosis of cute or chronic leukemia with a WBC count > 50,000 to 100,000/mm^3.

Front 72

Describe the physiologic effect of leukostasis

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Increase in blood viscosity => obstruction of the microcirculation or formation of thrombi of WBC's in small vessels => capillary plugging, vessel rupture, bleeding, and organ damage.

Front 73

What are the most common signs of leukstasis?

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1. Increased ICP

2. Respiratory distress

3. Other signs depend on organ(s) involved

Front 74

What are the most common complications of leukostasis?

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1. Pulmonary hemorrhage

2. Cerebral hemorrhage

Front 75

Please describe the medical management for leukostasis in leukemia

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1. Initiation of chemotherapy to treat the disease process

2. Initiation of leukapheresis to temporarily decrease the WBC count

3. IV fluids

4. Cranial radiation if appropriate

Front 76

Please describe the nursing interventions for leukostasis

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Frequency of monitoring depends on each patient and s/s.

General guidelines are followed:

1. If WBC >50,000 - 100,000/mm^3 - Neurologic exam q2-4 hr

2. VS monitoring q 2-4 h

3. Monitor for s/s of bleeding q2-4 hr

4. Management of myelosuppression

5. Contact physicians for aberrant findings.

Front 77

Retinoic acid syndrome (RAS) is a potentially life-threatening complication that can be observed in patients with ________ leukemia.

Back 77

APL (acute promyolytic leukemia).

Front 78

S/S of RAS (retinoic acid syndrome)

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Fever, dyspnea, weight gain, hypotension, pulmonary infiltrates