Leukemias, types, clinical features and management

1. Leukemia

2. Introduction
• Leukemia is a group of malignant disorders
affecting the blood and blood-forming tissues
in the bone marrow, lymphatic system, and
spleen.
• The word leukemia literally means “white
blood” because it is a neoplastic proliferation
of one type of blood cell, typically a leukocyte
or white blood cell.

3. Contd.
• Leukocytosis, an increased white blood cell
count, is a normal response to infection, but
when leukocytosis becomes chronic or
progressively elevates without obvious cause,
then it may indicate malignancy.

4. Risk Factors
• Genetic predisposition, chromosomal changes,
• Chemical agents (benzene)
• Chemotherapeutic agents
• Radiation,
• Immuno compromised patients
• Virus - only adult T cell leukemia is known to
result from a virus, human T cell leukemia
virus type 1 (HTLV-1).

5. Pathophysiology
• Hematopoiesis, the process by which blood
cells are formed, involves production of
specific cells from stem cell precursors
according to body needs.
• In leukemia, a defect occurs in the myeloid or
the lymphoid stem cell.
• The most common feature of all types of
leukemia is unregulated proliferation of
leukocytes in the bone marrow.

6. Formation of blood cell

7. Classification
Leukemia is classified by the type of white blood
cells affected and by how quickly the disease
progresses.
Based on type of white blood cells affected
• Lymphocytic leukemia (also known as lymphoid
or lymphoblastic leukemia) develops in the white
blood cells called lymphocytes
• Myeloid leukemia (also known as myelogenous)
may also start in white blood cells other than
lymphocytes, as well as red blood cells and
platelets in the bone marrow.

8. Based on disease progression
Acute and chronic forms
Acute forms: Acute leukemia is rapidly
progressing and results in the accumulation of
immature, functionless blood cells in the bone
marrow.
With this type of leukemia, cells reproduce and
build up in the marrow, decreasing the
marrow’s ability to produce enough healthy
blood cells.

9. Contd..
• Chronic forms: Chronic leukemia progresses
more slowly and results in the accumulation of
relatively mature, but still abnormal, white
blood cells.Chronic forms are rare in children.

10. Types of leukemia include:
Type Description
Acute lymphocytic
leukemia (ALL)
Progresses rapidly, replacing healthy cells that
produce functional lymphocytes with leukemia
cells that can't mature properly.
Common in children.
Acute myeloid leukemia
(AML)
Malignant, uncontrolled proliferation of an
abnormally differentiated, myeloid stem cell
results in high circulating numbers of immature
blood cells and replacement of normal marrow by
malignant cells.
Common in adults and children.
Chronic lymphocytic
leukemia (CLL)
Characterized by progressive accumulation of
phenotypically mature malignant B lymphocytes.
Common in adults.
Chronic myeloid leukemia
(CML)
Overproduction of mature and immature
granulocytes.
Common in adults

14. Management
Chemotherapy
• The protocol for treatment varies depending on
the type of leukemia. Generally, a combination of
drugs is given as this approach is more effective
than monotherapy.
There are generally 3 stages to chemotherapy:
• Induction
• Consolidation
• Maintenance

15. Induction
• Patients are usually hospitalized for 4 to 6
weeks during initial treatment.
• During this time, chemotherapy eradicates
both leukemic cells and normal myeloid cells,
so the person becomes severely neutropenic,
anemic, and thrombocytopenic, putting
patients at risk for severe infections and
bleeding.

16. Consolidation
• After the patient has recovered from the effects
of induction, consolidation treatment is
provided over 4 to 8 months, often with the
same chemotherapeutic agents used during
induction but at lower dosages in order to kill
any remaining malignant cells.

17. Maintenance
• Continued treatment may be provided for up to
3 years with some types of leukemia but with
less intense chemotherapy in order to retain
remission.
• The patient is monitored closely for both
progress and side effects with weekly blood
counts.

18. Chemotherapeutic agents used
• Vincristine
• Doxorubicin
• Methotrexate
• Cyclophosphamide

19. Relapse
• Sometimes people relapse after completing the
3 stages of chemotherapy. When that occurs,
re-induction may be carried out, especially
with children, usually using adifferent protocol
of drugs.

20. Other treatments
• Intrathecal chemotherapy is administered into the
spinal fluid for treatment of infiltration of the central
nervous system.
• Radiation to the brain may be indicated in addition to
intrathecal chemotherapy with severe disease,
especially in children when infiltration poses danger
to brain development.
• Bone marrow transplant or peripheral blood stem cell
transplant with donor stem cells or the patient’s stem
cells.
• Blood Transfusion/Platelet transfusion

21. Nursing management
Nursing Diagnosis
• Risk for Infection
• Risk for Deficient Fluid Volume
• Acute Pain
• Activity Intolerance
• Deficient Knowledge