Leukemia is a cancer of the blood or bone marrow characterized by an abnormal proliferation of white blood cells. This document discusses leukemia, including its definition, types (acute or chronic, based on affected cell type), symptoms, risk factors, diagnostic tests, and treatment approaches. Treatment often involves chemotherapy, and may include radiation therapy, immunotherapy, stem cell transplantation, or supportive care to manage complications like infection.

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2. LEUKEMIA
PRESENTED BY : Ms. IRENE THAKURIA
M.Sc. (N) II year
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4. LEUKEMIA
The word Leukemia comes from the Greek word
leukos which means "white" and aima which
means "blood".
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5. DEFINITION
Leukemia is a progressive, malignant disease of the
blood forming organs, marked by distorted
proliferation and development of leukocytes and their
precursors in the blood and bone marrow.
-National Cancer Institute
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6. INCIDENCE
• About 3- 4 percent in 1,00,000 population in
India.
• Affects approximately 9 times more in adults
than in children.
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7. ANATOMY AND PHYSIOLOGY
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9. o AGE
o GENDER
o FAMILY HISTORY
o GENETIC DISORDERS
o RADIATION
o ATOMIC BOMB EXPLOSIONS
o DIAGNOSTIC X RAYS
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10. o SMOKING
o EXPOSURE TO CERTAIN CHEMICALS
o CHEMOTHERAPY
o DOWN SYNDROME AND CERTAIN OTHER
INHERITED DISEASES
o MYELODYSPLASTIC SYNDROME AND CERTAIN
OTHER BLOOD DISORDERS
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11. o HUMAN T- CELL LEUKEMIA VIRUS TYPE 1 (
HTLV-1)
o OTHER MEDICAL THERAPY AND EVENTS –
Use of antibiotic chloramphenicol has been
linked with the development of childhood
leukemia
Medications, such as growth hormones and
phenylbutazone, have shown association with
leukemia
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12. Organ transplantations
Certain immunodeficiency syndrome –
Eg: Infantile X linked agammaglobulinemia
and lymphatic leukemia
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13. CLASSIFICATION
According to nature of disease
oAcute leukemia
oChronic leukemia
According to type of blood cell affected
oAcute lymphocytic leukemia (ALL)
oAcute myelogenous leukemia (AML)
oChronic lymphocytic leukemia (CLL)
oChronic myelogenous leukemia (CML)
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14. CLASSIFICATION cont.
According to nature of disease
o Acute leukemia
o Chronic leukemia
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16. ACUTE LEUKEMIA
• Characterized by clonal proliferation of immature
hematopoietic cells.
• It develops after malignant transformation of a
single type of immature hematopoietic cells
• Cellular replication and expansion of that
malignant clone.
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17. ACUTE LEUKEMIA -Clinical manifestations
• Low white blood cell count
• Infections
• Tiredness
• Shortness of breath
• Pale skin
• Sweating usually at night
• Fever
• Bone and joint aches
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18. CHRONIC LEUKEMIA
• In chronic leukemia, the leukemia cells come
from mature cells
• Distinguished by excessive build up relatively
mature but still abnormal WBC.
• Takes months to years to progress.
• Shows no symptoms initially.
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19. CHRONIC LEUKEMIA -Clinical
manifestations
• Malaise
• Weight loss
• Loss of appetite
• fever
• Low white blood cell count
• Night sweats
• Anemia
• Infections
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20. • Bruising or bleding (nose bleeds)
• Enlarged lymph nodes
• Pain or feeling of fullness in upper left
abdomen (spleenomegaly)
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21. Common symptoms of chronic or
acute leukemia
• Swollen lymph nodes
• Pallor
• Fatigue
• Bone, joint pain
• Abdominal pain
• Weight loss
• Headache
• Mouth sores
• Increased ICP ( Secondary to meningial
infiltration)
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22. ACCORDING TO TYPE OF BLOOD CELL
AFFECTED
o Acute lymphocytic leukemia (ALL)
o Acute myelogenous leukemia (AML)
o Chronic lymphocytic leukemia (CLL)
o Chronic myelogenous leukemia (CML)
o Hairy cell leukemia
o and unclassified leukemia(lymphoid and myeloid)
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24. ALL- CLINICAL MANIFESTATION
• Fever
• Pale skin
• Bleeding
• Anorexia, weight loss
• Fatigue
• Weakness
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25. DIAGNOSTIC TESTS
• Low RBC count, hb%, Hct, platelet count
• Low to high WBC count, high HDL
• Transverse lines of rarefraction at ends of
metaphysis of long bones on X- ray
• Presence of philadelphia syndrome
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26. TREATMENT
• Chemotherapy is mainstay of treatment;
involves 3 phases:
• INDUCTION PHASE:
• POST INDUCTION OR POSTEMISSION PHASE
• MAINTENANCE PHASE
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27. INDUCTION PHASE:
• AGGRESSIVE Treatment that seeks to destroy
leukemic cells in the tissues, peripheral blood,
and bone marrow to eventually restore
normal hematopoises or bone marrow
recovery.
• VINCRISTINE + PREDNISOLONE
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28. POST INDUCTION OR POSTEMISSION
PHASE
• INTENSIFICATION THERAPY:
• IT maybe given immediately after induction
therapy for several months
• CoNSOLIDATION THERAPY:
• It starts after a remission is achieved
• It may consist of one or two additional course of
same drug given during induction therapy.
• Purpose is to eliminate remaining leukemic cells
that may not be clinicallly or pathologically
eveident
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29. MAINTENANCE THERAPY
• It is treatment with low dose of same drug as
induction therapy
• Given every 3-4 weeks for a prolonged period
• Goal is to keep body free from leukemic cells.
• Prophylactic treatment of the CNS, intrathecal
administration and/ or cerebrospinal radiation to
eradicate leukemic cells
• Eat diet containing high levels of protein, fibers
and fluids
• Avoiding infection and injury
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30. ALL- TREATMENT CONT.
• Prophylactic treatment of the CNS, intrathecal
administration and/or cerebrospinal radiation
to eradicate leukemic cells.
• Diet having high protein and fibre.
• Drink adequate Fluid
• Avoid infection and injury.
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33. AML-ACUTE MYELOGENOUS
LEUKEMIA
• Represent only 1/4th of all leukemias
but it makes upto 80% of the acute
leukemias in adults
• Onset is often abruprt and dramatic
• Increase in advancing age after 60
years
• Characterised by the development
of immature myeloblasts in the
bone marrow
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34. • CLINICAL MANIFESTATIONS
• DIAGNOSTIC TESTS
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35. AML- TREATMENT
• Same treatment as ALL.
• Common chemotherapy agent for induction of
AML includes cytarabine and an antitumor
antibiotic such as mitoxantrone.
• Fluid therapy (2000-3000ml/day)
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38. • CLL are most common leukemia in adults
• Characterised by the production and
accumulation of functionally inactive but long
live, small, mature appearing lymphocytes
• B cells are usually involved
• Lymphocytes may infiltrate the bone marrow,
spleen and liver
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39. CLL- CLINICAL MANIFESTATIONS
• Chronic fatigue
• Anorexia
• Splenomegaly &
lymphadenopathy
• Hepatomegaly
• Fever
• Night sweats
• Weight loss
• Frequent infection
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40. DIAGNOSTIC FINDINGS
• Mild anemia with thrombocytopenia
• WBC > 100,000U/L
• Increased peripheral lymphocytes and
lymphocytes in bone marrow
• Auto immume hemolytic anemia
• Idiopathic thrombocytopenia perpurua
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41. CLL - TREATMENT
• Lymphocytic proliferation can be suppressed
with cholrambucil, cyclophosphamide and
prednisolone.
• Monoclonal antibody such as campath maybe
used.
• Transfusion therapy to replace RBCs and
platelet.
• Irradiation of painful enlarged lymph nodes.
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44. CML- CLINICAL MANIFESTATION
• Usually no initial
symptoms
• Fatigue and weakness
• Fever
• Sternal tenderness
• Weight loss
• Joint pain, bone pain
• Massive splenomegaly
• Increase in sweating
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45. DIAGNOSTIC FINDINGS
• PHILADELPHIA CHROMOSOME
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46. CML- TREATMENT
• It can be treated with drug like imatinib or dasatinib
• Combination chemotherapy includes prednisolone,
vincristine or methotrexate.
• Imatinib and other tyrosine kinase inhibitor target the
BCR –ABL protein that is present in nearly all patient
with CML.
• Take measures to prevent infection
• Promote safety
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48. CLINICAL MANIFESTATION
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49. DIAGNOSTIC EVALUATION
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50. DIAGNOSTIC EVALUATION
• Health history
• Physical examination
• Blood investigations – CBC
• Bone marrow biopsy
• Bone marrow aspiration
• Skin biopsy
• Cytogenetic
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51. DIAGNOSTIC EVALUATION cont.
• Lipid profile (lactate dehydrogenase)- elevated
• Polymerase chain reaction- presence of biomarkers
• Liver function test- elevated
• C reactive protein- elevated {10 milligram per liter
(mg/L)}
• Chest X ray - swollen lymph nodes
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52. • LUMBAR PUNCTURE
• CT SCAN
• MRI
• RADIONUCLIDE SCANNING
• ULTRASOUND
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54. IMMUNOPHENOTYPING:
• Immunophenotyping ia the examintion of
antigens (proteins that can induce an immune
response), on the surface of theleukemic cells.
Immunotherapy allows the doctor to confirm
the exact type of leukemia.
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55. X-ray Showing swollen lymph nodes
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56. MANAGEMENT
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57. MANAGEMENT
• Chemotherapy is a mainstay for leukemia
• Patient having high levels of WBC Count must
start with initial emergent treatment.
• It includes leukaoheresis and hydroxyurea.
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58. LEUKAPHERESIS
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59. MANAGEMENT cont.
• Combination therapy should be initiated.
Purpose of using multiple drug are:
– Decrease drug resistance
– Minimize the drug toxicity to the patient by using
multiple drug with varying toxicity
– Interrupt cell growth at multiple points in the cell
cycle.
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60. Other Modes of Attack
• Hormones such as prednisone and dexamethasone
(Decadron) in high doses can kill lymphoma or
lymphocytic leukemia cells.
• Antimitotic drugs such as vincristine (Oncovin) or
vinblastine (Velban) damage cancer cells by blocking a
process called mitosis (cell division), preventing cancer
cells from dividing and multiplying.
• Antibodies made specifically to attach to cancer cells
interfere with a cancer cell's function and kill the cell.
Some antibodies are combined with a toxin or
radioactive substance.
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61. MANAGEMENT cont.
The other options are :
• Watchful waiting
• Corticosteroids
• Radiation therapy
• Immunotherapy
• Biological therapy
• Targeted therapy
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62. RADIATION THERAPY
• Radiation therapy (also called radiotherapy)
uses high-energy rays to kill leukemia cells.
• This type of therapy takes place 5 days a week
for several weeks.
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63. BIOLOGICAL THERAPY
• Biological therapy for leukemia is treatment that
improves the body's natural defences against the
disease.
• One type of biological therapy is a substance
called a monoclonal antibody. It's given by IV
infusion
• The side effects of biological therapy differ with
the types of substances used, and from person to
person. It commonly cause a rash or swelling
where the drug is injected.
• They also may cause a headache, muscle aches, a
fever, or weakness.
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64. TARGETED THERAPY
• Targeted therapies use drugs that block
the growth of leukemia cells.
• For example, a targeted therapy may
block the action of an abnormal
protein that stimulates the growth of
leukemia cells.
• Side effects include swelling, bloating,
and sudden weight gain. Targeted
therapy can also cause anaemia,
nausea, vomiting, diarrhoea, muscle
cramps, or a rash.
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65. MANAGEMENT cont.
HEMATOPOIETIC STEM CELL
TRANSPLANTATION
• Any procedure where hematopoietic stem cells of any
donor and any source are given to a recipient with
intention of repopulating/replacing the hematopoietic
system in total or in part.
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66. Hematopoietic stem cell
transplantation- Types of transplant
cont.
• Autologous (your own cells)
• Allogeneic cells from another person
– Sibling
– Unrelated Donor
– Parent or relative
– or source: Umbilical cord
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67. AUTOGENIC HEMATOPOIETIC STEM
CELL TRANSPLANTATION
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69. SUPPORTIVE CARE
• INFECTIONS
• ANEMIA AND BLEEDING
• DENTAL PROBLEMS
• Diet and management
• Symptomatic management
• Discharge and home care– physical, psychological,
economic, spiritual necessary
• Continuation of medications on dicharge
• Folow up
• Sign and symptoms to inform if occurs on discharge
• Prevention of infections - instructions
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70. MANAGEMENT cont.
NURSING MANAGEMENT
• Obtain health history, focusing on fatigue, weight
loss, night sweats, and activity intolerance.
• Assess for signs of bleeding & infection.
• Evaluate splenomegaly,lymphodenopathy &
hepatomegaly.
• Examine patient for abnormal breathing sounds, skin
lesions.
• Inspect the patient for the sign of infection & the
incidence of frequency of infection.
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71. MANAGEMENT cont.
NURSING DIAGNOSIS:
• Risk for infection related inadequate secondary
defences: alteration in mature WBCs
• Acute pain related to enlarged lymph nodes as
evidenced by pain score level
• Activity intolerance related to generalised weakness
as verbalized by patient.
• Risk for deficit fluid volume related to haemorrhage,
vomiting .
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72. COMPLICATION
• Infection
• Multiorgan dysfunction
• Bleeding
• Thrombophlebitis
• DIC
• Leukostasis
• pneumonia
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73. ACUTE MYELOID LUEKEMIA:
Advancement in diagnosis and
treatment
• This article reviewed the latest developments related to
the diagnosis and treatment of AML.
• Current chemotherapy agents have limited therapeutic
efficacy, with an approximate 50–70% complete
remission (CR) rate after induction and with only 20–30%
of patients achieving long-term disease-free survival.
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74. • Through an extensive search they found out new
therapies like Tyrosine kinase 3 inhibitors,
immunotherapy, cellular therapy is the newer trend to
treat luekemia.
• A major task for medical workers is to improve the
survival of AML patients while minimizing
treatment-related toxicity. These therapy and gene
sequencing techniques should set the basis for next-
generation diagnostic methods. Further, target therapy
should be the focus of future clinical research in the
exploration of therapeutic possibilities.
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75. Drug Duo a
Weapon Against a Common Leukemia
 Dr. Tait Shanafelt, professor of medicine at Stanford
University
• A two-drug combo helps patients with a common form of
leukemia survive longer than the current standard of care, a
new clinical trial finds.
• The phase 3 trial of more than 500 U.S. patients with chronic
lymphocytic leukemia (CLL) found that a combination of
rituximab and ibrutinib extended patient survival.5/7/2020 75

76. • Specifically, 89.4% of the patients who received the
experimental drug combination did not have any
progression of their leukemia about three years after
treatment, compared with 72.9% of those who
received the traditional chemotherapy combination.
• As to overall survival, regardless of whether the
disease had progressed or not, the trial found that
three years after treatment, 98.8% of patients who
received the two-drug combination were alive,
compared with 91.5% of those who received the
traditional treatment.
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77. REFERENCE
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kluwer publication.2014
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Ltd. 2012
• Yu GM, Zheng HY. Acute myeloid luekemia- advancement in diagnosis and
treatment. Chin Med J(Engl).130(2).211-18.2017 DOI: 10.41031066-6999.198004
• The mystery of luekemia in older adults. Nursing made incredibly easy. 10(1).45-46
DOI: 10.1097/01.NME.000041025/8784.28
• Dr. Tait Shanafelt. Drug Duo a Weapon Against a Common Leukemia. New
England Journal of Medicine.381(5).2019
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79. • More immatured cells in examintion-acute
• Matured – chronic
• Causes – environmental/
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