Leukemia
&
Lymphoma
Keith Rischer, RN, MA, CEN
Leukemia
Patho
• Loss of regulation in cell division, causes proliferation of
malignant leukocytes
Classification based on predominant cell of origin
• Lymphoid
• Myeloid
Acute or Chronic
Lymphocytic leukemia
Acute lymphocytic leukemia (ALL)most common w/peds
• 5 yr survival 80% peds/40% w/adults
Chronic lymphocytic leukemia (CLL)-most common w/adults
• 73% survival rate
Myelogenous leukemia
Acute myelogenous leukemia (AML) 20% survival rate
Chronic myelogenous leukemia (CML)
Leukemia: Etiology
•
•
•
•
•
•
Chromosomal changes
Chemical Agents-Benzene
Chemotherapy-Alkylating Agents
Viruses-Retroviruses
Radiation
Unknown factors
Leukemia SxClinical Manifestations
–
–
–
–
–
–
–
Anemia
Fatigue and weakness
Bleeding
Fever and Infections
Weight loss-joint pain
Mouth sores
Hepatosplenomegaly & Lymphadenopathy
Diagnosis
General Treatment of Leukemia
Chemotherapy
• Induction therapy- attempts to induce or bring
about remission.
• Consolidation therapy - after remission
achieved-eliminate remaining cells
• Maintenance therapy- treatment with lower doses
of same drugs every 3-4 weeks
• Combination therapy
• Stem cell transplant
• Bone marrow transplant
Nursing Management
Acute
Many emotional-psychosocial
needs/support
– Communicate tx plan-expected course
– Protective Isolation/Neutropenic Precautions
– Educate!!
– Chemo-manage side effects
– Spiritual care
Neutropenia
• Severe decrease in neutrophils-secondary to
chemo or immunosuppressive therapy
• Sx: decreased immune/inflammatory responsemasks infection…low grade fever significant
>100.4
• Nursing Management:
–
–
–
–
Neutropenic precautions
obtain pan cultures
start IV abx
assess for septic shock
Lymph System
• Consists of: lymphatic capillaries, ducts,
lymph nodes, lymph fluid
• Function:
– Returns excess interstitial fluid to the blood
– Absorbs fatty acids
– Produces immune cells
– Lymph nodes: Filtration of bacteria and
foreign particles carried by lymph fluid.
Lymphoma – Hodgkin’s
Patho
Incidence
Clinical Manifestations
–
–
–
Enlargement of cervical,
axillary or inguinal lymph
nodes
*Wt Loss, *Fever and
chills,*Night sweats
(these correlate with a
worse prognosis, B sx’s)
Fatigue and weakness
Tachycardia
Diagnosis
Lymphoma – Hodgkin’s
Treatment: Based on stage of the disease
– Radiation alone or with chemotherapy
Objective:
– least amt of tx to achieve cure yet minimize
short-term & long-term complications
Nursing Management
– pain control
– managing side effects
– psychosocial support
Non-Hodgkin’s Lymphomas
Patho
Prevalence
Categories
– Low grade (indolent)
– Intermediate grade (aggressive)
– High grade (very aggressive)
• Affects all ages
Manifestations
Non-Hodgkin’s lymphomas
Diagnosis
Treatment
– Radiation if just stage I
– Chemotherapy involves multidose/multiagent
regimen
– Holistic nursing management-same as
previous blood disorders…pain control,
management of SE, psychosocial support,
– Spiritual care-multidisciplinary team
Multiple Myeloma
Patho
• excess production of plasma cells w/resultant
myeloma proteins destroys bone/bone marrow
Incidence
Clinical manifestations (develop slowly and
insidiously)
– Skeletal pain (esp pelvis, spine & ribs) *Major
manifestation, presents first.
– Osteolytic lesions; can see in skull, vertebrae & ribs
– Hypercalcemia from bony degeneration
– Anemia, thrombocytopenia, & granulocytopenia
Multiple Myeloma
Diagnosis
• Lab, x-rays, bone marrow
• Urine has Bence Jones protein
Collaborative management:
– Radiation
– Chemo
Nursing Management
–
–
–
–
–
Ambulation & adequate hydration
Ambulate w/care
Pain control
Infection control
Emotional/spiritual support