Acute Leukemia/Lymphoma

Presenting Symptoms: Signs of marrow failure: fatigue, bleeding, bruising, fever, infection, pallor Bleeding: platelet infusions Infections (neutrophils less than 500 per microliter) Broad spectrum antibiotics (until neutrophil levels increase) Sites: mucosal (pharynx, perianal) lungs skin (IV line sites)  Most common infectious organisms: Staphylococcus gram-negative bacteria Other infections, when patient is in relapse, or during treatment with broad-spectrum antibiotic: yeast: (Candida) fungi: (Aspergillus, Mucor, Pneumocystis) viruses: herpes virus Infiltration sites: Spleen Lymph nodes Liver Skin CNS Leukemic meningitis --headache, nausea, cranial nerve palsies Mediastinal mass (frequent presentation) Bone pain (sternal pain) Metabolic abnormalities: Uric acid nephropathy: secondary to rapid turnover of acute leukemic cells worsened: dehydration, acidosis, tumor cell lysis (increased by chemotherapy) improved/prevented: hydration, urine alkalinization, allopurinol hypokalemia hyperkalemia  Treatment: Difference between lymphoblastic leukemia lymphoma: percentage of bone marrow involvement Similar, aggressive treatment induction, consolidation, CNS prophylaxis, and maintenance treatment. With this approach: 40% or more of patients are cured Optimum therapy for adults: An anthracycline plus vincristine (Oncovin) and prednisone (+/-L-asparaginase (El-spar)) Complete response (CR): 50% -- 85% Following CR, post remission treatment is very important to lengthen the duration of remission: CNS prophylaxis: cranial radiation with intrathecal methotrexate intrathecal and high-dose systemic methotrexate maintenance treatment duration: about two years maintenance treatment includes: methotrexate   6-mercaptopurine   vincristine (Oncovin) prednisone   (Deltasone) optimal duration and intensity maintenance treatment in adults: unknown