- Presenting Symptoms:
- Signs of marrow
failure: fatigue, bleeding, bruising,
fever, infection, pallor
- Bleeding:
- 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
- optimal
duration and intensity
maintenance treatment in
adults: unknown
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