1. Leukemia Omidreza keshavarz Ahmad darvishi Nursing 86 Hormozgan university of medical sciences Bandarabbas faculty of nursing،midwifery and paramedical sciences 1388

3. Leukemia…..  Is the cancer of the white blood cells (leukocytes)  Bone marrow makes abnormally large number of immature white blood cells called blasts  blast cells in blood, bone marrow and other organs  Affects ability to produce other normal blood cells RBC&PLT A healthy WBC Hairy Cell Leukemia (a chronic leukemia)

4. Primary Classifications of Leukemia  Acute or Chronic  Myelogenous or Lymphocytic(B&T)

5. Acute Lymphocytic Leukemia (ALL) Chronic Lymphocytic Leukemia (CLL) Acute Mylogenous Leukemia (AML) Chronic Mylogenous Leukemia (CML) Mechanisms of the 4 primary classifications of Leukemia

6. Symptoms When there are excessive white blood cells --> Infections When there are few red blood cells: Paleness --> Anemia When there are few platelets --> Excessive bleeding Symptom result accumulation of blast cells in other organs

7. Symptoms infectionFever, chills, and other flu-like symptoms اکیموزو پورپورا خونریزی لثه Bleeding petechiae & rinoraggea & rangparidegi& Weakness and fatigue& dyspeniea Loss of appetite and/or weight Bone/joint pain Hepatomegaly Splenomegaly Lymphadenopathy CNS involvement vomiting & papilledema & exophtalmos &Headaches Confusion, loss of motor control Swollen testicles

8. diagnosis 1. Blood examination CBC differentiate + PBS - anemia, - thrombocytopenia, - variable leukocyte count, usually increased, - blood morphology: presence of blast cells 2. Bone marrow biopsy** - presence of blast cells, - suppression of normal haematopoiesis

9. diagnosis 3. LP 4. Chest xray 5. Computerized tomography scan 6.MRI 7.Physical examinations

10. Morphologic subtypes of acute lymphoblastic leukemias** Subtype Morphology Occurrence (%) L1 Small blasts 75 children L2larger blasts 20 adult L3 Large blasts, vacuolated cytoplasm 5

11. Treatment strategy in ALL

12. Treatments Chemotherapy Radiation therapy Bone Marrow Transplant (BMT) Biological therapy

13. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Most often given through an IV. Drugs do not reach cells in the CNS due to the blood-brain barrier. To reach leukemia cells in the CNS, must use intrathecal chemotherapy. Side effects: –Healthy cells can be damaged (hair, blood cells, cells in digestive tract). May lower resistance to infection.(neutropenia) Loss of hair. Mouth sores Bleeding.(leuckopenia) Nausea،vomit –May also affect a patient’s fertility.

14. Chemotherapy done in four stage 1.Induction:in this stage act to kill any most cancer cells Duration : 4-6 weeks Drugs: prednisone(daily. PO) L- asparginase(IM-IV) vincristine (weekly.IV) cyclophosphamide.(PO.IV) dexamethason (daily.PO) high risk cytosin arabinoide(.interathecally) high risk methotrexate(.interathecally) high risk

15. Chemotherapy done in four stage 2. Intensification: Duration : 6 month Drugs:L- asparginase(IM-IV) 6-mercaptopurine(PO) methotrexate(PO.IV)

16. Chemotherapy done in four stage 3. CNS prophylaxis : Duration : 4 week Drugs: methotrexate(.interathecally) hydrocortisone (.interathecally) scalp Radiation therapy

17. Chemotherapy done in four stage 4. Maintenance : Duration : 2-3 years Drugs: methotrexate(weekly.PO. IM) 6-mercaptopurine(daily PO) prednisone vincristine

18. Radiation therapy Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. Used along with chemotherapy. May be given in two ways: –To one specific area where there is a collection of leukemia cells. –Radiation that is directed at the whole body. Side effects: –May become very tired. –Can cause skin to become itchy, tender, or dry. –May cause nausea, vomiting, and loss of appetite. –In treatment to the brain, side effects may be permanent. Children my develop learning and coordination problems.

19. Biological therapy Involves treatment with substances that affect the immune system’s response to cancer Interferon is a form of biological therapy that is used against some types of Leukemia. BMT The patient’s leukemia-producing bone marrow is destroyed by high doses of drugs and radiation then replaced by healthy bone marrow.

20. Risk Factors Exposure to benzene in the workplace. Exposure to extraordinary doses of irradiation.