NURS 443 Lecture Notes - Lecture 9: Targeted Therapy, Cytogenetics, Corticosteroid
Leukemia
Description
Leukemia is a general term used to describe a group of malignant disorders affecting the blood and
blood-forming tissues of the bone marrow, lymph system, and spleen. It results in an accumulation of
dysfunctional cells because of a loss of regulation in cell division. Although leukemia is often thought of
as a disease of children, the number of adults affected is 10 times that of children.
Regardless of the specific type, leukemia has no single cause. Most types of leukemia result from a
combination of factors including genetic and environmental influences.
Classification
Leukemia can be classified based on acute versus chronic disease and on the type of WBC involved. By
combining the acute and chronic categories with the cell type involved, four major types of leukemia can
be identified. Table 58 summarizes the relative incidence and features of the four types of leukemia.
Acute myelogenous leukemia (AML) represents only one fourth of all leukemias, but it makes up
approximately 80% of the acute leukemias in adults. Its onset is often abrupt and dramatic. A patient
may have serious infections and abnormal bleeding from the onset of the disease. AML is characterized
by uncontrolled proliferation of myeloblasts, the precursors of granulocytes. There is hyperplasia of the
bone marrow. Clinical manifestations are usually related to replacement of normal hematopoietic cells
in the
Table 58 Types of Leukemia
Age of Onset
Clinical Manifestations
Diagnostic Findings
Acute Myelogenous Leukemia
(AML)
Most common cancer in
children ages 0-7 yr.
Increase in incidence with
advancing age after 55 yr.
Fatigue and weakness,
headache, mouth sores,
anemia, bleeding, fever,
infection, sternal tenderness,
gingival hyperplasia, mild
hepatospleoegaly ⁄3 of
patients).
Low RBC count, Hgb, Hct,
platelet count. Low to high WBC
count with myeloblasts. High
LDH. Hypercellular bone
marrow with myeloblasts.
Acute Lymphocytic Leukemia
(ALL)
In children median age at
diagnosis is 13 yr.
Increases in incidence with
advancing age after 60 yr.
Fever, pallor, bleeding,
anorexia, fatigue and weakness.
Bone, joint, and abdominal
pain. Generalized
lymphadenopathy, infections,
weight loss,
hepatosplenomegaly,
headache, mouth sores,
neurologic manifestations: CNS
involvement, increased
intracranial pressure (nausea,
Low RBC count, Hgb, Hct,
platelet count. Low, normal, or
high WBC count. High LDH.
Transverse lines of rarefaction
at ends of metaphysis of long
bones on x-ray. Hypercellular
bone marrow with
lymphoblasts. Lymphoblasts
also possible in cerebrospinal
fluid. Presence of Philadelphia
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vomiting, lethargy, cranial nerve
dysfunction) secondary to
meningeal infiltration.
chromosome (20%-25% of
patients).
Chronic Myelogenous
Leukemia (CML)
Increase in incidence with
advancing age after 55 yr.
No symptoms early in disease.
Fatigue and weakness, fever,
sternal tenderness, weight loss,
joint pain, bone pain, massive
splenomegaly, increase in
sweating.
Low RBC count, Hgb, Hct. High
platelet count early, lower
out later. ↑ Neutrophils,
normal number of lymphocytes,
and normal or low number of
monocytes. Low leukocyte
alkaline phosphatase. Presence
of Philadelphia chromosome in
90% of patients.
Chronic Lymphocytic Leukemia
(CLL)
Increase in incidence with
advancing age after 50 yr, with
predominance in men.
Frequently no symptoms.
Detection of disease often
during examination for
unrelated condition, chronic
fatigue, anorexia, splenomegaly
and lymphadenopathy,
hepatomegaly. May progress to
fever, night sweats, weight loss,
fatigue, and frequent infections.
Mild anemia and
thrombocytopenia with disease
progression. Total WBC count
>,/μL. Irease i
peripheral lymphocytes and
lymphocytes in bone marrow.
Hypogammaglobulinemia. May
have autoimmune hemolytic
anemia, idiopathic
thrombocytopenic purpura.
CNS, Central nervous system;
LDH, lactate dehydrogenase
marrow by leukemic myeloblasts and, to a lesser extent, to infiltration of other organs and tissue.
Acute lymphocytic leukemia (ALL) is the most common type of leukemia in children and accounts for
about 20% of acute leukemia cases in adults. In ALL, immature lymphocytes proliferate in the bone
marrow; most are of B cell origin. Fever is present in the majority of patients at time of diagnosis. Signs
and symptoms may appear abruptly with bleeding or fever, or they may be insidious with progressive
weakness, fatigue, and bleeding tendencies.
Chronic myelogenous leukemia (CML) is caused by excessive development of mature neoplastic
granulocytes in the bone marrow. CML usually has a chronic stable phase that lasts for several years,
followed by the development of an acute aggressive phase (blastic phase).
• ■The Philadelphia chromosome, which is present in 90% to 95% of patients with CML, is a diagnostic
hallmark of CML. In addition, its presence is an important indicator of residual disease or relapse
after treatment.
Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults and is characterized by the
production and accumulation of functionally inactive but long-lived, small, mature-appearing
lymphocytes. The B lymphocyte is usually involved. Lymph node enlargement (lymphadenopathy) is
present throughout the body. Because CLL is usually a disease of older adults, treatment decisions must
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Document Summary
Leukemia is a general term used to describe a group of malignant disorders affecting the blood and blood-forming tissues of the bone marrow, lymph system, and spleen. It results in an accumulation of dysfunctional cells because of a loss of regulation in cell division. Although leukemia is often thought of as a disease of children, the number of adults affected is 10 times that of children. Regardless of the specific type, leukemia has no single cause. Most types of leukemia result from a combination of factors including genetic and environmental influences. Leukemia can be classified based on acute versus chronic disease and on the type of wbc involved. By combining the acute and chronic categories with the cell type involved, four major types of leukemia can be identified. Table 58 summarizes the relative incidence and features of the four types of leukemia.
