ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Principles Of And A General Overview On The Supportive Treatment Of Acute Leukemias

Updated on January 21, 2014

A Leukemia Patient

Many tissues in the body such as the brain, meninges, CSF cisterns and testes act as sanctuaries for the leukemic cells since the systemically administered drugs do not freely reach them.
Many tissues in the body such as the brain, meninges, CSF cisterns and testes act as sanctuaries for the leukemic cells since the systemically administered drugs do not freely reach them. | Source

A General Overview

Management of leukemia requires the coordinated efforts of the physician, oncologist, radiotherapist and the blood bank officer. The services of a well- equipped laboratory are absolutely essential for proper work up of the case and follow up. When the disease is clinically evident, the tumour load is heavy and the malignant tissue proliferates rapidly. At this stage, it is essential to reduce the tumour load within a short time by the use of intensive chemotherapy. This phase is called “induction of remission”. The patient is deemed to have achieved remission when the clinical hematological abnormalities (both blood and bone marrow) have disappeard. Even at this stage, although tumour cells are not demonstrable by the usual laboratory techniques, 105-6 tumour cells persist in the body which are capable of proliferating and infiltrating the bone marrow and blood. This is the common cause for relapse.

Many tissues in the body such as the brain, meninges, CSF cisterns and testes act as sanctuaries for the leukemic cells since the systemically administered drugs do not freely reach them. The residual leukemic tissue in the brain and CSF is destroyed by radiotherapy applied over the skull and spine and drugs like methotrexate or cytosine arabinoside introduced intrathecally. This constitutes neuroprophylaxis.

Undergoing Chemotherapy

The present schedules of chemotherapy do not eradicate the leukemic cells completely. Hence maintenance therapy is given after the achievement of remission to prevent the surviving cells from proliferating and leading to relapse.
The present schedules of chemotherapy do not eradicate the leukemic cells completely. Hence maintenance therapy is given after the achievement of remission to prevent the surviving cells from proliferating and leading to relapse. | Source

Leukemia Treatment

Testicular involvement occurs in 10-15% of ALL cases before the onset of therapy. This usually clears up with chemotherapy. Next to the central nervous system, testes is the most frequent sanctuary site where leukemic cells proliferate. Though overt testicular leukemia is treated by local irradiation, at present there is no consensus regarding testicular prophylaxis. The present schedules of chemotherapy do not eradicate the leukemic cells completely. Hence maintenance therapy is given after the achievement of remission to prevent the surviving cells from proliferating and leading to relapse. Maintenance therapy is generally given for 3-5 years after which it could be withdrawn. During maintenance, regular short intensive regimen as given for induction are included in many treatment protocols. These pseudo-induction regimen are given to ensure that the leukemic cells do not reach significant numbers. It is possible that if the leukemic cell population is kept low, immunological defences of the host will eliminate them. Attempts have been made in the past to stimulate the host’s immune mechanisms nonspecifically and specifically, but this has not proven to be predictably effective.

A modern approach to the problem of eradicating the residual leukemic cells is the use of monoclonal immunoglobulins which selectively destroy the malignant cells. This is under trial. The total duration of treatment is generally limited to 5 years since the majority of patients attain freedom from the leukemic process by this period. Many of those who remain in the first remission without relapse achieve long-term survival (above 10 years) and cure, though a few may relapse even after this interval. In those in whom relapse occurs, survival is considerably shortened. Relapses are treated on the same lines as initial induction.

Intravenous Injection Administration

Special care of intravenous lines and injection sites, and Prophylactic use of antimicrobial drugs like cotrimoxazole and nystatin with a view to sterilize the gut flora.
Special care of intravenous lines and injection sites, and Prophylactic use of antimicrobial drugs like cotrimoxazole and nystatin with a view to sterilize the gut flora. | Source

Infections: Common Manifestation Of Acute Leukemia

Infections are very common in the active phase of acute leukemia, especially during the induction phase, because of impairment of cellular and humoral defence mechanisms. They account for 80% of deaths during induction and remission. The common infective agents include the pyogenic cocci, gram negative bacilli, Pseudomonas aerugenosa, anaerobes, Candida spp and the herpes viruses. Relatively avirulent organisms such as Mycoplasma pneumonia and Pneumocystis carinii become invasive and account for many deaths. The risk of tuberculosis flaring up during treatment with corticosteroids is also high. Fulminant infections are seen most frequently during the stage of induction. Bacterial infections are common when the neutrophil count is below 1000/cmm. Infection may be nosocomial or endogenous from the flora inhabiting the alimentary tract. Several methods have been employed to prevent such infections. These include:

  1. The provision of an isolated sterilized environment
  2. Reverse barrier nursing to avoid infection from attendants
  3. Provision of sterilized articles for food and drink
  4. Special care of intravenous lines and injection sites, and
  5. Prophylactic use of antimicrobial drugs like cotrimoxazole and nystatin with a view to sterilize the gut flora.

Radiation Therapy

The total duration of treatment is generally limited to 5 years since the majority of patients attain freedom from the leukemic process by this period. Many of those who remain in the first remission without relapse achieve long-term survival (above
The total duration of treatment is generally limited to 5 years since the majority of patients attain freedom from the leukemic process by this period. Many of those who remain in the first remission without relapse achieve long-term survival (above | Source

Fighting Infections In Acute Leukemia

Prophylactic antimicrobial drugs are started prior to the induction of remission and are continued during the phase of leucopenia. Systemic infection should be anticipated when there are early symptoms like fever and rigor or nay local lesions such as furuncles, cellulitis or ulcers. A combination of bactericidal antibiotics such as gentamicin 80mg, 8 hourly and carbenicillin 5g given intravenously 6 hourly should be instituted early, after taking blood for cultuyre and bacteriological specimens from the nose, throat, mouth, anus and genitalia for culture and sensitivity studies. Superficial candidiasis is treated by administering nystatin 500,000 units every 6 hours orally and more serious fungal infections by amphoterecin B in a dose of 1 mg/Kg body weigh intravenously. Antiviral drugs such as vidarabin 5 mg/kg/day or acyclovir 5mg/Kg/intravenously every 8 hours may be given for treating herpes and other viral infections. Pneumocystis carinii infection responds to cotrimoxazole in a daily dose of 9-12 g given in divided doses.

Delay in starting chemotherapy results in heavy mortality and hence it is necessary to start treatment on clinical grounds, even before bacteriological evidence is obtained. The advent of newer antimicrobial agents has been a great help in treating these patients. Granulocyte transfusion have been used in many centers and found to be beneficial during this period of severe leucopenia. They serve to reduce the risk of infections. Repeated infusions of 1011 granulocytes may be required. This facility is not available in many centers in developing countries. Granulocyte transfusions may result in sensitization. Use of granulocyte transfusion is restricted to selected cases at present.

© 2014 Funom Theophilus Makama

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)