Pediatric Nursing Demystified

• Induction: Complete remission of leukemic cells (<5% blast cells)
  Steroids and vincristine, L-asparaginase, and possibly doxorubicin
  4- to 6-week session


• Intensification or consolidation therapy: Decrease tumor burden
  L-asparaginase, high-dose methotrexate, leucovorin rescue,
  vincristine, doxorubicin, steroids, cytarabine, and mercaptopurine
  6 months of treatment: Combinations dependent on cell type


• CNS prophylactic therapy: Decrease CNS invasion
  Intrathecal chemotherapy: Methotrexate, cytarabine, and hydrocortisone
  Possible cranial irradiation


• Maintenance: Maintain remission with irradiation as cell type
  indicates:
  Combined drug regimen: Varied drugs (discontinue if toxic side
  effects [myelosuppression with low neutrophil count <1000/mm^3 ])


• Reinduction with relapse: Use of prednisone and vincristine and
  other chemotherapy
  Bone marrow transplantation (BMT) used to treat children with ALL
  and AML:
  Reserved for second remission with ALL
  May be used with first AML remission to improve prognosis


• Radiotherapy to destroy tumor

Nursing Interventions

Reinforce physician’s explanation of diagnosis and treatment plan.

Explain procedure at child’s level of understanding including what will

be seen, felt, heard, and smelled; use drawings when appropriate.

4

CHAPTER 8/ Oncology Conditions^157

Leukemia Type Staging System Factors Examined Findings

Acute lymphoid French-American-British Morphology (structure) L1 (85% of cases

leukemia (ALL) (most (FAB) system and cytochemical and best prognosis),

common form); reactivity of leukemia L2, and L3

cells

Acute myelogenous Eight subgroups

leukemia (AML) (not as related to

prognosis)

Note: Cytochemical markers are also used for staging leukemia because leukemic cell reactions to different chemicals differentiate between
ALL and AML
Chromosome studies may be performed because some children with chromosome abnormalities (trisomy 20, 21, and others) are higher risk
for types of leukemia.
Cell-surface immunologic markers can be used to identify type of cell involved. The common ALL antigen (CALLA)-positive children have
best survival rate.

TABLE 8–2•Staging: Cell Subtype Classification by Morphology for Treatment and

Prognosis