- 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