Types
Acute: rapid onset, blasts predominant. AML (adults), ALL (children most common cancer). Chronic: insidious, mature cells. CLL (elderly, most common adult leukemia), CML (Philadelphia chromosome, bcr-abl). Presentation: bone marrow failure (anemia, thrombocytopenia, neutropenia).
Treatment
AML: induction (7+3 — cytarabine + anthracycline), consolidation, allogeneic SCT. ALL: induction, consolidation, maintenance, CNS prophylaxis (intrathecal). CML: TKIs (imatinib — targets bcr-abl). CLL: observation then targeted therapy (ibrutinib, venetoclax). CAR T-cell for relapsed ALL.
Nursing Care
Neutropenic precautions. Bleeding precautions (thrombocytopenia). Transfusions for anemia. Tumor lysis syndrome: hyperuricemia, hyperkalemia — hydrate, allopurinol/rasburicase. Mucositis: oral care. Psychosocial support. Education: treatment phases, side effects, infection prevention.
Important Notes
- Tumor lysis syndrome within 24-48h of starting chemo in high-burden leukemias — monitor electrolytes, hydrate aggressively.
- Neutropenic patients with fever are medical emergency — cultures and broad-spectrum antibiotics within 1 hour.
Clinical Tips
- Imatinib (Gleevec) transformed CML from fatal to chronic, manageable condition.
- Allopurinol prevents tumor lysis syndrome — give before chemotherapy in high-risk patients.
Summary
Leukemia management requires intensive chemotherapy, stem cell transplant, neutropenic precautions, tumor lysis prevention, and supportive care.
