Medication
Targeted therapy drugs are the main treatment for chronic myeloid leukemia (CML), but some patients might also need other treatments.
Procedures
The priority action is to make certain the patient does not have a fracture of the spine, as the bone destruction in this disease is sufficiently severe to cause vertebral collapse. A patient who is undergoing chemotherapy for AML complains of pain in his lower back.
Nutrition
Which nursing intervention is most appropriate for a client with multiple myeloma? When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client.
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Keeping the patient on bed rest will not prevent bleeding when the patient has a low platelet count. Assessment for other areas of bleeding is also a priority intervention. The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae.
What are the treatment options for chronic myeloid leukemia (CML)?
What is the priority action in the treatment of acute myeloid leukemia?
Which nursing intervention is most appropriate for a client with multiple myeloma?
Can bed rest prevent bleeding in patients with acute myeloid leukemia (AML)?
What should a nurse do when caring for multiple myeloma patients?
When caring for a client with multiple myeloma, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and balancing rest and activity are appropriate interventions for any client.
What is the name of the abnormal form of hemoglobin in sickle cell anemia?
In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions. A patient presents with peripheral neuropathy and hypothesia of the feet.
What is sickle cell disease?
Explanation: . Sickle cell disease is a hereditary disorder. To manifest this disorder, a person must inherit two defective genes, one from each parent, in which case all the hemoglobin is inherently abnormal. If the person inherits only one gene, he or she carries sickle cell trait.
What does a blood smear reveal?
Explanation: . A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia.
What happens to sickle cells during a vascular occlusion?
The vascular occlusion induces severe pain in the ischemic tissue. The client may have increased tolerance for pain due to the chronic nature of the illness.
What is the treatment for chronic myelogenous leukemia?
Treatment of patients with chronic myelogenous leukemia (CML) is usually initiated when the diagnosis is established, which is done by the presence of an elevated white blood cell count, splenomegaly, thrombocytosis , and identification of the BCR/ABL translocation. [ 1] The optimal front-line treatment for patients with chronic-phase CML is the subject of active clinical evaluation but involves specific inhibitors of the BCR/ABL tyrosine kinase.
What is the best treatment for CML?
The only consistently successful curative treatment of CML has been allogeneic BMT or alloSCT. [ 38 - 40] Patients younger than 60 years with an identical twin or with human leukocyte antigen (HLA)-identical siblings can be considered for BMT early in the chronic phase. Although the procedure is associated with considerable acute morbidity and mortality, 50% to 70% of patients transplanted in the chronic phase survive 2 to 3 years, and the results are better in younger patients, especially those younger than 20 years. The results of patients transplanted in the accelerated and blastic phases of the disease are progressively worse. [ 41, 42] Most transplant series suggest improved survival when the procedure is performed within 1 year of diagnosis. [ 43 - 45 ] [ Level of evidence: 3iiiA] The data supporting early transplant, however, have never been confirmed in controlled trials. In a randomized clinical trial, disease-free survival and OS were comparable when allogeneic transplantation followed preparative therapy with cyclophosphamide and total-body irradiation (TBI) or busulfan and cyclophosphamide without TBI. The latter regimen was associated with less graft-versus-host disease (GVHD) and fewer fevers, hospitalizations, and hospital days. [ 46 ] [ Level of evidence: 1iiA]
What is a Ph1 negative CML?
Ph1-negative CML is a poorly defined entity that is less clearly distinguished from other myeloproliferative syndromes. Patients with Ph1-negative CML generally have a poorer response to treatment and shorter survival than Ph1-positive patients. [ 5] .
What is the cytogenetic abnormality of CML?
CML is a clonal disorder that is usually easily diagnosed because the leukemic cells of more than 95% of patients have a distinctive cytogenetic abnormality, the Philadelphia chromosome (Ph1) . [ 2] .
What is chronic phase CML?
Chronic-phase CML is characterized by bone marrow and cytogenetic findings as described above with less than 10% blasts and promyelocytes in the peripheral blood and bone marrow. [ 7 ]
What is the most sensitive technique for detecting BCR/ABL rearrangement?
A small subset of patients have BCR/ABL rearrangement detectable only by reverse transcriptase–polymerase chain reaction (RT–PCR), which is the most sensitive technique currently available. Patients with RT–PCR evidence of the BCR/ABL fusion gene appear clinically and prognostically identical to patients with a classic Ph1; however, patients who are BCR/ABL -negative by RT–PCR have a clinical course more consistent with chronic myelomonocytic leukemia, which is a distinct clinical entity related to myelodysplastic syndrome. [ 6, 8, 9] Fluorescence in situ hybridization of the BCR/ABL translocation can be performed on the bone marrow aspirate or on the peripheral blood of patients with CML. [ 10 ]
What is bone marrow sampling?
Bone marrow sampling is done to assess cellularity, fibrosis, and cytogenetics . The Philadelphia chromosome (Ph1) is usually more readily apparent in marrow metaphases than in peripheral blood metaphases; in some cases, it may be mashed and reverse transcriptase–polymerase chain reaction (RT–PCR) or fluorescence in situ hybridization (FISH) analyses on blood or marrow aspirates may be necessary to demonstrate the 9;22 translocation.