General objectives :

• At the end of teaching group will be able to

explain about leukemia and lymphoma and will
utilize their knowledge while caring for patient
in clinical setting.
 Specific objectives :
At the end of teaching group will be able to :
• define leukemia
• classification of leukemia
• enlist the risk factor
• explain pathophysiology of leukemia
• enlist the sign and symptoms of leukemia
• list down the diagnostic test of leukemia
• explain the management of leukemia
• define lymphoma
• classification of lymphoma
• enlist the risk factor
• enlist the sign and symptoms of leukemia
• list down the diagnostic test
• explain the management
LEUKEMIA

Pretti nhatti
MSC (N) IST YEAR
 INTRODUCTION

• The word Leukemia comes from the Greek leukos

which means “white” and emia which means
“blood”.
• Leukemia is a cancer of blood- forming cells in the
bone marrow. These deranged, immature cells
accumulate in the blood and within organs of the
body. They are not able to carry out the normal
functions of the blood cells. The DNA of the
immature blood cells , mainly white cells ,
becomes damaged in some way.
 LEUKEMIA

It is a type of cancer of the blood or

bone marrow characterized by an
abnormal increase of immature white
blood cells called blasts.
 ETIOLOGY

IONIZING ALKYNATING
RADIATION VIRUSES CHEMOTHER
APY

HAIR DYES FAMILY HISTORY CYTOTOXIC THERAPY

 MATERNAL
CHRONIC DOWN FETAL
EXPOSURE SYNDROME TRANSMISSI
ON
 RISK FACTORS

GENDER AGE

EXPOSURE

FAMILY LIFESTYLE
HISTORY
 PATHOPHYSIOLOGY
Due to etiological factor

In leukemia control is missing or abnormal

Uncontrolled proliferation of leukocytes

Lack of control cause bone marrow to be replaced by

immature& undifferentiated leukocytes
Immature leukocyte that circulate in blood

hepatomegaly
splenomegaly
hyperuricemia
Bone pain
 CLINICAL FEATURES

SWOLLEN UNEXPLAINE FREQUENT

LYMPH D FEVER INFECTIONS
NODES

FATIGUE ,
NIGHT
WEIGHT BRUISING
LOSS

PURPLISH PETECHIAE
PATCHES
CLASSIFICATIION

GENERAL
TYPE SPECIFIC
TYPE
 GENERAL TYPE

ACUTE CHRONIC
LEUKEMIA LEUKEMIA
 ACUTE LEUKEMIA
• Acute leukemia is characterized by a rapid increase
in the number of immature blood cells. The
crowding that results from such cells makes the
bone marrow unable to produce healthy blood
cells.
 CHRONIC LEUKEMIA
• Chronic leukemia is characterized by the excessive
buildup of relatively mature, but still abnormal,
white blood cells. Typically taking months or years
to progress, the cells are produced at a much higher
rate than normal, resulting in many abnormal white
blood cells.
 SPECIFIC LEUKEMIA
• Acute lymphoblastic leukemia (ALL) is the most
common type of leukemia in young children. It also
affects adults, especially those 65 and older..
• .
• Chronic lymphocytic leukemia (CLL) most often
affects adults over the age of 55. It sometimes
occurs in younger adults, but it almost never affects
children. Two-thirds of affected people are men.
• Acute myelogenous leukemia (AML) It is
treated with chemotherapy. The five-year survival
rate is 40%, except for APL (Acute Promyelocytic
Leukemia), which has a survival rate greater than
90%...

• Chronic myelogenous leukemia (CML) It is

treated with imatinib (Gleevec in United States,
Glivec in Europe) or other drugs.The five-year
survival rate is 90%.One subtype is chronic
myelomonocytic leukemia.
DIAGNOSTIC TESTS
HEALTH HISTORY

PHYSICAL
EXAMINATION

BLOOD TEST
SKIN BIOPSY

CYTOGENETIC

X- RAYS

CT SCAN

MRI
MANAGEMENT
ACUTE
LEUKEMIA

CHRONIC
LEUKEMIA
CHEMOTHERAPY

INDUCTION
PHASE

CONSOLI MAINTE
DATION NACE
PHASE PHASE
• Induction Phase:- The client receives an
intensive course of remission. The usual criteria for
complete remission are blast cells less than 5 % of the
bone marrow cells and normal peripheral blood counts

• Consolidation Phase: - Modified courses of

intensive chemotherapy are given to eradicate any
remaining disease. Usually a higher dose of one or
more chemotherapeutic agents is administered.

• Maintenance Phase: - Small doses of different

combinations of chemotherapeutic agents are given
every 3to 4 weeks.
 RADIATION THERAPY
• External beam radiation therapy :In which a machine
delivers a beam of radiation to a specific part of the body ,
is the type of radiation used most often for ALL.
 BIOLOGICAL THERAPY
• Biological or immunotherapy’s are
derived from or target substances
that occur naturally in the body.

• It is used alone as first line

treatment.

• In this therapy the immune system

of the person is boosted by agents
so that he will have a greater
tendency to fight against the
diseases.
• Examples of biological therapy include: interferon
and monoclonal antibodies.
 TARGETED THERAPY
In recent years , new drugs that target specific parts of
cancer cells have been developed. They can sometimes
be helpful even when chemo is not , or they can be used
along with chemo to help it work better. Some of these
drugs can be useful in certain people with ALL:

MIDOSTAURIN ENASIDENIB
 WHAT IS BONE MARROW
TRANSPLANTATION
• Bone marrow transplantation is also called
hematopoietic stem cell transplant is a type of
treatment for cancer. Stem cells are collected from
bone marrow. Today, stem cells are usually collected
from the blood.
• Before the transplant is done, the patient receives
high dose chemotherapy or radiation therapy to
destroy diseased cells.
 SOURCES

PERIPHERAL STEM CELL

BONE MARROW HARVEST

UMBILICAL CORD BLOOD SAMPLE

PERIPHERAL STEM CELL
BONE MARROW HARVEST
UMBILICAL CORD SAMPLE
FOR CHRONIC LEUKEMIA

CHRONIC ACCELERAT
PHASE ED PHASE
 CHRONIC PHASE
• The introduction of imatinib (Gleevec) in 2001
changed the treatment options for patients with
CML, providing a highly effective oral treatment for
newly diagnosed patients .Adverse effects
include edema, GI irritation hematologic toxicity
and rarely hepatotoxicity.
• For patients who cannot tolerate imatinib
mesylate, alpha interferon frequently
eliminates the Ph1 chromosome and blasts.
Adverse effects mainly fatigue and fevers
may be severe.
 ACCELERATED PHASE
• If imatinib is effective, high dose chemotherapy and
leukophoresis may be used to attempt to regain chronic
phase.
• Supportive care and palliative care.
• Lymphocyte proliferation can be suppressed with
chlorambucil (leukeran), cyclophosphamide (cytoxan),
and prednisone (orasone).
• B cell CLL.
• Splenectomy for painful splenomegaly
• Irradiation of painful enlarged lymph nodes.
• Bone marrow transplant and combinations of alpha
interferon and interleukin 2 are also used to treat CLL.
• Chemotherapy: Chlorambucil (leukeran) or
cyclophosphamide (cytoxan) may be given orally to
reduce the manifestations of CLL. Chemotherapy
generally is given for 2 weeks of every month.

• Targeted Therapy: are now being used in the

treatment of CLL. Alemtuzumab (Campath) is a
monoclonal antibody approved by FDA for the
treatment of CLL in clients who have been treated
with alkylating agents and for whom fludarabine
therapy has not been successful.
 BIOLOGICAL THERAPY
• Interferon alpha is the biological therapy
occasionally used to treat CMI.

• It can be given alone or in combination with the

chemotherapy drug cytarabine.

• This drug is usually injected into tissue just under

the skin and sometimes into the muscle
 PREVENTION

CIGGRATTE EXPOSURE TO PREVIOUS

SMOKING BENZENE CHEMOTHERAPY
 NURSING MANAGEMENT
• Nursing Assessment:
• Take nursing history, focusing on weight loose, fever,
pregnancy of infections, progressively increasing
fatigability, shortness of breath, palpitations, visual
changes (retinal bleeding).
• Examine patient for enlarged lymph nodes,
hepatosplenomegaly, evidence of bleeding, abnormal
breath sounds, skin lesions.
• Look for evidence of infections.
• Assess for sign of anemia, bleeding or infection.
• Evaluate splenomegaly, hepatomegaly,
 NURSING DIAGNOSIS
1) Acute pain related to tumour growth, infection.

2) Activity intolerance related to anaemia and adverse

effect of chemotherapy.

3) Risk for infection related to granulocytpenia.

4) Risk for injury related to bleeding.

 Lymphoma

• Lymphoma is a type of cancer that begin in

immune system cells called lymphocytes.
• Lymphoma is a group of blood cancers that
develop from lymphocytes.
• It is effect the lymph nodes, spleen ,
thymus ,bone marrow and other parts of the
body.
 CLASSIFICATION

• Hodgkin lymphoma
• Non Hodgkin lymphoma
 Hodgkin lymphoma

• It is chronic disease , the growth of the tumor

cells take place mainly in the lymphatic node.
• It compromises body’s ability to fight
infection.
 Types of hodkin

• Nodular sclerosis hodgkins disease

• Mixed cellularity hodgkin lymphoma

• Lymphocytic depletion hodgkins disease

(LDHD)
• Lymphocytes rich classic hodgkins lymphoma
 RISK FACTORS
TUBERC H.PYLO
ULOSIS RI

KAPOSIS HIV/
SARCOMA AIDS
 STAGES

STAGE I

STAGE IV STAGE II

STAGE III
 STAGE I
• The cancer is limited to one lymph node.
 STAGE II
• Cancer is in two different lymph nodes or the
cancer is in portion of tissues or an organ and
near by lymph nodes
 STAGE III
• when the cancer moves to lymph nodes both
above and below the diaphragm.
 STAGE IV
• Advanced stage of Hodgkins lymphoma.
• Cancer cells spread in several portion of the
body.
NON HODGKINS LYMPHOMA
• It occurs the cells in the system to abnormally
reproduce eventually causing tumors to grow.
 TYPES
• Lymphoblastic non- hodgkins lymphoma
• Burkitt or non burkitt lymphoma
• Large cell or diffuse histocytes non- hodgkins
lymphoma
• B cell chronic lymphocytic leukemia
• Follicular lymphoma
• Mature or peripheral T cell lymphoma
 Lymphoblastic non- hodgkins lymphoma

• It is occur in about 30 percent of the cases ,

invovled the T cells and usually presents with
a mass is the chest, swollen lymph nodes with
or without bone marrow and central nerves
system.
 Burkitt or non burkitt lymphoma

• It is a non hodgkin disease in which the cell

are under differentiate.
• In this cancer starts in immune cells called B
cells.
• It is associated with impaired immunity and
rapidly fatal if left untreated
Large cell or diffuse histocytes non- hodgkins lymphoma

• Accounts for 25% of the cases.

• Children with this types of non Hodgkin’s
lymphoma usually have lymphatic system
involvement as well as a non lymph structure
(jaw , lung, skin and bone ) involvment
B cell chronic lymphocytic leukemia

• Bone marrow and the the circulating blood

white cell is found mainly in the lymph node.
 Follicular lymphoma
• There are many different kinds of mature T
Cell lymphomas that all together make up
about 4% to 5% of all lyphomas
 Stages

Stage 1

Stage
4
Stage 2

Stage
3
 Stage 1
• Stage 1: is limited to one lymph node group
( neck underarm, groin etc) above the or
below the diaphragm.
 Stage 2

• It is limited to two lymph nodes group on the

same side of the diaphragm.
• NHL is limited to one extra nodal organ and
has spread to one or more lymph node group
on the same side of the diaphargm.
 Stage 3
• NHL is in two lymph node groups with or
without partial involvement of an extra
nodal organ or site above and below the
diaphragm
 Stages 4
• NHL is extensive in one organ or site with or
without NHL in distant lymph nodes.
Physical examination

Biopsy

Lumber puncture
 CT Scan

LYMPHANGIOGRA
M

POSITRON EMISSION
TOMOGRAPHY
MANAGEMENT

CHEMOTHERAPY

RADIATION THERAPY

BONE MARROW TRANSPLANT

 BIOLOGICAL THERAPY

RADIOIMMUNOTHERAPY

SURGERY
SUMMERIZATION
RECAPTULIZATION
ASSIGNMENT