From the Guidelines
A comprehensive care plan for a patient with leukemia should prioritize accurate diagnosis, risk assessment, and treatment with a curative intent, incorporating induction and consolidation chemotherapy, supportive care, and long-term follow-up, as recommended by the 2017 ELN guidelines 1.
Key Components of Care Plan
- Accurate diagnosis and classification of leukemia type
- Risk assessment, including patient's age, initial leucocyte count, AML subtype, karyotype data, and medical conditions
- Treatment with a curative intent, including induction and consolidation chemotherapy
- Supportive care measures, such as antiemetics, infection prophylaxis, and transfusion support
- Long-term follow-up procedures to monitor for relapse and manage late effects of treatment
Induction Chemotherapy
- Should include an anthracycline and cytosine arabinoside, with daunorubicin at least 60 mg/m² and cytarabine 100-200 mg/m² for 7 days 1
- Patients with excessive leucocytosis may require emergency leucapheresis prior to induction chemotherapy
Consolidation Therapy
- Patients entering clinical and hematological remission should receive one to two cycles of consolidation therapy, with options including high-dose cytarabine, allogeneic hematopoietic cell transplantation, or autologous hematopoietic cell transplantation 1
Supportive Care
- Antiemetics, such as ondansetron 8 mg every 8 hours
- Infection prophylaxis, such as fluconazole 400 mg daily and acyclovir 800 mg twice daily
- Transfusion support to maintain hemoglobin above 7-8 g/dL and platelets above 10,000/μL
- Pain management, nutritional support, and psychosocial care
Long-term Follow-up
- Regular monitoring of blood counts, bone marrow status, and treatment toxicities
- Clear thresholds for intervention and management of late effects of treatment
- Consideration of allogeneic hematopoietic cell transplantation for patients with primary refractory disease or those in second complete remission 1
From the FDA Drug Label
Patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in blast crisis (BC), accelerated phase (AP), or in chronic phase (CP) after failure of interferon-alpha therapy. Adult patients with relapsed or refractory Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL). Pediatric patients with newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) in combination with chemotherapy.
A comprehensive care plan for a patient with leukemia should include:
- Monitoring of blood counts: Perform complete blood counts weekly for the first month, biweekly for the second month, and periodically thereafter as clinically indicated.
- Management of cytopenias: Manage with dose reduction, dose interruption, or discontinuation of treatment.
- Monitoring of liver function: Assess liver function before initiation of treatment and monthly thereafter or as clinically indicated.
- Monitoring of cardiac function: Monitor and treat patients with cardiac disease or risk factors for cardiac failure.
- Management of fluid retention: Weigh patients regularly and manage unexpected rapid weight gain by drug interruption and diuretics.
- Monitoring for tumor lysis syndrome: Close monitoring is recommended.
- Monitoring for growth retardation in children: Close monitoring of growth in children under imatinib mesylate treatment is recommended.
- Counseling on pregnancy and contraception: Apprise women of the potential harm to the fetus, and to use effective contraception 2.
- Dose adjustments for hematologic adverse reactions: Dose reduction or treatment interruptions for severe neutropenia and thrombocytopenia are recommended as indicated in Table 1 2.
From the Research
Care Plan Suggestions for Leukemia Patients
A comprehensive care plan for a patient with leukemia should include the following components:
- Medication management: Tyrosine kinase inhibitors (TKIs) such as imatinib, dasatinib, and nilotinib are commonly used to treat chronic myeloid leukemia (CML) 3, 4, 5.
- Monitoring and follow-up: Regular monitoring of the patient's condition, including laboratory tests and molecular testing, is crucial to assess the effectiveness of treatment and detect any potential complications 6.
- Supportive care: Patients with leukemia may experience symptoms such as fatigue, pain, and infection, which require supportive care and management 7.
- Consideration of stem cell transplantation: Allogeneic stem cell transplantation (allo-SCT) may be considered for patients with CML who are resistant to TKIs or in an advanced phase 3, 7.
Factors to Consider in Care Planning
When developing a care plan for a patient with leukemia, the following factors should be considered:
- Patient characteristics: Age, sex, and comorbidities can influence treatment outcomes and should be taken into account when developing a care plan 4, 6.
- Treatment history: Patients who have previously received TKIs or other treatments may require adjusted treatment plans 5, 7.
- Disease phase: Patients with advanced-phase CML may require more aggressive treatment, including allo-SCT 3, 7.
- Medication adherence: Patients with CML may experience non-adherence to TKI therapy, which can impact treatment outcomes 4.
Potential Interventions
Potential interventions to improve care for patients with leukemia include:
- Patient education: Educating patients about their treatment options, potential side effects, and the importance of adherence can improve treatment outcomes 4.
- Medication management: Implementing strategies to improve medication adherence, such as pill boxes or reminders, can help patients stay on track with their treatment regimen 4.
- Supportive care: Providing supportive care, such as pain management and infection prevention, can improve patient quality of life 7.
- Multidisciplinary care: Involving a multidisciplinary team of healthcare professionals, including hematologists, nurses, and social workers, can provide comprehensive care for patients with leukemia 6, 7.