Leukemias & Nausea/Vomiting

Posted by Jenna at Thursday, July 28, 2011

Leukemias stem from 2 lines: the myeloid lineage (granulocytes including platelets, monocytes, basophils, eosinophils, neutrophils, & erythrocytes) or the lymphoid lineage (B & T lymphocytes). A leukemia diagnosis is made when >20% of the cells in the bone marrow are blasts, or immature blood cells.

Typical leukemia treatments consist of an induction phase aimed at achieving remission (>5% blasts in the bone marrow & recovery of blood counts), a consolidation phase to eradicate clinically undetectable disease, and a maintenance phase to prevent relapse & prolong remission. CNS prophylaxis is routine during all stages of ALL (acute lymphoblastic leukemia) treatment since the brain & spinal cord serve as a sanctuary for blasts. A cure is considered greater than 5 years out of treatment without return of disease.

ALL accounts for approximately 1 out of every 3 pediatric oncology diagnoses. Patients are usually stratified into 1 of 2 groups: low risk for relapse vs. high risk for relapse. A variety of factors including age, cytogenetics, WBC (white blood cell) count at diagnosis, & phenotype determine which category of treatment the patient will be placed in. Patients are either enrolled in a COG (children’s oncology group) protocol or are treated with the standard of care.

Other cancers that are 'common' in kids include neuroblastoma (cancer of the sympathetic nervous system), Wilm's tumor (mass in one or both kidneys), retinoblastoma (cancer of the retina), rhabdomyosarcoma (cancer of the muscle), osteosarcoma (cancer of the bone), AML (acute myelogenous leukemia), & various brain cancers (gliomas).

Unlike adult oncology, where pharmacists may have more say in the actual selection of chemo, peds oncology is more about supportive care treatment (since most chemo regimens are protocol). The most common supportive care issue in oncology is trying to prevent and also treat a patient's nausea/vomiting related to their chemo regimen. With highly emetogenic chemotherapy agents or regimens, giving scheduled (rather than prn) antiemetics help make sure your patient is as comfortable as possible during their course of treatment. There are a handful of other supportive care measures but I'm sure some of the other bloggers will cover in time.