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Childhood acute lymphoblastic leukemia: current perspectives
1City of Hope National Medical Center, Duarte, CA, USA. wlandier@coh.org
Insights
Childhood acute lymphoblastic leukemia (ALL) treatment is risk-directed, improving cure rates to over 80%. Nurses play a vital role in managing physical and psychosocial care for children with ALL.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Nursing
Background:
- Childhood acute lymphoblastic leukemia (ALL) is a complex hematologic malignancy.
- Understanding epidemiology, diagnosis, and treatment is crucial for improving outcomes.
Observation:
- Treatment strategies for childhood ALL are now risk-stratified.
- Risk-directed therapy optimizes treatment intensity based on prognostic factors.
- Long-term survivors face potential late sequelae, impacting quality of life.
Findings:
- Current risk-directed therapy for childhood ALL achieves cure rates exceeding 80%.
- Tailored treatment minimizes toxicity for low-risk patients and intensifies care for high-risk patients.
- Late treatment effects include neurocognitive, endocrine, oncologic, and cardiac issues.
Implications:
- Nursing care is integral to managing childhood ALL, from diagnosis to long-term follow-up.
- Key nursing interventions include physical and psychosocial support, and patient/family education.
- Nurses foster hope and normalcy, promoting the child's overall health and development.
Purpose/Objectives:
To provide an overview of childhood acute lymphoblastic leukemia (ALL), including epidemiology, clinical presentation, diagnostic classification, prognostic factors, current treatment, long-term sequelae, and nursing management.
Data Sources:
Journal articles, books, and clinical experience.
Data Synthesis:
Childhood ALL is a heterogeneous disorder, and current treatment is tailored to risk factors (e.g., initial white blood count, cytogenetic properties of the leukemic blasts). Risk-directed therapy ensures that children with a higher risk of relapse receive more intensive treatment, whereas those with lower risk disease receive less toxic therapy with decreased potential for treatment-related morbidity. Quality of life in long-term survivors is a significant issue. Late sequelae of treatment can include neurocognitive difficulties, endocrine dysfunction, secondary malignancies, and cardiomyopathy.
Conclusions:
With risk-directed therapy, cure rates for childhood ALL continue to improve. At least 80% of children diagnosed with ALL today are expected to survive their disease.
Implications For Nursing Practice:
Nurses caring for children with ALL can have a significant impact on the children's overall health, from diagnosis through long-term follow-up. Nursing interventions encompass the domains of physical and psychosocial care, as well as patient and family education. Assisting the child and family to maintain normalcy in the face of chronic illness, as well as fostering the family's hope for the future and their belief in the child's potential for survival, are key nursing strategies that promote the child's growth, development, and psychological health.