Supportive therapy is an important part of treatment for leukemia. It is given to
treat complications from treatment and the leukemia itself. Some of these
complications can include infection, bleeding and low blood cell counts.
Antibiotics, antivirals and antifungals
Different types of drugs are used to prevent and treat infections. An infection
is when bacteria, viruses or other harmful organisms enter the body and your
immune system cannot destroy them. Your immune system is your body's natural
defence against infection and disease.
You may receive antibiotics, antivirals and antifungals to prevent or treat
bacterial, viral and fungal infections. These are given to help prevent an
infection if your
white blood cell
white blood cell (WBC)
A type of blood cell that helps the body fight infection and diseases.
White blood cells are made in the bone marrow and are found in the blood and lymphatic
tissue. They play an important role in immune response (the immune system’s reaction to
the presence of foreign substances in the body).
Also called leukocyte.
(
WBC) count is too low, the risk of infection is high or the healthcare team
thinks that you have an infection. Antibiotic, antiviral or antifungal drugs are
given orally (by mouth) or
intravenously
intravenous (IV)
Within or into a vein (a blood vessel that carries blood from tissues and organs in the
body to the heart).
(
through an IV).
An infection is a serious complication in people with leukemia. Infections can
be caused by the leukemia as well as treatments such as chemotherapy. Infections
are common in people receiving cancer treatment because it lowers the number of
WBCs. WBCs are an important part of your immune system and play a key role in
defending your body against viruses and bacteria. When your WBC counts are low,
your immune system is less able to fight an infection on its own (called
immunosuppression
immunosuppression
Suppression of the body’s immune system so it is less able to fight infections or
diseases.
Immunosuppression can be caused by certain diseases, such as AIDS or lymphoma. It may
also be a side effect of certain chemotherapy drugs. Doctors may also deliberately
suppress the immune system before organ or stem cell transplants to prevent rejection.
Also called immunocompromised.
or immunocompromised). You will usually need to be treated in the hospital with
infection-fighting drugs.
An infection can start in almost any part of your body. Common locations of an
infection include the skin, mouth,
respiratory tract
respiratory tract
The pathway that air takes from your mouth and nose to your lungs when you breathe in.
The respiratory tract includes the nose, mouth, sinuses around the nose (called the
paranasal sinuses),
pharynx,
larynx(
voice box),
trachea(
windpipe),
bronchi
and
lungs.
(
such as sinuses or
lungs
lung
One of a pair of large organs in the chest (on each side of the heart) that transfer
oxygen from the air to the blood and release carbon dioxide from the blood to the air.
Pulmonary
means referring to or having to do with the lungs, as in pulmonary edema.
)
,
mucous membranes
mucous membrane
The thin, moist layer of tissue that lines some organs and body cavities, including the
nose, mouth, lungs, airways, vagina and gastrointestinal (GI) tract.
Glands in the mucous membrane make mucus (a thick, slippery fluid).
Also called mucosa.
,
blood,
urinary tract
urinary tract
The pathway that urine takes from the kidneys to the urethra.
The muscular sac in the pelvis that receives urine from the ureters (tubes that carry
urine from the kidneys), stores it and passes it from the body through the urethra.
and
kidney
kidney
One of a pair of bean-shaped organs at the back of the abdomen (on each side of the
spine) that maintain the balance of water and minerals in the body, play a role in
regulating blood pressure, produce certain
hormones,
filter waste from the blood and produce urine.
Urine made in the kidneys passes through the ureters to the bladder.
Renal
means referring to or having to do with the kidneys, as in renal failure.
)
and rectum. Examples of infections include
pneumonia
pneumonia
Infection of one or both lungs caused by bacteria, viruses or fungi. Signs and symptoms
include fever, chills, cough with sputum (phlegm), chest pain and shortness of breath.
,
sepsis
sepsis
Widespread infection in the blood or other tissues caused by bacteria. Sepsis usually
causes severe inflammation throughout the body, fever, chills and malaise.
,
shingles
shingles
A painful blister-like rash, usually on one side of the body, caused by the reactivation
of the
varicella zoster virus.
Also called herpes zoster.
and influenza.
The most common symptom of an infection is a
fever
fever
A rise in body temperature above the normal 36.3°C to 37.1°C (measured orally).
Your healthcare team will check your blood cell counts during treatment. You
will be given blood transfusions when needed to replace the blood cells you may
have lost. The types of replacement transfusions used include:
red blood cells
red blood cell (RBC)
A type of blood cell that carries oxygen to and carbon dioxide from tissues in the body.
Red blood cells contain hemoglobin (a protein that carries oxygen and gives blood its
red colour) and are made in the bone marrow.
Also called erythrocyte.
platelets
platelets
A type of blood cell that helps blood to clot. Platelets are made in the bone marrow.
Also called thrombocyte.
fresh frozen
plasma
plasma
The liquid part of blood that carries the blood cells. Plasma contains many proteins and
minerals.
cryoprecipitate (a product that replaces clotting factors)
A substance that stimulates the bone marrow to develop granulocytes (a type of white
blood cell). Granulocytes help defend the body against bacteria, viruses and types of
fungus.
G-CSF is a
cytokine
found naturally in the body. It can also be made in a lab.
G-CSF is a type of
biological therapy
used in cancer treatment to lower the risk of infection and the need for antibiotics.
,
or G-CSFs) may be used to stimulate the production of white blood cells. This
shortens the length of time you will have a low white blood cell count and
lowers the risk of infection.
Growth factors used in supportive therapy for leukemia may include filgrastim
(Neupogen) and pegfilgrastim (Neulasta). These drugs may be given as a
subcutaneous
subcutaneous (SC)
Beneath or just under the skin.
For example, a subcutaneous injection is given by inserting a needle just under the
skin.
Tumour lysis syndrome (TLS) can be life-threatening and needs to be treated
right away. It usually occurs at the start of chemotherapy when many tumour
cells are destroyed rapidly. When the cells die, their contents are released
into the bloodstream. This can create abnormally high levels of uric acid,
potassium and phosphorus. TLS occurs when cancer cells break down so quickly
that kidneys can't remove these substances from the blood fast enough.
The following treatments are used to lower the levels of these substances in the
blood. These treatments may be given orally as a tablet or intravenously.
A procedure that uses a special machine (pheresis machine) to separate and collect
specific white blood cells from withdrawn blood. The remaining blood is then returned to
the body.
Leukapheresis is used to lower a very high white blood cell count in people with cancer
(leukemia) or to remove white blood cells for transfusion.
is a procedure that uses a special machine to remove large numbers of white
blood cells from a sample of blood. The blood is then given back to the person.
This may be done to lower a very high white blood cell count in people with
leukemia.
O'Brien SG, Goldman JM. Diagnosis and treatment of chronic myeloid leukemia. Wiernik PH,
Goldman JM, Dutcher JP & Kyle RA (eds.).
Neoplastic Diseases of the Blood.
5th ed. Springer; 2013: 5: pp. 45-62.
American Cancer Society.
Treating Acute Lymphocytic Leukemia (ALL).
2021.
https://www.cancer.org/.
Kebriaei P, Ravandi F, de Lima M, Champlin R. Management of acute leukemias. DeVita VT Jr.,
Lawrence TS, Rosenberg SA, eds.
DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology.
11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 102:1742–1763..
National Comprehensive Cancer Network.
NCCN Guidelines for Patients: Acute Lymphoblastic Leukemia.
2021.
https://www.nccn.org/.
American Society of Clinical Oncology (ASCO).
Cancer.net: Leukemia - Acute Lymphocytic - ALL.
2017.
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