Supportive Care

This is similar but not identical to AML. This is to some extent individualised depending on the type of treatment the patient is receiving:

IV access - Insertion and care of Hickman, PICC/Midline and standard peripheral IV cannulae.

Infection prophylaxis - Antibacterial, antifungal, Amphotericin nasal spray, antiviral, protective isolation diet, isolation in single room.

The intensity and prolonged duration of induction and consolidation treatments makes fungal infections more likely and often difficult to control. Early diagnosis and treatment is essential. Azole antifungals can interact to increase the neuropathic complications of vincristine, so are relatively contraindicated during parts of treatment when vincristine is used. If an azole is to be used, fluconazole has less interaction than posoconazole or voriconazole. Liposomal amphotericin is a safe antifungal, but like posoconazole is not funded for use prophylactically in adults with ALL.

Pneumocystis pneumonia is much more likely to occur as a consequence of either ALL or the current intensive treatment schedules. PCP prophylaxis will need to be started when the patient is in complete remission.

Tumour lysis syndrome is more likely to occur in ALL than AML. Patients with Burkitt-like leukaemia are at highest risk. Give Allopurinol 300 mg po daily if renal function is normal. Seek advice if creatinine is elevated. Tumour lysis syndrome may occur in ALL, particularly if there is a high tumour burden, e.g. large tumour masses or a high white cell count. Consider Rasburicase for high risk patients.

Antiemetic Guidelines

Pain Management

Psychological Support

Blood and Platelet Transfusions

Nutritional Support

Management of the septic neutropenic patient

Emergencies in Acute Leukaemia

Complications of acute leukaemia and its treatment are an important cause of mortality and morbidity. They include:

Neutropenic sepsis

Tumour lysis syndrome if white count very high (relatively uncommon)

Hyperleucocytosis (recent reviews have not shown benefit of leukapheresis)

Methotrexate-induced stroke-like neurotoxicity. This is seen particularly in phases of treatment which include frequent intrathecal methotrexate. See Bhojwani, D., Sabin, N.D. (2014). "Methotrexate-induced neurotoxicity and leukoencephalopathy in childhood acute lymphoblastic leukemia." J Clin Oncol 32: 949-59.

Cytarabine-induced cerebellar toxicity

Acute promyelocytic leukaemia differentiation syndrome

Thrombo-haemorrhagic syndrome in APML

L-asparaginase-associated thrombosis

Leukaemic meningitis

Neutropenic enterocolitis

Transfusion-associated GVHD


About this Canterbury DHB document (4420):
Document Owner:	Peter Ganly (see Who's Who)
Last Reviewed:	December 2021
Next Review:	December 2024
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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Topic Code: 4420