Chapter 30: Managing Hematologic Neoplasms

The underlying pathology often involves the uncontrolled proliferation (clonal development) of hematopoietic stem cells, which disrupts normal bone marrow function and cellular regulation. Leukemias are categorized as acute (abrupt onset, immature blast cells) or chronic (gradual onset, mature leukocytes) and by cell line (myeloid or lymphoid). Acute Myeloid Leukemia (AML) is marked by abnormal myeloid blast cells crowding out normal production, requiring intensive induction and consolidation chemotherapy, focusing nursing care on infection, bleeding, and mucositis prevention. Chronic Myeloid Leukemia (CML) is associated with the characteristic Philadelphia chromosome (BCR-ABL gene), treated effectively with Tyrosine Kinase Inhibitors (TKIs), demanding stringent patient adherence to oral medications. Acute Lymphocytic Leukemia (ALL), prevalent in children, often involves CNS infiltration, necessitating intrathecal therapy alongside systemic agents. Chronic Lymphocytic Leukemia (CLL) affects older adults and is managed through watch-and-wait or targeted therapies, as malignant B cells accumulate due to impaired programmed cell death (apoptosis). The discussion extends to MDSs, which are clonal myeloid disorders resulting in low blood counts (cytopenias) and the risk of transforming into AML, often requiring blood transfusions and chelation for iron overload. MPNs, including Polycythemia Vera (PV), Essential Thrombocythemia (ET), and Primary Myelofibrosis, are defined by the overproduction of specific myeloid cell lines and are often linked to the JAK2 gene mutation; management focuses on reducing blood viscosity (PV via phlebotomy) or platelet counts (ET via cytoreduction) and controlling splenomegaly (myelofibrosis via JAK2 inhibitors). Lymphomas are classified into Hodgkin Lymphoma (HL), characterized by the pathognomonic Reed–Sternberg cell and high curability, and Non-Hodgkin Lymphomas (NHLs), a heterogeneous group that spreads unpredictably and can be indolent or aggressive. Treatment for lymphomas uses stage-based combination chemotherapy and monoclonal antibodies. Finally, Multiple Myeloma (MM), a plasma cell malignancy, is diagnosed by the classic CRAB features (Hypercalcemia, Renal dysfunction, Anemia, Bone destruction) resulting from M protein production and osteoclast activation. Treatment involves novel agent combinations (proteasome inhibitors, immunomodulators) and Autologous Hematopoietic Stem Cell Transplant (AuHSCT), with significant nursing focus on pain management and monitoring for peripheral neuropathy and hypercalcemia.