Acute Lymphoblastic Leukemia ALL Relapse,Radiation Therapy,Precautions

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ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

Related topics

ALL Diagnosis and Prognostic Features

Treatment and Work Up For ALL Patients

Dr Ira Shah
M.D, DCH(Gold Medalist), FCPS, DNB
Edited by Dr. Bharat R Agarwal
Consultant Pediatric Hematologist and Oncologist.

Q. How to manage a relapse?

A. Relapse may occur during or after completion of therapy and may occur in the bone marrow, testes or CNS. Allogenic bone marrow transplant should be considered in early relapse in therapy or within 6 months of termination of therapy or late marrow relapse with high tumor load as indicated by a peripheral blast count of 10,000/ul or more. For patients with late relapse (> 36 months in remission), a primary chemotherapy approach should be considered with bone marrow transplantation reserved for a subsequent marrow relapse.

Q. What is radiation therapy?

A. Radiation therapy is treatment with high-energy x- rays. High levels of radiation can kill cells and keep them from growing and diving. There is no pain or discomfort during the treatment. It is like having an ordinary x-ray taken except that the child needs to be held still for a few minutes.

The area to be irradiated is marked with a dye. This dye should not be washed off for the duration of therapy as it serves as a guide for aiming the radiation. While radiation therapy is being received, soap or lotion should not be used on these lines or within the radiation field, where the skin becomes tender. The area should also be kept dry.

There are various side effects of radiation therapy-

Skin damage - The skin in the treated area may be sensitive and therefore should be protected against sunlight and irritation. Sun blocking lotion containing PABA should be used to prevent burning. If the head is affected, soft hats and scarves may be worth. Body power, cornstarch, topical antibiotics or steroids may relieve itching, pain and speed healing.
Sore throat -
Hair loss - is usually temporary with hair growth beginning about 3 months after completion of treatment.
Nausea, vomiting & headaches - These last for about 4-5 hours and are relieved by anti-emetics.
Diarrhea - It is usually after radiation to the abdomen or pelvic area. It usually responds to simple measures.
Late effects - Following irradiation to the brain / CNS, some children may be drowsy. This symptom may begin at various times and may be seen as late as 5-7 weeks after therapy has been completed. It usually lasts about 5 to 10 days.
Long term effects - Radiation therapy to the head may affect intelligence / coordination. Also, growth may be affected. There is increased possibility of developing a secondary tumor at the radiation site.

Q. What are the precautions advised to patients?

A. The following precautious are advised to the patients while on therapy:

Immunization - To avoid live viral vaccines.

Mouth care - Teeth should be brushed after each meal using soft toothbrush. To prevent the severe tooth decay that can result when saliva flow is reduced from radiation to the head and neck, fluoride mouthwash may be recommended. Infants and toddlers may be given mouth care by wrapping a soft cloth around the parent's finger and gently wiping the teeth and gums with a solution of mouth rinse. When a patient has low blood counts, mouth care should be gentle.

Bleeding - Contact sports should be avoided. To control bleeding, apply pressure with a clean cloth till bleeding stops.

Danger signs - If the child shows any of the following symptoms, the parents should immediately notify the child's physician.

A fever or other sign of infection, a just "not looking well".
Exposure to a contagious infection especially chicken pox or measles, unless the child is immune from prior exposure.
Persistent headaches pain or discomfort anywhere in the body.
Difficulty in walking or bending.
Pain during urination or bowel movements.
Reddened or swollen areas.
Vomiting unless post chemo/ radiotherapy.
Problems with eyesight such as blurred or double vision.
Bleeding or multiple bruises.
Marked depression or a sudden change in behavior.

Last created on 13-07-2001
Last updated on 01-07-2006

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