Childhood acute lymphoblastic leukemia: current perspectives.

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.