Treatment of leukemia involves multimodal therapy, including the use of chemotherapeutic agents with or without cranial irradiation in 3 phases. 1) Remission Induction Therapy includes corticosteroids (usually prednisone), vincristine (Oncovin), L-asparaginase, with or without doxorubicin; 2) CNS Prophylactic Therapy includes intrathecal methotrexate; 3) Maintenance Therapy (or Consolidation) includes weekly methotrexate and daily 6-mercaptopurine.
Supportive Therapies: for the treatment of side effects induced by the chemotherapy agents.
Prophylactic Antibiotic Therapy: to reduce the incidence of infections. Infection is a frequent threat resulting from immunosuppression effects of chemotherapy agents.
Granulocyte Colony-Stimulating Factors (GCSF): filgrastim (Neupogen) IV or subcutaneously 24 hours after chemotherapy is discontinued and is given for 10 to 14 days. GCSF directs granulocyte development, which decreases the duration of the neutropenia.
Replacement of Blood Elements: for the treatment of anemia, agranulocytopenia, and thrombocytopenia.
Prevention and Treatment of Oral Ulcers (Stomatitis): Peridex is the most commonly used mouth rinse to prevent or treat Candida and bacterial infections. Other mouth rinses that can be used include normal saline or baking soda solutions. Antifungal and antibacterial mouthwashes (nystatin) are used after mouth rinses 30 minutes after using Peridex. Use a soft sponge toothbrush (Toothette).
Severe Oral Infections: Acyclovir may be used to treat severe oral lesions.
Prevention and Management of Nausea and Vomiting: administration of antiemetic before the chemotherapy begins (30 minutes to 1 hour) and every 2, 4, or 6 hours for at least 24 hours after chemotherapy.
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