Patient Encounter Part 4 Creating a Care Plan

After completion of induction and intensification therapy, RH will begin maintenance therapy for 2.5 years.

Which agents are used in maintenance therapy? Why is maintenance therapy of such a long duration?

Create a care plan to include: (a) monitoring parameters during maintenance therapy; (b) a list of drug-related problems to access toxicity during maintenance therapy; and (c) goals of maintenance therapy.

Children who were homozygous for one of the alleles require 6-mercaptopurine dose reductions of 90%, whereas heterozygotes require a dose reduction of approximately 50%. Children with dose reductions had equivalent OS when compared with children receiving full-dose 6-mercaptopurine, suggesting that TPMT polymorphisms are important for drug metabolism and toxicity but play no role in the pathogen-esis of ALL. TPMT screening is recommended for children starting therapy with 6-mercaptopurine, with empirical dose reductions for those with genotypes associated with a deficiency. The addition of intermittent "pulses" of vincristine and a steroid

(usually dexamethasone) to the antimetabolite backbone improves outcome and is en-

couraged in most modern continuation regimens.

The optimal duration of maintenance therapy in both children and adults is unknown, but most regimens are given for 2 to 3 years; extension of the regimen beyond 3 years has not shown any additional benefit.

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