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.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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