Closely matched HLA donors may be difficult to find from a donor listing and

Closely matched hla donors may be difficult to find

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Closely matched HLA donors may be difficult to find from a donor listing, and sibling donors are often the closest match. The degree of match is inversely related to the risk for graft rejection and the development of graft-versus-host disease (GVHD). In other words, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and GVHD. GVHD occurs to at least some extent in 11% to 85% of all allogenic HSCT recipients ( Kristovich & Callard, 2010 ). In addition to graft rejection and GVHD, additional initial complications of HSCT are infection, electrolyte imbalance, bleeding, and organ, skin, and mucous membrane toxicities. Long-term complications include impaired growth and fertility related to endocrine dysfunction, developmental delay, cataracts, pulmonary and cardiac disease, avascular necrosis of the bone, and development of secondary cancers. Ricci, 1787 PP: 37. Cellular Regulation 3 & 4 Hodgkin’s Lymphoma Clinical Manifestations Physiological Integrity: Physiological Adaptation Nursing Process: Assessment Applying LYMPHOMAS Lymphomas, or tumors of the lymph tissue (lymph nodes, thymus, spleen), account for about 10% to 15% of cases of childhood cancer ( Graham et al., 2014 ). Lymphomas may be divided into two categories—Hodgkin disease (or Hodgkin lymphoma) and non-Hodgkin lymphoma (NHL), which includes more than a dozen types. Hodgkin disease tends to affect lymph nodes located closer to the body’s surface, such as those in the cervical, axillary, and inguinal areas, whereas NHL tends to affect lymph nodes located more deeply inside the body. Hodgkin Disease In Hodgkin disease, malignant B lymphocytes grow in the lymph tissue, usually starting in one general area of lymph nodes. The presence of Reed–Sternberg cells (giant transformed B lymphocytes with one or two nuclei) differentiates Hodgkin disease from other lymphomas. As the cells multiply, the lymph nodes enlarge, compressing nearby structures, destroying normal cells, and invading other tissues. The cause of Hodgkin disease is still being researched, but there appears to be a link to Epstein–Barr virus infection ( Zupanec, 2010 ). Hodgkin disease is rare in children younger than 5 years of age and is most common in adolescents and young adults; in children 14 years and younger, it is more common in boys than girls ( Zupanec, 2010 ). In addition to the traditional staging (I through IV, depending on the amount of spread; Table 46.8 ), Hodgkin is also classified as A (asymptomatic) or B (presence of symptoms of fever, night sweats, or weight loss of 10% or more). Prognosis depends on the stage of the disease, tumor bulk, and A or B classification (disease classified as A generally carries a better prognosis). Overall, children with Hodgkin disease have a 75% 20-year survival rate ( Graham et al., 2014 ). Complications of Hodgkin disease include liver failure and secondary cancer such as acute nonlymphocytic leukemia and NHL. Chemotherapy, usually with a combination of drugs, is the treatment of choice for children with Hodgkin disease. Radiation therapy may also be necessary. In the child with disease that does not go into remission or in the
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