การพยาบาลผู้ป่วยเด็กโรคมะเร็งเม็ดเลือดขาวเฉียบพลันชนิดลิมโฟบลาสต์ที่ได้รับยาเคมีบำบัด : หลักการพยาบาลและการนำไปใช้ทางคลินิก

Somporn Poonpanitoopatum

Authors

Somporn Poonpanitoopatum Department of Nursing Service, Ramathibodi Hospital, Mahidol University

Keywords:

nursing care of pediatric oncology patients, acute lymphoblastic leukemia, chemotherapy drugs

Abstract

Acute lymphoblastic leukemia (ALL) is a hematologic malignancy characterized by abnormal proliferation and impaired differentiation of leukocyte precursor cells, resulting in the accumulation of malignant cells within the bone marrow. These leukemic cells progressively replace normal hematopoietic cells, leading to bone marrow failure, manifested as anemia, neutropenia with an increased risk of infection, and thrombocytopenia with bleeding complications. Standard treatment for pediatric ALL primarily involves chemotherapy administered in four major phases, including remission induction, consolidation/ intensification, central nervous system prophylaxis, and maintenance. The primary goal of treatment is to ensure patient safety throughout hospitalization, particularly during chemotherapy administration. However, chemotherapy-related adverse effects can significantly affect the physical and psychological well-being of pediatric patients as well as their family members. Therefore, nurses play a crucial role in achieving desirable clinical outcomes through comprehensive and evidence-based care. Pediatric oncology nurses are required to possess extensive knowledge of the pathophysiology of ALL, its clinical manifestations, diagnostic investigations, principles of chemotherapy, and nursing interventions to prevent treatment-related complications. Integrating clinical practice guidelines and evidence-based practice into patient and family care is essential for promoting safety, optimizing treatment outcomes, and improving quality of life for children with ALL and their families.

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References

Agrwal, S., & Sahi, P. K. (2020). National comprehensive cancer network guidelines for pediatric acute lymphoblastic leukemia. Indian Pediatrics, 57(6), 561–564. https://doi.org/10.1007/s13312-020-1855-1

Aungkaprasatchai, W., Chaimongkol, N., Hengudomsub, P., & Hendricks-Ferguson, V. L. (2024). A pilot study of a family management program for parents of children with acute lymphoblastic leukemia. Seminars in Oncology Nursing, 40(3), 151648. https://doi.org/10.1016/j.soncn.2024.151648

Bunyatisai, W., Jia-Mahasap, B., & Chitapanarux, I. (2019). Treatment outcomes of acute lymphoblastic leukemia in both children and adults using the Thai pediatric oncology group-based protocol at Chiang Mai University hospital. Journal of Thai Association of Radiation Oncology, 25(1), 12-18.

Burke, M. J., & Rheingold, S. R. (2017). Differentiating hypersensitivity versus infusion-related reactions in pediatric patients receiving intravenous asparaginase therapy for acute lymphoblastic leukemia. Leukemia & Lymphoma, 58(3), 540–551. https://doi.org/10.1080/10428194.2016.1213826

Carobolante, F., Chiaretti, S., Skert, C., & Bassan, R. (2020). Practical guidance for the management of acute lymphoblastic leukemia in the adolescent and young adult population. Therapeutic Advances in Hematology, 11, 1-25. https://doi.org/10.1177/2040620720903531

Cheyprasert, W. (2017). Common pediatric cancers: Basic knowledge, diagnosis, and treatment. Chiang Mai: Phapphim Publishing.

Durfee, E. (2022). Tumor lysis syndrome. Critical Care Nurse, 42(3), 19–25. https://doi.org/10.4037/ccn2022795

Gupta, K., Walton, R., & Kataria, S. P. (2021). Chemotherapy-induced nausea and vomiting: Pathogenesis, recommendations, and new trends. Cancer Treatment and Research Communications, 26, 100278. https://doi.org/10.1016/j.ctarc.2020.100278

Hanafy, N., Khedr, R., Abdelwahab, E., & Abouelnaga, S. (2018). Enhancing a specialized nursing care guidelines improves acute lymphoblastic leukemia patients' outcome during induction phase: A developing country experience. Blood, 132(Suppl1), 5850. https://doi.org/10.1182/blood-2018-99-119160

Hayashi, H., Makimoto, A., & Yuza, Y. (2024). Treatment of pediatric acute lymphoblastic leukemia: A historical perspective. Cancers, 16(4), 723. https://doi.org/10.3390/cancers16040723

Hoelzer, D., Bassan, R., Dombret, H., Fielding, A., Ribera, J. M., Buske, C., . . . ESMO Guidelines Committee (2016). Acute lymphoblastic leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 27(suppl 5), v69–v82. https://doi.org/10.1093/annonc/mdw025

Inaba, H., Teachey, D., Annesley, C., Batra, S., Beck, J., Colace, S., . . . Stehman, K. (2025). Pediatric acute lymphoblastic leukemia, Version 2.2025, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 23(2), 41–62. https://doi.org/10.6004/jnccn.2025.0006

Jinna, S., Karra, S., Penney, S. W., & Khandhar, P. B. (2025). Thrombocytopenia. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK542208/

Kantarjian, H., Pui, C. H., & Jabbour, E. (2025). Acute lymphocytic leukaemia. Lancet, 406(10506), 950–962. https://doi.org/10.1016/S0140-6736(25)00864-5

Karol, S. E., & Pui, C. H. (2020). Personalized therapy in pediatric high-risk B-cell acute lymphoblastic leukemia. Therapeutic Advances in Hematology, 11, 1-16. https://doi.org/10.1177/2040620720927575

Kim, J. T., Park, J. Y., Lee, H. J., & Cheon, Y. J. (2020). Guidelines for the management of extravasation. Journal of Educational Evaluation for Health Professions, 17, 21. https://doi.org/10.3352/jeehp.2020.17.21

Lee, J. W., & Cho, B. (2017). Prognostic factors and treatment of pediatric acute lymphoblastic leukemia. Korean Journal of Pediatrics, 60(5), 129–137. https://doi.org/10.3345/kjp.2017.60.5.129

Lertvivatpong, N. & Rujkijyanont, P. (2024). Childhood acute lymphoblastic leukemia. Journal of Hematology and Transfusion Medicine, 34(1), 57-65.

Lertvivatpong, N., Rujkijyanont, P., Traivaree C., & Monsereenusorn, C. (2025). Prognostic factors and outcomes of pediatric acute lymphoblastic leukemia using ThaiPOG protocols: A single institute experience. Journal of Hematology and Transfusion Medicine, 35(1), 1-10. https://doi.org/10.69898/jhtm.35.2025.274105

Malard, F., & Mohty, M. (2020). Acute lymphoblastic leukaemia. Lancet, 395(10230), 1146–1162. https://doi.org/10.1016/S0140-6736(19)33018-1

Mulrooney, D. A., Hyun, G., Ness, K. K., Bhakta, N., Pui, C. H., Ehrhardt, M. J., . . . Hudson, M. M. (2019). The changing burden of long-term health outcomes in survivors of childhood acute lymphoblastic leukaemia: A retrospective analysis of the St Jude Lifetime Cohort Study. The Lancet Haematology, 6(6), e306–e316. https://doi.org/10.1016/S2352-3026(19)30050-X

Murtaza, G., Faqah, A., Konowitz, N., Lu, H., Kuruvilla, A., & Adhikari, S. (2017). Acute pancreatitis related to a chemotherapy drug. World Journal of Oncology, 8(1), 18–19. https://doi.org/10.14740/wjon1006e

Puckett, Y., Chan, O., & Doerr, C. (2023). Acute lymphocytic leukemia (Nursing). StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK568716/

Quintanilla-Flores, D. L., Flores-Caballero, M. Á., Rodríguez-Gutiérrez, R., Tamez-Pérez, H. E., & González-González, J. G. (2014). Acute pancreatitis and diabetic ketoacidosis following l-asparaginase/prednisone therapy in acute lymphoblastic leukemia. Case Reports in Oncological Medicine, 2014, 139169. https://doi.org/10.1155/2014/139169

Roberts, K. G. (2018). Genetics and prognosis of ALL in children vs adults. Hematology. American Society of Hematology. Education Program, 2018(1), 137–145. https://doi.org/10.1182/asheducation-2018.1.137

Russell, T. B., & Kram, D. E. (2020). Tumor lysis syndrome. Pediatrics in Review, 41(1), 20–26. https://doi.org/10.1542/pir.2018-0243

Shah, B., Mattison, R. J., Abboud, R., Abdelmessieh, P., Aldoss, I., Burke, P. W., . . . Stehman, K. (2024). Acute lymphoblastic leukemia, version 2.2024, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer, 22(8), 563–576. https://doi.org/10.6004/jnccn.2024.0051

Siegel, R. L., Giaquinto, A. N., & Jemal, A. (2024). Cancer statistics, 2024. A Cancer Journal for Clinicians, 74(1), 12–49. https://doi.org/10.3322/caac.21820

Strategy and Planning Division, The Ministry of Public Health. (2025). Public Health Statistics A.D. 2024. Nonthaburi: The Ministry of Public Health.

Terwilliger, T., & Abdul-Hay, M. (2017). Acute lymphoblastic leukemia: A comprehensive review and 2017 update. Blood Cancer Journal, 7(6), e577. https://doi.org/10.1038/bcj.2017.53

The Hematology Association of Thailand. (2018). Guidelines for the treatment of pediatric cancers. Bangkok: Sahamit Printing and Publishing.

Thomas, T., Clark, C., Backler, C., Bohlke, K., Centofanti, D., Jotwani, A. C., . . . Morgan, R. L. (2025). ONS/ASCO Guideline on the management of antineoplastic extravasation. Clinical Journal of Oncology Nursing, 29(5), 384–399. https://doi.org/10.1188/25.CJON.384-399

Vokurka, S., Maňásek, V., Hrabánková Navrátilová, D., Šípová, S., Šustková, Z., . . . Wintnerová, J. (2020). Extravasation (paravasation) of chemotherapy drugs - updated recommendations (2020) for standard care in the Czech Republic from the cooperation of the Supportive Care Group of the Czech Society for Oncology, Czech Society for Hematology, Oncology Section of the Czech Nurses Association and the Society for Ports and Permanent Catheters. Klinicka Onkologie, 33(5), 390–395. https://doi.org/10.14735/amko2020390

White, V. M., Skaczkowski, G., Pinkerton, R., Coory, M., Osborn, M., Bibby, H., . . . Anazodo, A. (2018). Clinical management of Australian adolescents and young adults with acute lymphoblastic and myeloid leukemias: A national population-based study. Pediatric Blood & Cancer, 65(11), e27349. https://doi.org/10.1002/pbc.27349

Xu, Z. N., Gao, L. P., Wang, X. K., Yu, X. L., Cong, Y., & Wang, P. J. (2025). Optimizing nursing care for neutropenic patients: A holistic perspective on education, support, and clinical management. Frontiers in Medicine, 12, 1633708. https://doi.org/10.3389/fmed.2025.1633708

Yokoe, T., Hayashida, T., Nagayama, A., Nakashoji, A., Maeda, H., Seki, T., . . . Kitagawa, Y. (2019). Effectiveness of antiemetic regimens for highly emetogenic chemotherapy-induced nausea and vomiting: A systematic review and network meta-analysis. The Oncologist, 24(6), e347–e357. https://doi.org/10.1634/theoncologist.2018-0140

Zhu, Z., & Yan, J. (2025). Molecular genetic characteristics and clinical significance of childhood acute lymphoblastic leukemia. Frontiers in Pediatrics, 13, 1665431. https://doi.org/10.3389/fped.2025.1665431