Clinical Review

Leukaemia update. Part 2: managing patients with leukaemia in the community

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1932 (Published 09 April 2013) Cite this as: BMJ 2013;346:f1932
  1. Nicholas F Grigoropoulos, clinical research fellow1,
  2. Roger Petter, general practitioner2,
  3. Mars B Van ‘t Veer, consultant haematologist3,
  4. Mike A Scott, clinical director3,
  5. George A Follows, consultant haematologist3
  1. 1Department of Pathology, Division of Molecular Histopathology, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Linton Health Centre, Cambridge, UK
  3. 3Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
  1. Correspondence to: G A Follows george.follows{at}addenbrookes.nhs.uk
  • Accepted 25 February 2013

Summary points

  • Neutropenic fever is a medical emergency and should be suspected in all unwell patients with leukaemia

  • Leukaemia and its treatment can affect all organ systems

  • Chemotherapy can cause psychological disturbances that require a multidisciplinary approach

  • Optimal support for patients with leukaemia involves a balance of community and hospital based care

  • Most intercurrent drugs can be continued throughout leukaemia treatment. Warfarin is usually changed to low molecular weight heparin and antihypertensives may be stopped during septic episodes; antiplatelet drugs are usually stopped if safe

Although curative chemotherapy is typically delivered in the inpatient setting, patients are at home for substantial periods of time while they progress through treatment. Patients with chronic leukaemia are usually treated entirely as outpatients. Almost all of these patients will develop complications from their disease or its treatment, and after completing chemotherapy, some patients will experience late complications. A balance between hospital and community based care is vital to optimise treatment efficacy and avoid unnecessary hospital admissions. This article reviews some of the adverse effects of leukaemia chemotherapy that non-specialists should be aware of and considers the longer term problems seen in survivors.

Sources and selection criteria

We searched PubMed for clinical trials and the Cochrane Library for meta-analyses. We also sought expert opinion from experienced consultant haematologists. Keywords used were leuk(a)emia, chemotherapy, supportive care, and community care. We also reviewed guidelines from the British Committee for Standards in Haematology and the National Institute for Health and Clinical Excellence.

Supporting patients with leukaemia through chemotherapy

Treatment and prevention of infection including neutropenic sepsis

Neutropenic sepsis is a medical emergency, and prompt treatment with intravenous antibiotics is usually life saving.1 Although incidence depends on regimen intensity, all patients on chemotherapy are at risk. Patients may present with non-specific symptoms, rigors, or symptoms associated with the infection site. Patients are advised to contact the acute oncology service available at their local treatment centre, and to monitor …

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