Chronic lymphocytic leukemia and its impact on the immune system.

Myelosuppression and immunosuppression are terms that often are used interchangeably, yet they have very different meanings. Myelosuppression, which is caused by many types of cancer treatments (e.g., chemotherapy, radiation therapy), occurs when the body's population of blood cells is lowered. In contrast, immunosuppression occurs when the body's immune function is compromised. Diseases of either the B or T lymphocytes (e.g., lymphoma, multiple myeloma, CLL) alter the normal functioning of the lymphocytes, rendering them unable to mount an immune response. With CLL, B lymphocytes are unable to mature into immunoglobulin-producing plasma cells (delGiglio et al., 1993). Multiple myeloma occurs when the plasma cells become malignant (Mansen et al., 1997). Knowledge of the basic principles of immunology assists nurses in understanding the complexities of the immune system and the effects of common cancer treatments. Patients with CLL require astute assessment of infectious symptoms, comprehensive nursing care and symptom management, and education about the disease and its effects. Hays and McCartney (1998) also noted that the challenges of caring for patients with CLL include patient management in the outpatient setting, quality-of-life issues, and ongoing support because of the chronicity of the disease.