How to treat lymphocytic leukemia folk remedies. What is chronic lymphocytic leukemia What is the phenotype characteristic of chronic lymphocytic leukemia cells

Chronic lymphocytic leukemia (CLL) occurs in 25-30% of all leukemia cases and is the most common type of leukemia among cancer patients. average age who is 72 years old. The prevalence of the disease in this age category seriously limits therapeutic options due to a significant number of comorbidities.

The causes of CLL remain unknown to date, however, scientific studies point to some factors contributing to its development, incl. genetic and immune disorders, severe viral infections.

As a rule, chronic lymphocytic leukemia is a latent disease; in 70% of patients, its asymptomatic course is observed. The disease is discovered by chance, during a routine blood test, which shows high level leukocytes in the blood combined with a low number of red blood cells. Only 30% of patients at the time of diagnosis have the following symptoms:

• fatigue;
• tendency to frequent infections;
• causeless increase in body temperature above 38 ° C;
• subcutaneous hemorrhages;
• pallor of the skin,
• an unusual rash similar to that of Cesari's syndrome;
• cardiopalmus;
• dyspnea;
• night sweats;
• a feeling of fullness in the lower abdomen, indicating an enlarged spleen;
• increase lymph nodes.

Among the first systemic clinical symptoms there is a rapid (for 6 months) and significant weight loss, sometimes exceeding 10% of body weight, an unreasonable increase in body temperature, observed for two or more weeks, weakness.

Clinical manifestations of chronic lymphocytic leukemia

CLL is characterized by the accumulation of functionally immature white blood cells (lymphocytes) in the bone marrow, blood, lymph nodes, spleen, and other organs.

Functionally immature white blood cells, which live longer than normal lymphocytes, begin to accumulate and “crowd out” healthy blood cells. Gradually, a deficiency of normal blood cells develops, accompanied by anemia, thrombocytopenia; there is a tendency to bruising and bleeding; due to impaired immune response, recurrent infections are life-threatening.

Malignant changes in the immune system contribute to the development of other types of cancer: every fourth patient with CLL has other malignant neoplasms, such as colon, lung or skin cancer.

Clarification of the diagnosis

Diagnosis of chronic lymphocytic leukemia is based on the results of blood and bone marrow tests.
The basis for the diagnosis of CLL is the immunophenotyping of leukocytes, which allows to determine which protein dominates on the surface of lymphocytes.

An increase in the number of leukocytes and specific changes in the ratio of lymphocytes in the bone marrow confirm the presence of the disease. To choose an effective method of therapy and make a prognosis, it is necessary to assess the severity of the disease, which is determined based on the quantitative indicators of lymphocytes in the blood and their level in the bone marrow. It is also necessary to assess the size of the hematopoietic organs - the liver and spleen - their increase indicates an increase in the number of malignant lymphocytes in the lymph nodes and their spread to these organs.

Depending on the stage of chronic lymphocytic leukemia, the average duration of patients can range from 18 months to 10 years.

Treatment of chronic lymphocytic leukemia

As a rule, CLL progresses slowly, which makes it possible to delay the start of treatment for several years, until the increase in lymphocytes in the bone marrow and a decrease in the values ​​of red blood cells and platelets in the blood.

Drug treatment of CLL does not provide a complete cure, and the drugs themselves can cause multiple severe side effects. Usually, anticancer drugs (often in combination with corticosteroids) are indicated only with a significant increase in the number of lymphocytes. Such treatment usually produces significant improvements quickly, but this is often temporary. In general, the use of corticosteroids for a long time can aggravate the situation, making the patient more susceptible to various types severe infections.

There are two types of lymphocytes in human blood: B-lymphocytes, which are immune cells responsible for the production of antibodies, and T-lymphocytes. Almost 95% of patients suffer from B-cell leukemia, for the treatment of which alkylating agents are used that can interact with the DNA of malignant cells and destroy them. Only bone marrow transplantation in combination with the introduction of healthy stem cells will help completely destroy malignant cells, avoid relapses and normalize the process of hematopoiesis.

A new word in the treatment of chronic lymphocytic leukemia

Significant containment of the progression of chronic lymphocytic leukemia, and in combination with chlorambucil - and increase the patient's survival - contributes to the use of monoclonal antibodies. Monoclonal antibodies are large protein molecules with a complex spatial structure, produced inside living cells using the latest advances in molecular biology and genetic engineering.

Unlike chemotherapy, treatment of CLL with the new method makes it possible to make tumor cells "visible" to the immune system and destroy them without harming healthy cells. Such an innovative approach increases the patient's chance for a long life, not overshadowed by the progression of the disease.

Description:

Chronic lymphocytic leukemia is a cancer of the lymphatic tissue in which tumor lymphocytes accumulate in the peripheral blood, bone marrow, and lymph nodes. Unlike acute leukemia, the tumor grows rather slowly, as a result of which hematopoietic disorders develop only in the later stages of the disease.

Symptoms of chronic lymphocytic leukemia:

Weakness
Enlarged lymph nodes
Heaviness in the abdomen (in the left hypochondrium)
Tendency to infections
sweating
Weight loss

Most often, the first symptom of chronic lymphocytic leukemia is an increase in the size of the lymph nodes. Due to the enlargement of the spleen, there may be a feeling of heaviness in the abdomen. Often, patients experience significant general weakness, lose weight, they have an increased incidence of infectious diseases. Symptoms develop gradually over a long period of time. In about 25% of cases, the disease is discovered by chance during a blood test prescribed for another reason (medical examination, examination for a non-hematological disease).

Stages of chronic lymphocytic leukemia:

There are several approaches to determining the stages of chronic lymphocytic leukemia - the Rai system, Binet and the International Working Group on Chronic Lymphocytic Leukemia. All of them take into account the fact that the life expectancy of patients with chronic lymphocytic leukemia depends on the extent of the tumor (the number of affected groups of lymph nodes) and the degree of hematopoiesis in the bone marrow. Violation of bone marrow hematopoiesis caused by tumor growth in the bone marrow leads to the development of anemia (a decrease in the number of red blood cells in the blood) and thrombocytopenia (a decrease in the number of platelets). Determining the stage of chronic lymphocytic leukemia allows you to decide on the need to start treatment and choose the most appropriate therapy regimen for this patient.

In accordance with the modern staging system for chronic lymphocytic leukemia, proposed by the International Working Group on Chronic Lymphocytic Leukemia, there are three stages:
Stage A - with the defeat of no more than 2 groups of lymph nodes (or in the absence of their defeat); and missing.
Stage B - 3 or more groups of lymph nodes are affected; thrombocytopenia and anemia are absent.
Stage C - the presence of thrombocytopenia or anemia, regardless of the number of affected groups of lymph nodes.

Depending on the presence of certain symptoms, Roman numerals can be added to the letter designation of the stage of chronic lymphocytic leukemia:
I - in the presence of lymphadenopathy
II - with an increase in the spleen (splenomegaly)
III - in the presence of anemia
IV - in the presence of thrombocytopenia

Diagnostics:

In order to make a diagnosis of chronic lymphocytic leukemia, it is necessary to carry out the following studies:
Medical examination
Clinical blood test with leukocyte count
Bone marrow examination reveals a lesion pattern characteristic of this disease.
Immunophenotyping of bone marrow and peripheral blood cells reveals specific immunological markers characteristic of tumor cells in chronic lymphocytic leukemia.
Biopsy of the affected lymph node with its morphological and immunological examination.
Determination of the level of β 2-microglobulin helps to predict the course of the disease.
Cytogenetic analysis allows obtaining data on the characteristics of tumor cells, which in some cases have prognostic value.
Determining the level of immunoglobulins allows you to determine how high the risk of developing infectious complications in a given patient.

Treatment of chronic lymphocytic leukemia:

For treatment appoint:

Unlike many other tumors, it is believed that in chronic lymphocytic leukemia it is not advisable to carry out therapy in the early stages of the disease. This is due to the fact that in most patients in the initial stages of chronic lymphocytic leukemia, the disease is "smoldering" in nature, and patients can go without treatment for a long time, feeling normal and maintaining their usual lifestyle. Treatment should be started only when signs of progression of the disease appear, which include:
Rapid increase in the number of lymphocytes in the blood
Progressive enlargement of lymph nodes
Significant enlargement of the spleen
Increasing anemia and thrombocytopenia
The appearance of symptoms of a tumor - fever, night sweats, weight loss, severe weakness

There are several approaches to the treatment of chronic lymphocytic leukemia:
Chemotherapy with chlorbutine has until recently been the standard treatment for chronic lymphocytic leukemia. At present, the use of a new group of drugs, the so-called purine analogues, of which Fludara is a representative, has been proven to be more effective.
TO effective methods treatment of chronic lymphocytic leukemia include bioimmunotherapy using monoclonal antibodies. The introduction of these drugs allows selective destruction of tumor cells without damaging healthy tissues of the body.
With the unsatisfactory effectiveness of other methods of treatment, high-dose chemotherapy with transplantation of hematopoietic stem cells can be carried out. applied as helper method treatment in the presence of a large tumor mass.
Removal of the spleen (splenectomy) is sometimes indicated with a significant increase in this organ.

The choice of treatment method is a very important decision, which must be based on accurate data regarding the diagnosis, taking into account the individual characteristics of the patient. Discussion of treatment issues with the patient and, if he wishes, with his relatives is an integral part of the approval of the overall treatment program.

Lymphocytic leukemia - what it is, and what this term means, becomes clear when its synonym, lymphocytic leukemia, is used. Leukemia is an oncological process, a malignant, clonal, neoplastic disease of the hematopoietic system. Lymphatic leukemia is also a malignant, clonal oncohematological disease.

Lymphoid tissue undergoes pathological growth, which is observed in the lymph nodes, hepatobiliary system, spleen, and bone marrow, and eventually spreads to various organs and tissues, and this happens depending on the nature and stage pathological process. The causes of occurrence are variable factors, which include hereditary predisposition, gender of the patient, age criteria and race. The appearance of this disease is considered the most common oncohematological lesion among the male half of the representatives of the Caucasian race.

What is lymphocytic leukemia

Many patients do not know what kind of lymphocytic leukemia disease is, and are not even aware of its existence. People with a minimum stock of medical knowledge are usually familiar with the term leukemia, but, approximately believing that this is blood cancer, they do not even suspect that this is not one disease, but a whole group of diseases, variable in etiology. In lymphocytic leukemia, lymphatic tissues, nodes and cells are affected. Lymphocytic leukemia is a malignant process that leads to negative changes in lymphocytes, gradually spreading to the lymph nodes and lymphoid tissues.

All blood cells are in continuous circulation. This is the result of a characteristic change in the immunophenotype of lymphocytes, which are already cancerous cells. The process spreads through the bone marrow and peripheral blood. These cells are involved in the process of pathological transformation and immune system and other blood cells. The result of this is an increase in the number of leukocytes, which are no longer the usual 19-37% of lymphocytes, but more than 90%. But a high percentage of lymphocytes in the blood does not mean that they perform their functions, because these are the so-called "new", atypical cells that are no longer responsible for immunity.

In the normal state, B-lymphocytes go through several stages of development and are responsible for humoral immunity, reaching the final stage and forming a plasma cell. Having turned into an atypical formation, they begin to accumulate in an immature form in the hematopoietic organs, as a result of which healthy tissues are infected and the number of leukocytes increases. Serious pathologies develop, immunity decreases, functional failures in organs and systems are noted. The patient's condition begins to deteriorate, the body can not resist viral and infectious diseases. But the affected spleen, and liver, and destruction of bone marrow cells - all this leads to the fact that the patient's condition worsens. It is much more difficult to tolerate the manifestations of diseases due to weakened immunity, and over time it turns out to be defenseless against lymphocytic leukemia, which affected the organs and tissues of the body.

Reasons for the appearance

Lymphocytic leukemia in children is a specific disease, also known as acute lymphoblastic anemia, the symptoms of which are most often observed in children aged 2 to 4 years. The emergence of cases of the disease in adults and the elderly, often manifested in modern conditions. This is due to the deterioration of the environmental situation and the weakening of natural immunity. The root cause of the pathology is considered to be the formation of a cell clone, a group of blood cells of an atypical structure, arising from different reasons– from the exchange of regions between two chromosomes to amplification, when there is an additional copying of one of the regions. This occurs, presumably, even in fetal development and refers to common phenomena. But in order for atypical cells to begin uncontrolled reproduction, an additional provoking factor is needed. The reasons that trigger the division of atypical cells, invasion of lymphoid tissues and damage to the lymph nodes include various negative reasons:

• unfavorable conditions for gestation and contact of the mother during gestation with toxic substances;
• viral and infectious diseases (there is an unproven theory about a virus that starts the process of division and accelerates the development of a tumor);
• genetic predisposition or congenital anomalies;
• taking cytostatics and a history of oncology in close relatives;
• unproven assumption about influence radiotherapy after another oncological disease.

None of these causes is confirmed in the process of studying the course of the disease. There are neither reliable statistical data nor a sufficient number of clinical studies that would confirm the proposed hypotheses.

Classification

The disease is standardly classified into two types: acute lymphocytic leukemia and chronic. Acute lymphocytic leukemia is also called lymphoblastic, the chronic form is sometimes referred to as lymphocytic lymphocytic leukemia.

The acute stage is defined by numerous accompanying symptoms and is confirmed by a study of the number of leukocytes in a blood test. However, laboratory studies are undertaken only to confirm the diagnosis, which presumably can already be established by the rapid deterioration of the patient's well-being, sudden and sharp general weakness, the presence of an acute stage of the disease with a rapidly developing negative scenario.

• benign, proceeding with a relatively slow growth of lymphocytes, sometimes for decades, remaining at the same level;
• progressive form, sometimes called classic: this form develops faster and is accompanied by damage to the lymph nodes;
• tumor is characterized by the growth of lymph nodes, the tonsils also increase in size, but there is no increase in the level of leukocytes, or it rises slightly;
• splenomegalic is accompanied by a significant growth of the liver and spleen, sometimes with concomitant moderate intoxication;
• bone marrow, in which proliferating lymphocytes partially or massively replace the bone marrow, and complications are observed in the form of cytolysis;
• prolymphocytic - a rapidly developing form with an increase in both lymph nodes and spleen:
• paraproteinemic lymphocytic leukemia, for which hallmark serves as a pathological secretion of B-lymphocytes by a cell clone (monoclonal gammopathy);
• hairy cell leukemia, accompanied by the development of hemorrhagic syndrome, associated both with a change in the structure of lymphocytes and granulocytopenia, or cytopenia;
• T-cell, quite rarely manifested, with the characteristic presence of anemia (thrombocytopenia and anemia appear due to lesions of the skin tissue and lower dermal layers as a result of the infiltration process).

Acute and chronic (CLL) processes involve different methods therapy, a differentiated approach to predicting life expectancy in lymphocytic leukemia, and variable tactics in relation to patients after treatment.

stages

There are 4 stages of CLL, when the development of the disease reaches certain negative signs:

1. Damage to 1 organ or group of lymph nodes;
2. The formation of several lymphocytic zones;
3. Inflammatory process in the lymph nodes around the diaphragm;
4. Active development of symptoms of previous stages with damage to tissues of non-lymphoid organs.

In patients, damage lymphatic system often proceeds in a rather lubricated form, and the stage can only be determined in laboratory studies.

Symptoms

Symptoms of lymphocytic leukemia do not always give rise to suspicion. They are expressed in significant weakness, loss of appetite, increased sweating, a drop in resistance and a tendency to various diseases. Laboratory research make it possible to detect anemia and thrombocytopenia, a decrease in the number of neutrophils, the presence of pathological cells in the peripheral blood. Often, the disease is detected during research in rheumatology or therapy with suspected pathology of the hepatobiliary system. But the main signs - an increase in lymph nodes and a sharp weakening of the immune system lead to the need for a thorough examination.

Diagnostics

Preliminary diagnosis of lymphocytic leukemia is carried out on the basis of anamnesis, visual examination, palpation of the lymph nodes, and examination of the condition of the skin. But the final diagnosis childhood and in adults, it is possible only after studying the indicators of blood tests, which give reason to diagnose lymphocytic leukemia. Blood tests are given as follows:

• general;
• biochemical;
• immunophenotyping (for the presence of a specific oncomarker);
• myelogram.

Treatment

The tactics of treating lymphocytic leukemia is determined on the basis of existing features development and stage and laboratory tests. Treatment for benign lymphocytic leukemia may be observation, diet, or intermittent herbal treatment. With prolymphocytic lymphocytic leukemia, a massive drug treatment, a radical change in diet. In some forms, the main condition is good nutrition and treatment. folk remedies carried out at the request of the patient and in agreement with the attending physician. But with lymphocytic leukemia, which is accompanied by the rapid growth of atypical lymphocytes, damage to the lymph nodes and internal organs, chemotherapy and even sometimes removal of the spleen are needed. At this stage of lymphocytic leukemia, folk remedies can hardly improve the condition.

Forecast

The prognosis depends on the individual manifestation of lymphocytic leukemia, and on how timely treatment was started. If all the lymph nodes have not been affected, the intermediate risk category and statistical survival leave certain chances for recovery and optimistic prognosis with timely treatment started.

For many people, a diagnosis of lymphocytic leukemia or blood cancer sounds like a death sentence. But few people know that over the past 15 years, a powerful drug arsenal has appeared in medicine, thanks to which it is possible to achieve long-term remission or the so-called “relative cure”, and even the abolition of pharmacological drugs.

What is lymphocytic leukemia and what causes it?

This cancer, in which leukocytes, bone marrow, peripheral blood are affected, and lymphoid organs are involved in the process.

Scientists are inclined to believe that the cause of the disease lies at the genetic level. The so-called family predisposition is very pronounced. It is believed that the risk of developing the disease in the closest relatives, namely in children, is 8 times higher. At the same time, a certain gene disease-causing, was not found.

The disease is most common in America, Canada, Western Europe. And almost a rarity is lymphocytic leukemia in Asia and Japan. Even among representatives of Asian countries who were born and raised in America, this disease is extremely rare. Such long-term observations led to the conclusion that the factors environment do not affect the development of the disease.

Lymphocytic leukemia can also develop as a secondary disease after radiation therapy (in 10% of cases).

It is assumed that some congenital pathologies can lead to the development of the disease: Down syndrome, Wiskott-Aldrich syndrome.

Forms of the disease

Acute lymphocytic leukemia (ALL) is a cancer that is morphologically represented by immature lymphocytes (lymphoblasts). There are no specific symptoms by which an unambiguous diagnosis can be made.

Chronic lymphocytic leukemia (CLL) is a tumor consisting of mature lymphocytes and is a long-term sluggish disease.

Symptoms

Symptoms characteristic of LL:

• enlargement of peripheral lymph nodes, liver, spleen;
• increased sweating, skin rashes, slight fever:
• loss of appetite, weight loss, chronic fatigue;
• muscle weakness, bone pain;
• immunodeficiency ─ the immunological reactivity of the body is disturbed, infections are added;
• immune hemolysis ─ damage to red blood cells;
• immune thrombocytopenia ─ leads to hemorrhages, bleeding, presence;
• secondary tumors.

Stages of lymphocytic leukemia depending on the form of the disease

ALL stages:

1. Primary attack ─ the period of manifestation of the first symptoms, an appointment with a doctor, an accurate diagnosis.
2. Remission (weakening or disappearance of symptoms) ─ occurs after treatment. If this period lasts more than five years, then the patient is diagnosed with a complete recovery. However, every six months you need to conduct a clinical blood test.
3. Relapse is the recurrence of the disease against the background of an apparent recovery.
4. Resistance ─ resistance and resistance to chemotherapy, when several courses of treatment have not yielded results.
5. Early mortality ─ the patient dies at the beginning of chemotherapy treatment.

The stages of CLL depend on blood parameters and on the degree of involvement of lymphoid organs (lymph nodes of the head and neck, armpits, groin, spleen, liver) in the pathological process:

1. Stage A - pathology covers less than three areas, severe lymphocytosis, low risk, survival more than 10 years.
2. Stage B - three or more areas affected, lymphocytosis, moderate or intermediate risk, survival 5-9 years.
3. Stage C - all lymph nodes are affected, lymphocytosis, thrombocytopenia, high risk, survival 1.5-3 years.

What is included in the diagnosis?

Standard examinations for diagnosis:

1. Clinical research methods ─ a detailed blood test (leukocyte formula).
2. Immunophenotyping of leukocytes is a diagnostic that characterizes cells (determines their type and functional state). This allows you to understand the nature of the disease and predict its further development.
3. Trepanobiopsy of the bone marrow ─ puncture with the extraction of an integral fragment of the bone marrow. In order for the method to be as informative as possible, the tissue taken must retain its structure.
4. Cytogenetic research is obligatory in oncohematology. The method is an analysis of the chromosomes of bone marrow cells under a microscope.
5. Molecular biological research ─ gene diagnostics, DNA and RNA analysis. It helps to diagnose the disease at an early stage, plan and justify further treatment.
6. Immunochemical analysis of blood and urine ─ determines the parameters of leukocytes.

Modern treatment of lymphocytic leukemia

The treatment approach for ALL and CLL is different.

Therapy of acute lymphocytic leukemia takes place in two stages:

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1. The first stage is aimed at achieving a stable remission by destroying pathological leukocytes in the bone marrow and blood.
2. The second stage (post-remission therapy) is the destruction of inactive leukocytes, which in the future can lead to a relapse.

Standard treatments for ALL:

Chemotherapy

Systematic (drugs enter the general circulation), intrathecal (chemotherapeutic drugs are injected into the spinal canal, where the cerebrospinal fluid is located), regional (drugs act on a specific organ).

Radiation therapy

It can be external (irradiation with a special apparatus) and internal (placement of hermetically packed radioactive substances in the tumor itself or near it). If there is a risk of tumor spread to the central nervous system, then external radiation therapy is used.

TCM or THC

Transplantation of bone marrow or hematopoietic stem cells (blood cell precursors).

biological therapy

It is aimed at restoring and stimulating the patient's immunity.

Restoration and normalization of the bone marrow occurs no earlier than two years after chemotherapy treatment.

For the treatment of CLL, chemotherapy and TKI therapy ─ tyrosine kinase inhibitors are used. Scientists have isolated proteins (tyrosine kinases) that promote the growth and production of white blood cells from stem cells. TKI drugs block this function.

Prognosis and life expectancy

Cancer is the second leading cause of death in the world. The share of lymphocytic leukemia in these statistics does not exceed 2.8%.

Important!

The acute form mainly develops in children and adolescents. Forecast for a favorable outcome in conditions innovative technologies treatment is very high and amounts to more than 90%. At the age of 2-6 years, almost 100% recovery occurs. But one condition must be observed ─ timely application for specialized medical care!

The chronic form is a disease of adults. There is a clear pattern in the development of the disease associated with the age of patients. The older the person, the greater the likelihood of occurrence. For example, at the age of 50, 4 cases per 100,000 people are recorded, and at 80 years old, this is already 30 cases for the same number of people. The peak of the disease occurs at 60 years of age. lymphocytic leukemia more common in men, it is 2/3 of all cases. The reason for this gender differentiation is not clear. The chronic form is incurable, but the ten-year survival prognosis is 70% (over the years, the disease has never relapsed).

Lymphocytic leukemia is a malignant lesion that occurs in the lymphatic tissue. It is characterized by the accumulation of tumor lymphocytes in the lymph nodes, in the peripheral blood and in the bone marrow. The acute form of lymphocytic leukemia has recently been classified as a “childhood” disease due to its exposure mainly to patients aged two to four years. Today, lymphocytic leukemia, the symptoms of which are characterized by their own specificity, is observed more often among adults.

general description

The specificity of malignant neoplasms as a whole is reduced to a pathology accompanied by the formation of cells, whose division occurs in an uncontrolled manner with the subsequent ability to invade (that is, to invade) the tissues adjacent to them. At the same time, they also have the possibility of metastasizing (or moving) to organs located at a certain distance from them. This pathology is directly related to both tissue proliferation and cell division that arose due to one or another type of genetic disorder.

With regard specifically to lymphocytic leukemia, as we have already noted, it is a malignant disease, while the growth of lymphoid tissue occurs in the lymph nodes, in the bone marrow, in the liver, in the spleen, and also in some other types of organs. Mostly the diagnosis of pathology is noted in the Caucasian race, and for every one hundred thousand people annually there are about three cases of the disease. Basically, the defeat of the disease occurs among the elderly, while the male sex is twice as likely to be affected by lymphocytic leukemia than the female. In addition, the predisposition to the disease is also determined by the influence of the hereditary factor.

The existing classification, which determines the course and specifics of the disease, distinguishes two forms of lymphocytic leukemia: acute (lymphoblastic) leukemia and chronic leukemia (lymphocytic leukemia).

Acute lymphocytic leukemia: symptoms

To diagnose this form of the disease, peripheral blood is used, in which characteristic blasts are found in about 98% of the total number of cases. A blood smear is characterized by a "leukemic dip" (or "gaping"), that is, there are only mature cells and blasts, there are no intermediate stages. The acute form of lymphocytic leukemia is characterized by normochromic anemia, as well as. Somewhat less common are other signs of an acute form of lymphocytic leukemia, namely leukopenia and leukocytosis.

In some cases, consideration of the overall blood picture in combination with symptoms suggests the relevance of acute lymphocytic leukemia, however, diagnostic accuracy is possible only when conducting a study that affects the bone marrow, in particular, to characterize its blasts histologically, cytogenetically and cytochemically.

The main symptoms of the acute form of leukocytosis are as follows:

• Complaints of patients on general malaise, weakness;
• Loss of appetite;
• Change (decrease) in weight;
• Unmotivated rise in temperature;
• Anemia, provoking pallor of the skin;
• Shortness of breath, cough (dry);
• Stomach ache;
• Nausea;
• Headache;
• The state of general intoxication in the widest variety of manifestations. Intoxication defines this type of condition in which there is a violation of the normal functioning of the body due to the penetration or formation of toxic substances in it. In other words, this is a general poisoning of the body, and depending on the degree of its damage against this background, the symptoms of intoxication are determined, which, as noted, can be very different: nausea and vomiting, headache, diarrhea, abdominal pain - a disorder of the functions of the gastrointestinal tract; symptoms of cardiac arrhythmia (arrhythmia, tachycardia, etc.); symptoms of dysfunction of the central nervous system(dizziness, depression, hallucinations, impaired visual acuity), etc. ;
• Pain in the region of the spine and limbs;
• Irritability;
• An increase in the development of the disease of peripheral lymph nodes. In some cases - mediastinal lymph nodes. The mediastinal lymph nodes, in turn, are divided into 4 main groups: the lymph nodes of the upper mediastinum to the site of the bifurcation of the trachea; retrosternal lymph nodes (in the area behind the sternum); bifurcation lymph nodes (lymph nodes of the lower tracheobroncheal region); lymph nodes of the region of the lower posterior mediastinum .;
• About half of the total number of cases of the disease is characterized by the development of hemorrhagic syndrome with its characteristic hemorrhages - these are petechiae. Petechiae are a small type of hemorrhage, focusing mainly on the skin, in some cases on the mucous membranes, their sizes can be different, from a pinhead to the size of a pea;
• The formation of foci of extramedullary lesions in the central nervous system provokes the development of neuroleukemia;
• In rare cases, testicular infiltration occurs - such a lesion in which they increase in size, predominantly such an increase is unilateral (respectively, the leukemic nature of the occurrence is diagnosed in about 1-3% of cases).

Chronic lymphocytic leukemia: symptoms

In this case, it is about oncological disease lymphatic tissue, for which a characteristic manifestation is the accumulation of tumor lymphocytes in the peripheral blood. When compared with acute form lymphocytic leukemia, it can be distinguished that the chronic form is characterized by its slower course. As for violations of hematopoiesis, they occur only at a late stage of the course of the disease.

Modern oncologists use several types of approaches that allow you to determine the accuracy of compliance with a particular stage. chronic form lymphocytic leukemia. Life expectancy among patients suffering from this disease depends directly on two factors. In particular, these include the degree of disturbance in the bone marrow of the process of hematopoiesis and the degree of prevalence, which is characteristic of a malignant neoplasm. Chronic lymphocytic leukemia, in accordance with the general symptoms, is divided into the following stages:

• Initial stage (A). It is characterized by a slight increase in the area of ​​the lymph nodes of one or two groups. For a long time, the trend in blood leukocytosis does not increase. Patients remain under medical supervision, without the need for cytostatic therapy. Thrombocytopenia and anemia are absent.
• Expanded stage (B). In this case, leukocytosis takes on an increasing form, the lymph nodes increase on a progressive or generalized scale. Recurrent infections develop. For the advanced stage of the disease, appropriate active therapy is required. Thrombocytopenia and anemia are also absent.
• Terminal stage (C). This includes cases in which malignant transformation of the chronic form of leukocytosis occurs. Thrombocytopenia occurs and, regardless of the susceptibility to the defeat of a particular group of lymph nodes.

The letter designation is often displayed using Roman numerals, which also determine the specifics of the disease and the presence of certain of its signs in the patient in a particular case:

• I - in this case, the figure indicates the presence of lymphadenopathy (that is, an increase in lymph nodes);
• II - an indication of an increase in the size of the spleen;
• III - an indication of the presence of anemia;
• IV - an indication of the presence of thrombocytopenia.

Let us dwell in more detail on the main symptoms that characterize chronic lymphocytic leukemia. Here, the following manifestations become relevant, the development of which is gradual and slow:

• General weakness and malaise (asthenia);
• Feeling of heaviness that occurs in the abdomen (especially from the left hypochondrium);
• Sudden weight loss;
• Enlarged lymph nodes;
• Increased susceptibility to various types of infections;
• excessive sweating;
• Decreased appetite;
• Enlargement of the liver (hepatomegaly);
• Enlargement of the spleen (splenomegaly);
• Anemia;
• Thrombocytopenia (a symptom characterized by a decrease in the concentration of platelets in the blood below a certain norm);
• Neutropenia. In this case, we mean a symptom characterized by a decrease in the blood of neutrophilic granulocytes. Neutropenia, which in this case acts as a symptom of the underlying disease (lymphocytic leukemia itself), is a disease accompanied by a change (decrease) in the number of neutrophils (neutrophilic granulocytes) in the blood. Neutrophils in particular are blood cells that mature in the bone marrow within a period of two weeks. Due to these cells, the subsequent destruction of foreign agents that may be in the circulatory system occurs. Thus, against the background of a decrease in the number of neutrophils in the blood, our body becomes more susceptible to the development of certain infectious diseases. Similarly, this symptom is attached to lymphocytic leukemia;
• The occurrence of frequently manifested allergic reactions.

Chronic lymphocytic leukemia: forms of the disease

Morphological and Clinical signs diseases determine a detailed classification of chronic lymphocytic leukemia, which also indicates the appropriate response to the treatment produced. The main forms of chronic lymphocytic leukemia include:

• Benign form;
• Classical (progressive) form;
• Tumor form;
• Splenomegalic form (with enlargement of the spleen);
• Bone marrow form;
• A form of chronic lymphocytic leukemia with a complication in the form of cytolysis;
• Prolymphocytic form;
• Leukemia hairy cell;
• T-cell form.

Benign form. It provokes a slow and noticeable increase only over the years in the blood of lymphocytosis, which is also accompanied by an increase in the number of leukocytes in it. It is noteworthy that in this form the disease can last for a considerable time, up to decades. The ability to work is not impaired. In most cases, when patients are under observation, sternal puncture and histological examination lymph nodes are not carried out. These studies have a significant effect on the psyche, while neither they nor cytostatic medications may, due to similar features of the course of the disease, be needed at all until the end of the patient's life.

Classical (progressive) form. It begins by analogy with the form of the previous one, however, the number of leukocytes increases from month to month, and the growth of lymph nodes is also observed, which can be dough-like in consistency, slightly elastic and soft. The appointment of cytostatic therapy is carried out in case of a noticeable increase in the manifestations of the disease, as well as in the case of growth of lymph nodes and leukocytosis.

tumor form. Here, the peculiarity lies in the significant increase in the consistency and density of the lymph nodes, while leukocytosis is low. There is an increase in the tonsils almost to their closure with each other. The spleen enlarges to moderate levels, in some cases the increase can be significant, up to a protrusion within a few centimeters in the hypochondrium. Intoxication in this case has a mild character.

Bone form. It is characterized by rapidly progressive pancytopenia, partial or total replacement by mature lymphocytes in their diffusely growing bone marrow stage. There is no enlargement of the lymph nodes; in the vast majority of cases, the spleen is not enlarged, as is the liver. As for morphological changes, they are characterized by the homogeneity of the structure that nuclear chromatin acquires, in some cases pictonicity is observed in it, structural elements are rarely determined. It is noteworthy that earlier this form was fatal, with a life expectancy with the disease of up to 2 years.

Prolymphocytic form. The difference lies primarily in the morphology of lymphocytes. Clinical features are characterized by the rapid development of this form with a significant increase in the spleen, as well as with a moderate increase in peripheral lymph nodes.

Chronic lymphocytic leukemia with paraproteinemia.Clinical picture has the usual features of the forms listed above, accompanied by monoclonal gammopathy type G- or M-.

Hairy cell form. In this case, the name defines the structural features of lymphocytes, which represent the development of the process of chronic lymphocytic leukemia in this form. The clinical picture has characteristic features, which consist in cytopenia in one form or another (moderation / severity). The spleen is enlarged, the lymph nodes are of normal size. The course of the disease in this form is different, up to the complete absence of signs of progression for many years. There is granulocytopenia, in some cases provoking the occurrence of fatal complications of an infectious nature, as well as thrombocytopenia, characterized by the presence of a hemorrhagic syndrome.

T-shape. This form accounts for about 5% of cases. Infiltration affects mainly skin tissue and deep layers of the dermis. The blood is characterized by leukocytosis in varying degrees its severity, neutropenia, anemia occurs.

Lymphocytic leukemia: treatment of the disease

The peculiarity of the treatment of lymphocytic leukemia is that experts agree on the inappropriateness of its implementation at an early stage. This is due to the fact that the majority of patients during initial stages the course of the disease carries it in a "smoldering" form. Accordingly, a long time can be dispensed with without the need to take medicines, as well as to live without any restrictions, while being in a relatively good condition.

Therapy is performed for chronic lymphocytic leukemia, and only if there are grounds for this in the form of characteristic and striking manifestations of the disease. Thus, the expediency of treatment arises if there is a rapid increase in the number of lymphocytes, as well as with the progression of an increase in lymph nodes, a rapid and significant increase in the spleen, an increase in anemia and thrombocytopenia.

Treatment is also necessary if signs characteristic of tumor intoxication occur. They consist in increased sweating at night, in rapid weight loss, constant weakness and fever.

Today, it is actively used for treatment chemotherapy. Until recently, chlorbutin was used for procedures, but now the greatest effectiveness of treatment is achieved with the use of purine analogues. The current solution is bioimmunotherapy, the method of which involves the use of antibodies of the monoclonal type. Their introduction provokes the selective destruction of tumor cells, while damage to healthy tissues does not occur.

In the absence of the desired effect in the use of these methods, the doctor prescribes high-dose chemotherapy, which involves the subsequent transplantation of hematopoietic stem cells. In the presence of a significant tumor mass in a patient, it is used radiation therapy, serving as adjuvant therapy in treatment.

A severe enlargement of the spleen may require the complete removal of this organ.

Diagnosis of the disease requires contact with specialists such as a general practitioner and a hematologist.