International FAB-classification differentiates acute leukemias according to the type of tumor cells into two large groups - lymphoblastic and non-lymphoblastic. In turn, they can be divided into several subspecies:

1. Acute lymphoblastic leukemias:

• pre-B-form
• B-form
• pre-T-form
• T-shape
• Other or neither T nor B-form

1. Acute non-lymphoblastic or, as they are also called, myeloid leukemias:

Acute myeloid, which is characterized by the appearance of a large number of precursors of granulocytes

Acute monoblastic and acute myelomonoblastic, which are based on active reproduction of monoblasts

Acute megakaryoblastic - develops as a result of active reproduction of platelet precursors, the so-called megakaryocytes

Acute erythroblastic, characterized by increased levels of erythroblasts

1. A separate group is acute undifferentiated leukemia

Symptoms of acute leukemia

Acute myeloid leukemia

Acute myeloid leukemia is characterized by a slight enlargement of the spleen, high body temperature and damage to internal organs.

So, for example, with leukemic pneumonitis, the focus of infiltration and inflammation is in the lungs, causing characteristic symptoms - coughing and fever.

Every fourth patient with myeloid leukemia has leukemic meningitis with severe headaches, fever, chills and neurological symptoms.

At a severe stage in the course of the process, leukemic infiltration of the kidneys may develop, leading to serious renal failure, up to complete urinary retention.

Specific leukemides appear on the skin - pink or light brown formations, the liver enlarges and becomes dense.

With intestinal damage, bloating, stool dilution is observed, severe, unbearable pain appears. In severe cases, ulcers form, cases of perforation are possible.

Acute lymphoblastic leukemia

This variant of the disease is characterized by an increase in the spleen and lymph nodes. As a rule, the pathological process is recorded in the supraclavicular region, first on one side, and then on both. The lymph nodes are dense, painless, and when adjacent organs are compressed, characteristic symptoms may occur.

For example, with an increase in lymph nodes in the mediastinum, a cough may appear, as well as respiratory distress in the form of shortness of breath. The defeat of the mesenteric nodes in the abdominal cavity leads to the appearance of pain in the abdomen. Men may experience induration and pain in the ovaries, most often on one side.

Acute erythromyeloblastic leukemia

In acute erythromyeloblastic leukemia, anemic syndrome comes to the fore - a pronounced decrease in the level of erythrocytes and hemoglobin in the blood, manifested by weakness, pallor and increased fatigue.

Stages of acute leukemia

Doctors-oncologists distinguish five stages of the disease, proceeding with characteristic symptoms:

The initial stage of acute leukemia

This period often runs latently, without pronounced clinical manifestations. It lasts from several months to several years - at this time the pathological process is just beginning, the level of leukocytes changes insignificantly (and their number can both increase and decrease), immature forms appear and anemia develops.

A blood test at this stage is not as informative as a bone marrow study, which allows detecting a large number of blast cells.

Advanced stage of acute leukemia

At this stage, the true symptoms of the disease appear, due to the inhibition of hematopoiesis and the appearance of a large number of immature cells in the peripheral blood.

In the advanced stage of acute leukemia, two variants of the course of the disease can be distinguished:

The patient feels satisfactory, there are no complaints, but at the same time, characteristic signs of leukemia are found in the blood test

The patient has a significant deterioration in well-being, but at the same time without pronounced changes in the peripheral blood

Remission, that is, the period of exacerbation subsiding, can be complete and incomplete.

Complete remission is characterized by the absence of symptoms of the disease, as well as blast cells in the blood. In the bone marrow, the level of immature cells should not exceed 5%.

With incomplete remission, the patient may feel relieved and feel better, but the level of blast cells in the bone marrow remains elevated.

Recurrences of acute leukemia can occur directly in the bone marrow, as well as outside it.

This stage is characterized by a large number of immature leukocytes in the peripheral blood and is accompanied by inhibition of the function of all vital organs. Most often ends in death.

Diagnostics of the acute leukemia

The doctor may suspect the diagnosis of acute leukemia by changes in the blood test, but the key criterion is an increase in blast cells in the bone marrow.

Changes in peripheral blood count

In most cases with acute leukemia, patients develop anemia with a sharp decrease in the level of erythrocytes and hemoglobin. A drop in the level of platelets is also noted (it is restored in the stage of remission and falls again with an exacerbation of the pathological process).

As for leukocytes, a double picture can be observed - both leukopenia, that is, a decrease in the level of leukocytes, and leukocytosis, that is, an increase in the level of these cells. As a rule, pathological blast cells are also present in the blood, but in some cases they may be absent, which does not exclude leukemia.

Leukemia, in which a large number of blast cells are fixed in the blood, is called "leukemic", and leukemia with the absence of blast cells is called "aleukemic".

Changes in the red bone marrow

The study of red bone marrow is the most important criterion for the diagnosis of acute leukemia.

The disease is characterized by a specific picture - an increase in the level of blast cells and inhibition of the formation of erythrocytes.

Another important diagnostic technique is bone trepanobiopsy. Bone sections are sent for biopsy, which in turn allows to identify blast hyperplasia of the red bone marrow and confirm the disease.

Diagnostic criteria for acute leukemia:

30% or more of all cellular elements of the red bone marrow account for blasts

The level of erythrokaryocytes is more than 50%, blasts - not less than 30%

In acute promyelocytic leukemia, the appearance in the bone marrow of specific hypergranular atypical promyelocytes

Treatment of acute leukemia

The treatment regimen for acute leukemia depends on the age and condition of the patient, the type and stage of development of the disease, and is always calculated individually in each case.

There are two main types of therapy for acute leukemia - chemotherapy and surgical treatment - bone marrow transplantation.

Chemotherapy consists of two sequential stages:

The first step is to induce remission. Chemotherapy helps oncologists reduce blast cell levels

The consolidation stage required to kill the remaining cancer cells

Re-induction, as a rule, completely repeating the scheme (drugs, dosages, frequency of administration) of the first stage

In addition to chemotherapy drugs, cytostatics are present in the general treatment regimen.

According to statistics, the total duration of chemotherapy treatment for acute leukemia is about 2 years.

Chemotherapy in combination with cytostatics is an aggressive method of action, causing a number of side effects (nausea, vomiting, deterioration of health, hair loss, etc.). In order to alleviate the patient's condition, concomitant therapy is prescribed. In addition, depending on the condition, antibiotics, detoxification agents, platelet and erythrocyte mass, blood transfusion can be recommended.

Bone marrow transplant

Bone marrow transplantation provides the patient with healthy stem cells, which later become the ancestors of normal blood cells.

The most important condition for transplantation is complete remission of the disease. It is important that the bone marrow cleared of blast cells is refilled with healthy cells.

In order to prepare the patient for the operation, special immunosuppressive therapy is performed. This is necessary to destroy leukemic cells and suppress the body's defenses to reduce the risk of transplant rejection.

Contraindications for bone marrow transplantation:

Dysfunction of internal organs

Acute infectious diseases

Recurrence of acute leukemia that does not translate into remission

Disease prognosis

According to statistics, the prognosis in children with acute leukemia is better than in adults. So, child survival rate for 5 years is%, adult - from 20 to 40%.

Acute myeloid leukemia is potentially more dangerous, in its case the five-year survival rate in patients under 55 years of age is 40-60%, and in the elderly only 20%.

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Stages of leukemia

Stages of leukemia

The Israeli Center for Blood Diseases at the private clinic "Herzliya Medical Center" provides treatment for leukemia at any stage.

When it comes to cancers that form in any organ, the stages of cancer are classified into four clinical stages of the disease. Under this system, the staging of the cancer is determined based on the size of the tumor and its spread to other organs.

Due to the fact that the development of leukemia occurs in the bone marrow, after which the disease spreads to other organs until it is detected, there is no need to use the traditional classification of the stage of the disease. Instead, doctors use a cytology grouping system to determine the type and subtype of leukemia. The classification of tumor cells allows predicting the prognosis of specific forms of leukemia and the likely response of the disease to treatment.

The most popular classification method for acute leukemia is the Franco-American-British System (FAB). According to this classification, acute leukemia is divided into eight subtypes of acute myeloid leukemia (AML) and three subtypes of acute lymphocytic leukemia (ALL). Initially, the FAB system was based on the microscopic manifestation of leukemic cells, but in recent years, studies have shown that cellular characteristics, such as the genetic composition and the number of certain types of cells, allow leukemia to be classified and prognosis in leukemia.

Chronic lymphocytic leukemia is classified according to one of the cytological staging systems known as the Rai Classification and Binet Staging.

Determination of the stage of leukemia according to the Paradise classification

According to this classification, chronic lymphocytic leukemia can have a low, medium and high degree of risk, each of which, respectively, includes 0, I, II, III and IV stages:

• Stage 0. Patients at low risk with lymphocytosis and high lymphocyte counts (more lymphocytes per cubic millimeter);
• Stage I. Patients are at intermediate risk, characterized by lymphocytosis and enlarged lymph nodes (lymphadenopathy);
• Stage II. Patients are at intermediate risk but also have lymphocytosis and enlarged liver (hepatomegaly) or enlarged spleen (splenomegaly) with or without enlarged lymph nodes;
• Stage III. Patients are at high risk for lymphocytosis with anemia (low red blood cell count) with or without lymphadenopathy, hepatomegaly, or splenomegaly.
• Stage IV (terminal stage of acute leukemia). Patients are at high risk, lymphocytosis, thrombocytopenia (low platelet count in the blood).

Determination of the stage of leukemia by the Binet method

Binet's staging classifies chronic lymphocytic leukemia depending on the amount of lymphoid tissues involved in the pathogenic process (spleen, lymph nodes in the neck, groin, armpits), as well as the presence of a low number of red blood cells (anemia) or platelets in the blood (thrombocytopenia).

Stages of leukemia according to Binet's classification:

• Stage A. Patients have fewer than three areas of enlarged lymphoid tissue and do not have anemia or thrombocytopenia. Lymph nodes of the neck, groin and armpits, as well as the spleen, enlarged on one or both sides, are considered separate areas.
• Stage B. There are three areas of lymphoid tissue enlargement; no anemia or thrombocytopenia.
• Stage C. There are more than three areas of lymphoid tissue enlargement, anemia and / or thrombocytopenia. These symptoms usually indicate end-stage acute leukemia.

Clinical features of the classifications of the stages of leukemia

One of the main advantages of the Bineta system is its ability to identify the form of CLL, which may have a better prognosis than the Paradise classification.

There are several other types and subtypes of chronic leukemia, the most famous of which are hairy cell leukemia, prolymphocytic leukemia, T-cell chronic lymphocytic leukemia, and chronic myelomonocytic leukemia.

Hairy cell leukemia, like CLL, is a slow-growing lymphocytic cancer that can be identified under a microscope (depending on the cell surface, experts can make a prognosis). Hairy cell leukemia typically affects middle-aged men. However, most patients report non-specific symptoms, in part caused by anemia. However, hairy cell carcinoma differs from CLL in symptoms, treatment and diagnosis.

Prolymphocytic leukemia (PLL) and T-cell chronic lymphocytic leukemia (T-CLL) are unusual forms of CLL and are rare (in 1% of all CLL cases). PLL is more common in men. At the same time, more than half of cancer cells are prolymphocytes, which are larger in comparison with CLL cells and have less condensed genetic material.

T-CLL is inherently more aggressive than other forms of CLL and less responsive to treatment.

There is some disagreement among scientists about the categorization of chronic myelomonocytic leukemia (CML). Some experts consider it "pre-leukemia" or "myelodysplastic syndrome" rather than malignant disease. The disease is most common in the elderly, is diagnosed incidentally, and may be asymptomatic. Patients report symptoms of fatigue, bruising, and abdominal discomfort caused by an enlarged spleen.

The disease can remain inactive for a long time and progress very slowly - over months or even years, then eventually turns into an acute form of leukemia, usually with a fatal outcome (that is, the patient is put in the terminal stage of acute leukemia).

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Stages of leukemia

When an adult is diagnosed with cancer, it is a shock and great grief, but if cancer is found in a child, it is a huge tragedy. Leukemia or leukemia is a blood cancer that affects the bone marrow and the hematopoietic system. Because of one mutating cell, turned into a malignant one, which is continuously dividing, displacing healthy ones. There are two forms of the course of the disease, chronic and acute, the second in most cases develops in children. Every year in the Russian Federation, leukemia is diagnosed in about 5,000 children and adolescents under the age of 18. On average, this figure is a person per hundred thousand of the population.

Leukemia Causes

Having learned the terrible diagnosis, a lot of questions appear in my head and one of the main ones is understanding the reason why the disease has developed. For decades, oncologists around the globe have been trying to identify the exact cause of the transformation of cells into cancerous ones, but apart from the fact that this is a failure at the DNA level, they cannot name anything more specific. But, despite the fact that the exact cause has not been established, scientists determine a number of factors that can affect the changes in the cellular level, by creating favorable conditions for this. In the case of blood cancer, the main ones include:

Radioactive radiation. It was noted that people who were exposed to radiation, who lived near nuclear power plants, where there were explosions with the spread of radiation (Chernobyl nuclear power plant, Hiroshima and Nagasaki, Semipalatinsk nuclear test site) were 45 times more likely to be diagnosed with oncology.

Excessive ultraviolet radiation can cause cells to degenerate into cancerous cells.

The hereditary factor, there are different opinions and significant disagreements around it, but we will not exclude it. If more than two blood relatives suffered from oncology in a family, you need to be more careful about your health.

Carcinogenic substances, unfortunately, in the world of modern technology, no one monitors environmental friendliness. Waste from industrial plants, exhaust gases from vehicles, vegetables and fruits are in the air and they are saturated with chemical elements for better growth. This is the global error of humanity. But there are carcinogens that are voluntarily consumed by many in the form of alcohol and smoking, causing irreparable damage to health.

Stages of acute leukemia

Stages of acute leukemia

The result of treatment of any disease, including cancer, directly depends on the prevalence of the process. The more neglected the process, the more difficult it is to respond to therapy and more often leads to irreversible consequences. In order for the doctor to be able to give a tentative prognosis to the patient and determine the tactics of the necessary treatment for acute leukemia, the degree of the disease was developed. There are five of them, each of them has its own clinical picture, prevalence, name and prognosis.

The primary period precedes the development of the disease; it can last from several months to ten years. This period is characterized by reproduction by dividing a single malignant cell, to such an amount that can paralyze the normal process of hematopoiesis.

The initial stage, during this period, leukocytosis is often observed - this is a decrease or increase in the number of white blood cells. Anemia is less common, no significant abnormalities are observed on the part of erythrocytes, sometimes it is accompanied by a decrease in the level of platelets, and there is also a small number of immature cells. The initial stage is best diagnosed by examining the bone marrow contents, since it is in it that the most blast cells are localized. Symptoms at this stage may have nonspecific signs, but sometimes they are absent, due to which it is difficult to identify pathology.

• Increased fatigue;
• an unreasonably slight increase in temperature;
• pallor of the skin;
• drowsiness or vice versa, insomnia;
• exacerbation of chronic diseases.

An advanced stage, the second stage of the disease is detected more often with the help of laboratory tests, there are significant changes in the hematopoietic system and rejuvenation of bone marrow cells. The insidiousness of leukemia lies in two possible types of the course of the disease. The patient may have a number of symptoms of pathology, but there are no signs of the disease in the blood. Conversely, the patient may not suspect anything, but blood tests reveal manifestations of the disease.

The clinical picture can vary, it is divided into three main syndromes:

• infectious-toxic, accompanied by inflammatory diseases, occurring in an aggravated form and do not respond to treatment for a long time.
• Hemorrhagic syndrome is characterized by an increased risk of bleeding and poor blood clotting. There are frequent nosebleeds, poorly healing cuts and wounds, even minor, subcutaneous bruises.
• Anemic syndrome, accompanied by a decrease in hemoglobin, is characterized by dizziness, weakness up to loss of consciousness, drowsiness and pallor of the skin.

Symptoms can manifest themselves both all together, and one by one, or do not manifest themselves at all.

Remission stage. May be complete or incomplete. In the first case, the number of blast cells in the bone marrow does not exceed 5%, the test values \u200b\u200bare close to normal, there is a confident tendency to an increase in the number of platelets and erythrocytes, and the patient has no complaints about his health. In the second case, with incomplete remission, a positive trend is observed, but the increased number of blast cells remains at the level of 20%. Full recovery is considered when the disease has not manifested itself after five years.

Relapse. Remission, after some time, can be replaced by a relapse - this is a condition in which the clinical picture returns to the patient with renewed vigor. Recurrence of leukemia is characterized by the growth of tumor cells in the bone marrow. Each new manifestation of pathology is more dangerous than the previous one.

Terminal stage. It is characterized by the ineffectiveness of chemotherapy courses and limited sensitivity to cytostatic drugs. Hematopoiesis is completely suppressed, ulcerative-necrotic processes, active metastasis and damage to various internal organs by cancer cells develop. The terminal stage is considered an irreversible process and has a poor prognosis. Refers to the last and most difficult stage of acute leukemia.

Associated inflammatory processes

High fever is one of the symptoms of leukemia

Patients with leukemia are protected from external factors as much as possible, trying to prevent the entry of a viral infection, since any disease for a weakened organism can be fatal. In addition to the attack of harmful microorganisms, the patient's body is exposed to various inflammatory processes, especially on the mucous membranes: stomatitis, periodontal disease, throat disease. Especially dangerous is angina with leukemia, if its occurrence coincided with a period when the patient is not yet aware of the presence of oncology, the doctor may well take it for a primary disease in a necrotic or deftheritic form. If catarrhal sore throat develops, its not quite characteristic symptoms and its complex course may attract the attention of a doctor. Main features:

• a strong rise in temperature over 39 degrees;
• expressions on the gums;
• necrosis of the tonsils and surrounding tissues with a characteristic dirty gray coating of the affected area;
• bleeding from foci of inflammation is not uncommon;
• enlargement of the liver, spleen, lymph nodes;
• weight loss;
• often accompanied by pneumonia.

Angina against the background of acute leukemia is very difficult to treat, complex therapy is used, based on which large doses of antibiotics, mainly of the penicillin series, are prescribed, administered intramuscularly. Apply rinsing and inhalation with antiseptic, antimicrobial drugs. To relieve swelling in the oral cavity and prevent the development of false croup or laryngeal stenosis, antihistamines are prescribed.

Treatment of leukemia itself is a very long and painstaking process, which is based on chemotherapy, it can help the patient achieve remission or convert the disease into a chronic form, weakening the clinical picture. The angina-type leukemia differs in an extremely complex course, often has an unfavorable prognosis, leading to a fatal outcome in a percentage of up to 70-75% of all cases.

At what degree of prevalence the diagnosed disease would not be, it should be remembered that you should believe in the best until the last breath, lowering your hands, you will only aggravate the situation, leaving no chance for recovery ...

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You need to contact a dermatologist and a surgeon. Treatment options vary, depending on your case. Usually, such rashes are treated with cauterization, surgical excision, or radiation. ...

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Leukemia

What is this blood disease?

Leukemia is a tumor of the blood formation system in which leukemia changes occur at the level of stem polypotent cells or committed uni-or bipotent bone marrow progenitor cells.

Cell differentiation is largely preserved.

Progressive cell overdevelopment in the blood forming organs, and often in the blood, with a sharp predominance of proliferative processes (with an increase in cell mass) over normal differentiation (maturation in accordance with specialization) of blood cells;

The proliferation of various pathological elements developing from the source cells,

constituting the morphological essence of a particular type of leukemia;

The phenomena of aplasia (undevelopment), metaplasia (perverted development), metastasis and the appearance of foci of extramedullary (extramedullary) hematopoiesis;

A regular change in the specialized cells that make up the tumor in chronic leukemia and lymphocytomas, blast cells that determine the development of blast leukemia;

All leukemic cells are a clone - the offspring of one mutated cell - and carry all its signs (leukemic clone);

All leukemic cells are characterized by tumor progression, resulting from the increased variability of their hereditary apparatus and leading to an increase in the number of clone cells.

Forms of leukemia:

Depending on the number of white blood cells in the blood, the following forms of leukemia are distinguished:

a) leukemia - the number of leukocytes is more than 50 thousand

b) subleukemic - the number of leukocytes from 10 to 50 thousand in 1 μl of blood;

c) aleukemic - the number of leukocytes in 1 μl of blood is normal;

d) leukopenic - the number of leukocytes less than 5 thousand in 1 μl of blood.

Types of acute leukemia:

All acute leukemia are divided into three large groups: acute myeloid, or non-lymphoblastic, and lymphoblastic leukemia. In accordance with the FAB classification, the blast cells of patients with acute non-lymphoblastic leukemia are divided into 9 types and are denoted by the letter M.

Non-lymphoblastic leukemia:

Accordingly, 9 variants of acute non-lymphoblastic leukemia are distinguished:

1. MO - myeloid with minimal differentiation (Acute undifferentiated leukemia - MO - blasts are the earliest type of myeloid leukemic cells.

They do not have any distinct signs of morphological differentiation);

Myeloid leukemia:

Myeloproliferative diseases (the main diseases of the myeloid leukemia group):

Chronic myeloid leukemia - a tumor of myeloid tissue;

Subleukemic myelosis (myelofibrosis, osteomyelosclerosis) is a tumor of myeloid tissue, which is based on three-growth proliferation of myeloid elements and connective tissue. In myelofibrosis, tumor transformation occurs at the level of a hematopoietic stem cell or a myelopoiesis progenitor cell;

Erythremia (true polycemia, Wakez-Osler disease) is a clonal tumor of myeloid tissue, the substrate of which is mainly erythrokaryocytes;

Chronic myelomonocytic leukemia occurs as a result of tumor transformation;

Chronic monocytic leukemia is a tumor of myeloid tissue. The disease has a progressive course;

Chronic megakaryocytic leukemia (idiopathic thrombocythemia, hemorrhagic thrombocythemia) is a myeloproliferative disease with a primary lesion of the megakaryocytic germ. The leading symptoms are an increase in platelet count and overdevelopment of megakaryocytes in the bone marrow.

Lymphoblastic leukemia:

Lymphoproliferative diseases include:

Chronic lymphocytic leukemia is a benign tumor of immunocompetent tissue, the basis of which is mature lymphocytes;

Plasmacytoma (myeloma);

Causes of Leukemia:

Leukemia is a multifactorial disease. Each person can have various factors that caused the onset of the disease.

Group 1 - infectious viral causes. More than one hundred blastomogenic viruses are known, which are divided into two large groups: RNA-containing viruses and DNA-containing viruses. RNA-containing viruses include avian leukemia viruses, Routh sarcomas, myeloblastosis, erythroblastosis, mouse leukemia viruses, mouse mammary cancer viruses. The most important of the DNA-containing viruses are papova groups (the combined name for viruses that cause papillomas in humans, rabbits, dogs; complete in mice), herpes viruses, smallpox groups, etc. R. Hübner and D. Todaro proposed the theory of oncogenes, according to which in the cells of humans and animals already has the genome of the oncogenic virus, blocked and not showing its activity. When exposed to any carcinogens, this inactive DNA begins to function as part of the cell’s genome, causing the transformation of a normal cell into a cancerous one.

Signs of leukemia:

Leukemia is characterized by a systemic progressive proliferation of leukemic cells, first in the bone marrow, spleen and lymph nodes, then they move to other organs and tissues, forming leukemic formations around the vessels and in their walls, leukemia cells appear in the blood. In leukemia, blast cells inhibit the differentiation of normal stem cells. Leukemia cells, like all tumor cells, are characterized by atypism of varying severity. The use of chromosomal analysis made it possible to establish that for any leukemia, a clone of tumor leukemic cells, the descendants of one originally mutated cell, is dispersed throughout the body.

Primary macroglobulinemia (Wandelstrom disease);

Heavy chain disease (Franklin disease).

Acute leukemia - stages, forms and signs:

Stage of acute leukemia:

During acute leukemia, several stages are distinguished:

3) remission (complete or incomplete);

5) terminal (final).

The initial stage of acute leukemia:

The initial stage is characterized by a significant variety of clinical symptoms. From the side of red blood, no significant changes were noted, anemia was less common. On the part of white blood, leukopenia or leukocytosis (a decrease in the level of leukocytes or an increase), a small percentage of immature forms, and in some cases a tendency to a decrease in the number of platelets, can be observed.

Expanded stage of acute leukemia:

The secondary period (the period of the expanded clinical picture of the disease). The first signs are more often detected in the laboratory. The advanced stage is characterized by the presence of the main clinical manifestations of the disease: inhibition of normal blood formation, high blastosis (rejuvenation) of the bone marrow and the appearance of immature pathological forms in the blood.

The patient’s well-being does not suffer, there are no complaints, but in the blood there are signs (manifestation) of leukemia;

There are complaints, but there are no pronounced pathological changes in the blood cells.

1) infectious-toxic syndrome - manifests itself in the form of various inflammatory processes;

2) hemorrhagic syndrome - manifested by increased bleeding and the possibility of hemorrhage and hemorrhage;

3) anemic syndrome - manifested by a decrease in the content of hemoglobin, red blood cells. Pale skin, mucous membranes, fatigue, shortness of breath, dizziness, decreased cardiac activity appear.

Remission of acute leukemia:

Remission may be complete or incomplete. Complete remission includes conditions in which there are no clinical symptoms of the disease, the number of blast cells in the bone marrow does not exceed 5% in the absence of them in the blood. With incomplete remission, there is a clear clinical and hematological improvement, but the number of blast cells in the bone marrow remains elevated.

Relapse of acute leukemia:

Relapse of acute leukemia can occur in the bone marrow or outside the bone marrow (skin, etc.). Each subsequent relapse is prognostically more dangerous than the previous one.

The terminal stage of acute leukemia:

The terminal stage of acute leukemia is characterized by resistance to cytostatic therapy, marked inhibition of normal blood formation, development of ulcerative necrotic processes. In the clinical course of all forms, there are much more common “acute leukemia” features than differences and features, but differentiation of acute leukemia is important for predicting and choosing cytostatic therapy .

Forms of acute leukemia:

Forms of acute leukemia with high leukocytosis are prognostically less favorable. There are forms of leukemia, which from the very beginning are characterized by leukopenia (a decrease in the number of white blood cells in the blood). Complete blast hyperplasia (complete rejuvenation of blood cells) occurs only in the final stage of the disease.

Acute promyelocytic leukemia:

Acute promyelocytic leukemia is characterized by extreme malignancy of the process, a rapid increase in severe intoxication, severe hemorrhagic syndrome, leading to cerebral hemorrhage and death of the patient.

Acute myeloid leukemia:

Acute myeloid leukemia is characterized by a progressive course, severe intoxication and fever, severe anemia, moderate intensity of hemorrhagic manifestations (tendency to bleeding), private ulcerative necrotic lesions of the mucous membranes and skin.

Acute lymphomonoblastic leukemia:

Acute lymphomonoblastic leukemia is a sub-option of acute myeloid leukemia. In the clinical picture, they are almost identical, but the myelomonoblastic form is more malignant, with more pronounced intoxication, deep anemia, thrombocytopenia, more pronounced hemorrhagic syndrome, frequent mucous and skin necrosis, and overgrowth of gums and tonsils. Blast cells are revealed in the blood - large, irregularly shaped. When tested in cells, a positive reaction to peroxidase, glycogen and lipids is determined. A characteristic feature is a positive reaction to nonspecific esterase in cells and lysozyme in serum and urine. The average life expectancy of patients is half that of myeloid leukemia. Infectious complications are usually the cause of death.

Acute monoblastic leukemia:

Acute monoblastic leukemia is a rare form of leukemia. The clinical picture resembles acute myeloid leukemia and is characterized by a tendency to bleeding and the development of anemia, enlarged lymph nodes, enlarged liver, and ulcerative necrotic stomatitis. Anemia, thrombocytopenia, and an elevated white blood cell count are noted. Young blast cells appear. When examined in cells, a weakly positive reaction to lipids and a high activity of nonspecific esterase are determined. Treatment rarely causes clinical hematologic remissions.

Acute lymphoblastic leukemia:

Acute lymphoblastic leukemia is more common in children and young people. It is characterized by an increase in any group of lymph nodes, spleen. The well-being of patients does not suffer, intoxication is moderate, anemia is negligible. Hemorrhagic syndrome is often absent. Patients complain of bone pain. Acute lymphoblastic leukemia is characterized by the frequency of neurological manifestations (neuroleukemia).

Symptoms of acute myeloid and monoblastic leukemia:

Acute myeloid and monoblastic leukemia is characterized by a rise in temperature to high values. The spleen is enlarged moderately. The liver is usually not palpable. Most often, leukemic infiltration occurs in the spleen, liver, meninges, skin, testicles, lungs, and kidneys. In 25% of cases, leukemic meningitis with the corresponding symptoms occurs. Leukemic pneumonitis is characterized by the appearance of dry cough, wheezing in the lungs.

Symptoms of acute lymphoblastic leukemia:

With lymphoblastic leukemia, enlargement of the lymph nodes and spleen is typical. Lymph nodes are denser, usually localized in the supraclavicular region, first on one side, then on the other. Usually they are painless. Symptoms depend on the location of these nodes. If the lymph nodes are enlarged in the mediastinum, then there is a dry cough, shortness of breath. Enlarged intestinal nodes cause abdominal pain. Often patients complain of pain in the lower leg, fever. The testicles are often affected, usually on one side. The testicle becomes dense, increases.

Symptoms of acute erythromyeloblastic leukemia:

Acute erythromyeloblastic leukemia in most cases begins with anemic syndrome. Other forms of leukemia are devoid of any specificity.

Signs of acute leukemia:

For acute leukemia, a triad of symptoms is typical: leukocytosis, the appearance of a large number of blast cells and a leukemic failure (there are blasts and mature white blood cells in the peripheral blood without intermediate stages of maturation). Anemia may occur at the onset of acute leukemia. Platelet count is reduced or normal. In acute leukemia, the bone marrow contains tens of percent of blast cells. The main diagnostic sign is a uniform picture of bone marrow hematopoiesis.

Chronic leukemia - signs, stages of their symptoms:

Chronic myeloid leukemia (chronic myelosis) occurs in two stages.

The first stage is benign, takes several years, is characterized by an increase in the spleen.

The second stage is malignant, lasts 3-6 months. Spleen, liver, lymph nodes

enlarged, leukemic infiltrations of the skin, nerve trunks, and meninges appear.

Signs of chronic leukemia:

Infectious diseases are often reported. Typical signs of intoxication are weakness, sweating. Sometimes the first symptom is a slight pain, heaviness in the left hypochondrium, which is associated with an enlargement of the spleen, subsequently there are spleen heart attacks. For no apparent reason, the temperature rises, bone pains appear.

Stages and symptoms of chronic leukemia:

There are 3 stages of chronic myeloid leukemia - initial, advanced and terminal (final).

Symptoms of the advanced stage:

The advanced stage is characterized by the appearance of clinical symptoms of leukemia associated with the leukemic process. Patients note rapid fatigue, sweating, fever, weight loss. There is severity and pain in the left hypochondrium, especially after walking. An objective examination of an almost constant sign during this period is an enlargement of the spleen, which in some cases reaches significant sizes. When palpating, the spleen remains painless. Half of the patients develop spleen infarction, manifested by acute pain in the left hypochondrium with a shift to the left side, left shoulder, aggravated by a deep breath.

Symptoms of the thermal stage:

In the terminal stage, there is a sharp deterioration in general condition, increased sweating, persistent unmotivated increase in temperature. There are severe pains in the bones and joints. An important sign is the appearance of insensitivity to therapy. Significantly enlarged spleen. Anemia, thrombocytopenia is increasing. With a moderate increase in the number of leukocytes, the formula rejuvenates by increasing the percentage of immature cells (promyelocytes, myeloblasts and undifferentiated). Hemorrhagic syndrome, which was absent in the expanded stage, almost always appears in the terminal period.

Erythremia (Wakez disease, true polycythemia):

Erythremia (Wakez’s disease, true polycythemia) - chronic leukemia, belongs to the group of benign tumors of the blood system. Tumor proliferation of all hematopoietic germs, especially erythroid germs, is observed, which is accompanied by an increase in the number of red blood cells (in some cases, white blood cells and platelets), hemoglobin, the mass and viscosity of the circulating blood, and an increase in blood coagulation. An increase in the mass of red blood cells in the bloodstream and vascular depots determines the features of clinical symptoms, the course and complications of the disease. Erythremia occurs mainly in old age.

Symptoms of erythremia at different stages:

There are 3 stages of the disease: initial, detailed (erythremic) and terminal. In the initial stage, patients usually complain of heaviness in the head, tinnitus, dizziness, increased fatigue, decreased mental performance, coldness of the limbs, and sleep disturbance. External characteristic signs may be absent. The expanded stage is characterized by more vivid clinical symptoms. The most common and characteristic sign are headaches, which are sometimes in the nature of painful migraines with visual impairment.

Chronic leukemia of lymphocytic origin:

The following forms are distinguished:

Lymphomatosis of the skin (Cesari's disease),

Chronic lymphocytic leukemia:

Chronic lymphocytic leukemia is a benign tumor disease of lymphoid (immunocompetent) tissue, while, unlike other forms of leukemia, tumor progression is not detected throughout the disease. The main morphological substrate of the tumor is mature lymphocytes, which grow and accumulate in an increased amount in the lymph nodes, spleen, liver, bone marrow.

Symptoms of chronic lymphocytic leukemia:

The disease begins gradually without severe clinical symptoms. Often the diagnosis is made for the first time with a random blood test, an increase in the number of leukocytes, the presence of lymphocytosis is detected. Gradually appear weakness, fatigue, sweating, weight loss. There is an increase in peripheral lymph nodes, mainly in the cervical, axillary and inguinal areas. Subsequently, mediastinal (mediastinal) and retroperitoneal lymph nodes are affected. When probing, peripheral lymph nodes of a soft or doughy consistency are determined, not soldered together and skin, painless. The spleen is significantly enlarged, dense, painless.

1) a typical benign form of the disease with widespread enlargement of lymph nodes, moderate enlargement of the liver and spleen, leukemic blood picture, lack of anemia, rare infectious and autoimmune disorders. This form is most common and is characterized by a long and favorable course;

2) a malignant variant, characterized by a severe course, the presence of dense lymph nodes forming conglomerates, high leukocytosis, inhibition of normal blood formation, frequent infectious complications;

3) splenomegaly form, often without peripheral lymphadenopathy, often with an increase in abdominal lymph nodes. White blood cell count is normal or slightly reduced. Characterized by rapidly increasing anemia;

4) a bone marrow form with isolated bone marrow damage, a leukemic blood picture, and the absence of an increase in lymph nodes and spleen. Anemia, thrombocytopenia with hemorrhagic syndrome often develops;

5) the skin form (Cesari syndrome) proceeds with predominant leukemic skin infiltration;

6) forms with an isolated increase in certain groups of lymph nodes and the presence of appropriate clinical symptoms.

Myeloma occurs in two phases.

The first phase, during which the blood counts do not change, the bones do not break down or break down slowly, relatively benign.

Diagnosis of leukemia:

The diagnosis is based on clinical and hematological findings. The study of bone marrow punctate helps. Of particular difficulty in diagnosing leukemia is the initial period, which may resemble siderohrestical anemia, aplastic anemia, hemolytic anemia of Markiatha-Michele. Sometimes acute lymphoblastic leukemia is confused with infectious mononucleosis.

Chronic myeloid leukemia (chronic myelosis):

The diagnosis is based on a clinical picture, a picture of blood and bone marrow. Chronic myeloid leukemia and its aleukemic variant should be differentiated from hepatolienal syndrome, lymphogranulomatosis, infectious diseases: malaria, brucellosis. Differential diagnosis of chronic myeloid leukemia should be carried out primarily with leukemoid reactions of the myeloid type (as a result of the body's response to infection, intoxication, etc.). The imperious crisis of chronic myelogenous leukemia can give a picture resembling acute leukemia. In this case, the history of the disease, a marked increase in the spleen, and the presence of the Philadelphia chromosome in the bone marrow testify in favor of chronic myelogenous leukemia.

Benign subleukemic myelosis:

Diagnosed mainly in old age. Over the years, patients have not presented any complaints. As the disease progresses, weakness, fatigue, sweating, discomfort and heaviness in the abdomen appear, especially after eating. Redness of the face, skin itching, heaviness in the head are noted. The main early symptom is an enlarged spleen, liver enlargement is usually not so pronounced. Enlarged liver and spleen can lead to portal hypertension.

Erythremia:

The diagnosis is based on an increase in the mass of circulating red blood cells and the clinical picture. Differential diagnosis should be carried out with a secondary polycythemia syndrome with a tumor of the pituitary, adrenal gland, and spleen tuberculosis.

Paraproteinemic leukemia. Myeloma:

The diagnosis is made on the basis of typical clinical symptoms (damage to the bone tissue, hematopoietic and urinary systems), bone radiography, hyperproteinemia, marrow puncture with the detection of typical myeloid cells. Bone pain must be differentiated from pain arising from rheumatic diseases.

Leukemia treatment:

The tactics of treatment depend on the stage of acute leukemia: the initial stage, the developed period, partial remission, complete remission, relapse (leukemic phase with the release of blasts into the blood and leukemic phase without the appearance of blasts in the blood), terminal stage. For the treatment of acute leukemia, a combination of cytostatic drugs prescribed by the courses is used. Treatment is divided into stages: the treatment period to achieve remission, treatment during the remission period and the prevention of neuroleukemia (leukemic brain damage). Cytostatic therapy is carried out during remission courses or continuously.

1) vincristine-prednisone (effective in children under 10 years of age);

5) vincristine-methotrexate-b-mercaptopurin-prednisolone (VAMP).

Treatment of watering can in children and adults:

Treatment of other forms of acute leukemia in children and all forms of acute leukemia in adults. In acute leukemia, which from the very beginning flows with a blood leukocyte level below 2000 in one μl, with deep thrombocytopenia, which threatens or has begun hemorrhagic syndrome, it is dangerous to start therapy with cytostatic drugs without the introduction of platelet mass. If there are signs of sepsis, you should also suppress the infection with antibiotics, then introduce cytostatics.

Treatment of a patient with acute leukemia with relapse:

In case of relapse, a new therapy is not prescribed that was not used during the remission of the combination of cytostatics. In children, L-asparaginase is often effective. The duration of continuous maintenance therapy should be at least 3 years. For the timely detection of relapse, it is necessary to carry out control studies of the bone marrow at least 1 time per month in the first year of remission and 1 time in 3 months after a year of remission.

Treatment of chronic myeloid leukemia (chronic myelosis):

In the expanded stage, myeloid leukemia is prescribed small doses of myelosan, usually over the course of a day. With the fall of leukocytes dots. in one μl (15-20 g / l) go to maintenance doses. In parallel with myelosan, irradiation of the spleen is used. In addition to myelosan, it is possible to prescribe myelobrom, 6-mercaptopurine, hexaphosphamide, hydroxyurea.

Treatment of benign subleukemic myelosis:

With small changes in the blood, slow growth of the spleen and liver, active treatment is not carried out.

A significant increase in the number of platelets, white blood cells or red blood cells, especially with the development of the corresponding clinical manifestations (foci of hemorrhage, blood clots);

The predominance of cellular hyperplasia in the bone marrow over fibrosis;

Increased functional activity of the spleen.

Acute leukemia (acute leukemia) is a serious malignant disease that affects the bone marrow. The pathology is based on a mutation of hematopoietic stem cells - precursors of blood cells. As a result of the mutation, the cells do not mature, and the bone marrow is filled with immature cells - blasts. Changes also occur in the peripheral blood - the number of basic shaped elements (red blood cells, white blood cells, platelets) in it falls.

With the progression of the disease, tumor cells extend beyond the bone marrow and penetrate into other tissues, as a result of which the so-called leukemic infiltration of the liver, spleen, lymph nodes, mucous membranes, skin, lungs, brain, other tissues and organs develops. The peak incidence of acute leukemia falls at the age of 2-5 years, then there is a slight increase in 10-13 years, boys are sick more often than girls. In adults, a dangerous period in terms of the development of acute leukemia is the age after 60 years.

Depending on which cells are affected (myelopoiesis or lymphopoiesis germ), two main types of acute leukemia are distinguished:

• ALL - acute lymphoblastic leukemia.
• AML - acute myeloid leukemia.

ALL often develops in children (80% of all acute leukemia), and AML - in older people.

There is a more detailed classification of acute leukemia, which takes into account the morphological and cytological features of blasts. An exact determination of the type and subspecies of leukemia is necessary for doctors to select treatment tactics and make a prognosis for the patient.

Causes of Acute Leukemia

The study of the problem of acute leukemia is one of the priority areas of modern medical science. But, despite numerous studies, the exact causes of leukemia have not yet been established. It is only clear that the development of the disease is closely related to factors that can cause cell mutation. These factors include:

• Hereditary addiction. Some variants of ALL in almost 100% of cases develop in both twins. In addition, cases of acute leukemia in several family members are not uncommon.
• Exposure to chemicals(in particular benzene). AML may develop after chemotherapy for another disease.
• Radiation exposure.
• Hematologic diseases - aplastic anemia, myelodysplasia, etc.
• Viral infections, and most likely an abnormal immune response to them.

However, in most cases of acute leukemia, doctors still fail to identify the factors that provoked the cell mutation.

During acute leukemia, five stages are distinguished:

• Preleukemia, which often goes unnoticed.
• The first attack is an acute stage.
• Remission (full or incomplete).
• Relapse (first, repeated).
• Terminal stage.

From the moment of the mutation of the first stem cell (namely, it all starts with one cell) until the onset of symptoms of acute leukemia, an average of 2 months pass. During this time, blast cells accumulate in the bone marrow, which do not allow normal shaped blood elements to mature and enter the bloodstream, as a result of which characteristic clinical symptoms of the disease appear.

The first "swallows" of acute leukemia can be:

• Fever.
• Decreased appetite.
• Pain in bones and joints.
• Pallor of the skin.
• Increased bleeding (hemorrhages on the skin and mucous membranes, nosebleeds).
• Painless swollen lymph nodes.

These signs are very reminiscent of an acute viral infection, therefore, patients are often treated for it, and during the examination (including a general blood test), a number of changes characteristic of acute leukemia are found.

In general, the picture of the disease in acute leukemia is determined by the dominant syndrome, several of them are distinguished:

• Anemic (weakness, shortness of breath, pallor).
• Intoxication (loss of appetite, fever, weight loss, sweating, drowsiness).
• Hemorrhagic (hematomas, petechial rash on the skin, bleeding, bleeding gums).
• Osteoarticular (periosteum and articular capsule infiltration, osteoporosis, aseptic necrosis).
• Proliferative (swollen lymph nodes, spleen, liver).

In addition, infectious complications very often develop in acute leukemia, the cause of which is immunodeficiency (insufficiently mature lymphocytes and white blood cells in the blood), less often neuroleukemia (metastasis of leukemia cells to the brain, which proceeds as meningitis or encephalitis).

The symptoms described above cannot be ignored, since the timely detection of acute leukemia significantly increases the effectiveness of anticancer treatment and gives the patient a chance for a full recovery.

Diagnosis of acute leukemia consists of several stages:

There are two treatments for acute leukemia: multicomponent chemotherapy and bone marrow transplantation. The treatment protocols (prescription regimens) for ALL and AML are different.

The first stage of chemotherapy is the induction of remission, the main purpose of which is to reduce the number of blast cells to an undetectable level by available diagnostic methods. The second stage is consolidation aimed at eliminating the remaining leukemia cells. This step is followed by reinduction - a repetition of the induction step. In addition, a mandatory element of treatment is maintenance therapy with oral cytostatics.

The choice of protocol in each specific clinical case depends on what risk group the patient belongs to (the role is played by the person’s age, genetic characteristics of the disease, the number of white blood cells in the blood, reaction to previous treatment, etc.). The total duration of chemotherapy for acute leukemia is about 2 years.

Criteria for the complete remission of acute leukemia (all must be present simultaneously):

• lack of clinical symptoms of the disease;
• the detection in the bone marrow of not more than 5% of blast cells and the normal ratio of cells of other hematopoietic growths;
• the absence of blasts in peripheral blood;
• the absence of extramedullary (i.e. located outside the bone marrow) lesions.

Chemotherapy, although aimed at curing the patient, has a very negative effect on the body, as it is toxic. Therefore, against its background, patients begin to lose hair, nausea, vomiting, impaired functioning of the heart, kidneys, and liver appear. In order to timely detect side effects of treatment and monitor the effectiveness of therapy, all patients need to regularly take blood tests, undergo bone marrow tests, biochemical blood tests, ECG, echocardiography, etc. After completion of treatment, patients should also remain under medical supervision (outpatient).

Of great importance in the treatment of acute leukemia is concomitant therapy, which is prescribed depending on the patient's symptoms. Patients may require a blood transfusion, prescription of antibiotics, detoxification treatment to reduce the intoxication caused by the disease and the chemotherapy used. In addition, if there are indications, prophylactic irradiation of the brain and endolumbar administration of cytostatics are carried out to prevent neurological complications.

Proper care of the sick is also very important. They must be protected from infections, creating life conditions that are closest to sterile, excluding contacts with potentially infectious people, etc.

The bone marrow is transplanted for patients with acute leukemia, because only it has stem cells that can become the ancestors of the formed elements of the blood. The transplantation performed in such patients should be allogeneic, i.e. from a related or unrelated compatible donor. This treatment procedure is indicated for both ALL and AML, and it is advisable to transplant during the first remission, especially if there is a high risk of relapse - the return of the disease.

At the first relapse of AML, transplantation is generally the only salvation, since the choice of conservative treatment in such cases is very limited and often comes down to palliative therapy (aimed at improving the quality of life and alleviating the condition of a dying person).

The main condition for transplantation is complete remission (so that the "empty" bone marrow can be filled with normal cells). To prepare the patient for the transplant procedure, conditioning is also mandatory - an immunosuppressive therapy designed to destroy the remaining leukemia cells and create a deep depression of immunity, which is necessary to prevent transplant rejection.

Contraindications to bone marrow transplantation:

• Serious dysfunction of the internal organs.
• Acute infectious diseases.
• Recurrence of untreated leukemia.
• Elderly age.

Leukemia prognosis

The forecast is influenced by the following factors:

• age of the patient;
• type and subspecies of leukemia;
• cytogenetic characteristics of the disease (for example, the presence of the Philadelphia chromosome);
• body reaction to chemotherapy.

The prognosis for children with acute leukemia is much better than for adults. This is due, firstly, to the higher reactivity of the child's body for treatment, and secondly, to the presence in elderly patients of a mass of concomitant diseases that do not allow for full chemotherapy. In addition, adult patients are more likely to see doctors when the disease is already running, while the parents are usually more responsible for the health of their children.

If you operate with numbers, then the five-year survival rate for ALL in children, according to various sources, is from 65 to 85%, in adults - from 20 to 40%. In AML, the prognosis is slightly different: five-year survival is observed in 40-60% of patients under 55 years of age, and only 20% of older patients.

Summing up, I want to note that acute leukemia is a serious illness, but treatable. The effectiveness of modern protocols for its treatment is quite high, and relapse of the disease after a five-year remission almost never occurs.

Zubkova Olga Sergeevna, medical observer, epidemiologist

Acute leukemia is a group of severe blood diseases of a tumor nature, in which the pathological process begins at the level of hematopoietic progenitor cells (stem cells), which lose their ability to mature to mature forms, which leads to hematopoiesis failure and the accumulation of immature blast forms in bone marrow and blood .

The main substrate of the tumor is young, the so-called blast cells.

Depending on the morphology and cytochemical parameters of the cells in the acute leukemia group, acute myeloid leukemia, acute monoblastic leukemia, acute myelomonoblastic leukemia, acute promyelocytic leukemia, acute erythromyelosis, acute megakaryoblastic leukemia, acute leukemia are distinguished.

Etiology

The cause of acute leukemia and chronic human myelogenous leukemia can be violations of the composition and structure of the chromosome apparatus, hereditarily determined or acquired under the influence of certain mutagenic factors. One of them is ionizing radiation.

The cause of leukemia is also chemical mutagens. The incidence of acute leukemia among people exposed to benzene, as well as among patients receiving cytostatic immunosuppressants (imuran, cyclophosphamide, leukaran, sarcolysin, mustargen, etc.), has been proven; the frequency of acute leukemia among this group of patients rises hundreds of times. There are known facts of the occurrence of acute myeloid leukemia, acute erythromyelosis against the background of prolonged chemotherapy for chronic lymphocytic leukemia, Waldenstrom macroglobulinemia, myeloma, lymphogranulomatosis and other tumors.

Predisposing for glucoses shown role of hereditary defects in myeloid and lymphatic tissue. Observations of the dominant and recessive inheritance of chronic lymphocytic leukemia are described, a low incidence of this leukemia in some ethnic groups and an increased incidence in others is noted. More often in these cases it is not leukemia itself that is inherited, but increased variability - chromosome instability that predisposes the parent myeloid or lymphatic cells to leukemic transformation.

The use of chromosomal analysis made it possible to establish that for any leukemia, a clone of tumor leukemic progeny cells of one originally mutated cell is dispersed throughout the body. The instability of the genotype of malignant cells in leukemia causes the appearance of new clones in the initial tumor clone, among which the most autonomous clones are “selected” during the life of the body, as well as under the influence of therapeutic agents. This phenomenon explains the progression of the course of leukemia, their departure from the control of cytostatics.

Stages of leukemia

1) initial;
2) detailed;
3) remission (complete or incomplete);
4) relapse;
5) terminal.

initial stage acute leukemia is most often diagnosed when patients with previous anemia develop a picture of acute leukemia.

Extended stage characterized by the presence of the main clinical and hematological manifestations of the disease.

Remission may be complete or incomplete. Complete remission includes conditions in which there are no clinical symptoms of the disease, the number of blast cells in the bone marrow does not exceed 5% in the absence of them in the blood. The composition of peripheral blood is close to normal. With incomplete remission, there is a clear clinical and hematological improvement, but the number of blast cells in the bone marrow remains elevated.

Relapse acute leukemia can occur in the bone marrow or outside the bone marrow (skin, etc.). Each subsequent relapse is prognostically more dangerous than the previous one.

Terminal stage acute leukemia is characterized by resistance to cytostatic therapy, pronounced inhibition of normal blood formation, the development of ulcerative necrotic processes.

In the clinical course of all forms, there are much more common “acute leukemia” features than differences and features, but differentiation of acute leukemia is important for predicting and choosing cytostatic therapy.

Clinical picture

Clinical symptoms are very diverse and depend on the location and massiveness of leukemic infiltration and on signs of suppression of normal blood formation (anemia, granulocytopenia, thrombocytopenia).

The first manifestations of the disease are of a general nature: weakness, loss of appetite, sweating, malaise, fever of the wrong type, joint pain, the appearance of small bruises after minor injuries. The disease can begin acutely - with catarrhal changes in the nasopharynx, tonsillitis. Sometimes acute leukemia is detected by an occasional blood test.

In the expanded stage of the disease in the clinical picture, several syndromes can be distinguished: anemic syndrome, hemorrhagic syndrome, infectious and ulcerative necrotic complications.

Anemic syndrome manifested by weakness, dizziness, pain in the heart, shortness of breath. Objectively, pallor of the skin and mucous membranes is noted. The severity of anemia is different and is determined by the degree of suppression of erythropoiesis, the presence of hemolysis, bleeding, etc.

Hemorrhagic syndrome found in almost all patients. Gum, nose, uterine bleeding, hemorrhage on the skin and mucous membranes are usually observed. Extensive hemorrhages occur at injection and intravenous injection sites. In the terminal stage, ulcerative necrotic changes appear at the site of hemorrhages in the mucous membrane of the stomach and intestines. The most pronounced hemorrhagic syndrome is observed with promyelocytic leukemia.

Infectious and ulcerative necrotic complications are a consequence of granulocytopenia, a decrease in the phagocytic activity of granulocytes and are found in more than half of patients with acute leukemia. Often there are pneumonia, tonsillitis, urinary tract infections, abscesses at the injection sites. The temperature can be different - from subfebrile to constantly high. A significant increase in lymph nodes in adults is rare, in children - quite often. Especially characteristic lymphadenopathy for lymphoblastic leukemia. Lymph nodes in the supraclavicular and submandibular areas increase more often. On palpation, the lymph nodes are dense, painless, can be slightly painful with rapid growth. An increase in the liver and spleen is not always observed, mainly with lymphoblastic leukemia.

Diagnostics

In the peripheral blood, in most patients, normochromic anemia, less often hyperchromic type, is detected. Anemia deepens with the progression of the disease to 20 g / l, and the number of red blood cells is noted below 1.0 g / l. Often anemia is the first manifestation of leukemia. The number of reticulocytes is also reduced. The number of leukocytes is usually increased, but does not reach such high numbers as with chronic leukemia. The number of leukocytes varies significantly from 0.5 to 50-300 g / l.

Forms of acute leukemia with high leukocytosis are prognostically less favorable. There are forms of leukemia, which from the very beginning are characterized by leukopenia. In this case, total blast hyperplasia occurs only in the terminal stage of the disease.

All forms of acute leukemia are characterized by a decrease in platelet count to 15-30 g / l. Especially pronounced thrombocytopenia is observed in the terminal stage.

In the leukocyte formula - blast cells up to 90% of all cells and a small number of mature elements. Exit to the peripheral blast cells is the main morphological sign of acute leukemia.

In addition to morphological characters, cytochemical studies (lipid content, peroxidase activity, glycogen content, acid phosphatase activity, nonspecific esterase activity, etc.), bone marrow biopsy, and blood smears are used to differentiate leukemia forms.

Forms of leukemia

Acute Promyelocytic Leukemia characterized by extreme malignancy of the process, a rapid increase in severe intoxication, severe hemorrhagic syndrome, leading to cerebral hemorrhage and death of the patient.

Tumor cells with a large granularity in the cytoplasm make it difficult to determine the structure of the nucleus. Positive cytochemical signs: peroxidase activity, a lot of lipids and glycogen, the reaction to acid phosphatase is sharply positive, the presence of glycosaminoglycan.

Hemorrhagic syndrome depends on severe hypofibrinogenemia and an excess of thromboplastin in leukemic cells. The output of thromboplastin provokes intravascular coagulation.

Acute myeloid leukemia characterized by a progressive course, severe intoxication and fever, early onset of clinical and hematological decompensation of the process in the form of severe anemia, moderate intensity of hemorrhagic manifestations, private ulcerative necrotic lesions of the mucous membranes and skin.

Myeloblasts predominate in the peripheral blood and bone marrow. A cytochemical study reveals peroxidase activity, increased lipid content, and low activity of non-specific esterase.

Acute lymphomonoblastic leukemia is a subvariant of acute myeloid leukemia. The clinical picture is almost identical, but the myelomonoblastic form is more malignant, with more pronounced intoxication, deep anemia, thrombocytopenia, more pronounced hemorrhagic syndrome, frequent mucous and skin necrosis, gingival and tonsil hyperplasia. Blast cells are revealed in the blood - large, irregular in shape, with a young nucleus resembling a monocyte nucleus in shape. A cytochemical study in cells determines a positive reaction to peroxidase, glycogen and lipids. A characteristic feature is a positive reaction to nonspecific esterase in cells and lysozyme in serum and urine.

The average life expectancy of patients is half that of myeloid leukemia. Infectious complications are usually the cause of death.

Acute monoblastic leukemia- a rare form of leukemia. The clinical picture resembles acute myeloid leukemia and is characterized by anemic tendency to hemorrhages, enlarged lymph nodes, enlarged liver, and ulcerative necrotic stomatitis. In the peripheral blood - anemia, thrombocytopenia, lymphomonocytic profile, increased leukocytosis. Young blast cells appear. During a cytochemical study in cells, a weakly positive reaction to lipids and a high activity of non-specific esterase are determined. Treatment rarely causes clinical hematologic remissions. The life expectancy of the patient is about 8-9 months.

Acute lymphoblastic leukemia more common in children and young people. Characterized by an increase in any group of lymph nodes, spleen. The well-being of patients does not suffer, intoxication is moderate, anemia is negligible. Hemorrhagic syndrome is often absent. Patients complain of bone pain. Acute lymphoblastic leukemia is characterized by the frequency of neurological manifestations (neuroleukemia).

In the peripheral blood and in punctate lymphoblast, young large cells with a rounded nucleus. In a cytochemical study: the reaction to peroxidase is always negative, there are no lipids, glycogen in the form of large granules.

A distinctive feature of lymphoblastic acute leukemia is a positive response to the therapy used. The frequency of remission is from 50% to 90%. Remission is achieved by using a complex of cytostatic agents. Relapse of the disease can be manifested by neuroleukemia, infiltration of nerve roots, bone marrow tissue. Each subsequent relapse has a worse prognosis and flows more malignantly than the previous one. In adults, the disease is more severe than in children.

Erythromyelosischaracterized by the fact that the pathological transformation of hematopoiesis applies to both white and red sprouts of bone marrow. In the bone marrow, young undifferentiated cells of the white row and blast anaplastic cells of the red sprout are found - large numbers of erythro and normoblasts. Large red cells have an ugly appearance.

In peripheral blood - persistent anemia, anisocytosis of red blood cells (macrocytes, megalocytes), poikilocytosis, polychromasia and hyperchromia. Erythro and normoblasts in peripheral blood - up to 200-350 per 100 leukocytes. Leukopenia is often noted, but there may be a moderate increase in white blood cells to 20-30 g / l. As the disease develops, blast monoblast forms appear. Lymphadenopathy is not observed, the liver and spleen may be enlarged or remain normal. The disease lasts longer than the myeloblastic form, in some cases there is a subacute course of erythromyelosis (up to two years without treatment).

Treatment

The duration of continuous maintenance therapy should be at least 3 years. For the timely detection of relapse, it is necessary to carry out control studies of the bone marrow at least 1 time per month in the first year of remission and 1 time in 3 months after a year of remission. During remission, so-called immunotherapy can be carried out, aimed at destroying the remaining leukemic cells using immunological methods. Immunotherapy consists in administering BCG vaccine or allogeneic leukemic cells to patients.

Relapse of lymphoblastic leukemia is usually treated with the same combinations of cytostatics as during induction.

With non-lymphoblastic leukemia, the main task is usually not to achieve remission, but to restrain the leukemic process and prolong the patient's life. This is due to the fact that non-lymphoblastic leukemia is characterized by a sharp inhibition of normal hematopoietic sprouts, and therefore intensive cytostatic therapy is often impossible.

Combinations of cytostatic drugs are used to induce remission in patients with non-lymphoblastic leukemia; cytosine arabinoside, daunomycin: cytosine arabinoside, thioguanine; cytosine arabinoside, oncovin (vincristine), cyclophosphamide, prednisolone. The course of treatment lasts 5-7 days, followed by a 10-14 day break necessary to restore normal hematopoiesis, inhibited by cytostatics. Maintenance therapy is carried out with the same drugs or their combinations used during the induction period. In almost all patients with non-lymphoblastic leukemia, relapse develops, requiring a change in the combination of cytostatics.

An important place in the treatment of acute leukemia is occupied by the treatment of extra bone marrow localizations, among which the most frequent and formidable is neuroleukemia (meningo-encephalitis syndrome: nausea, vomiting, intolerable headache; syndrome of local damage to the substance of the brain; pseudotumor focal symptomatology; disorder of cranial function ; oculomotor, auditory, facial and trigeminal nerves; leukemic infiltration of nerve roots and trunks: polyradiculoneuritis syndrome). The method of choice for neuroleukemia is the intralumbar administration of methotrexate and irradiation of the head at a dose of 2400 rad. In the presence of extra-bone marrow leukemic foci (nasopharynx, testicle, mediastinal lymph nodes, etc.) that cause organ compression and pain, local radiation therapy with a total dose of 500-2500 rad is indicated.

Infectious complications are treated with broad-spectrum antibiotics directed against the most common pathogens - Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus. Apply carbenicillin, gentamicin, zeporin. Antibiotic therapy is continued for at least 5 days. Antibiotics should be administered intravenously every 4 hours.

For the prevention of infectious complications, especially in patients with granulocytopenia, careful care of the skin and mucous membrane of the oral cavity, placement of patients in special aseptic wards, and intestinal sterilization with non-adsorbable antibiotics (kanamycin, rovamycin, neolecine) are necessary. The main treatment for hemorrhage in patients with acute leukemia is platelet transfusion. At the same time, the patient is transfused with 200-10000 g / l of platelets 1-2 times a week. In the absence of platelet mass, fresh whole blood can be transfused with a hemostatic purpose or direct transfusion can be used. In some cases, to stop bleeding, the use of heparin is indicated (in the presence of intravascular coagulation), epsilon-aminocaproic acid (with increased fibronolysis).

Modern treatment programs for lymphoblastic leukemia make it possible to obtain complete remissions in 80-90% of cases. The duration of continuous remissions in 50% of patients is 5 years or more. In the remaining 50% of patients, therapy is ineffective and relapses develop. With non-lymphoblastic leukemia, complete remissions are achieved in 50-60% of patients, but relapses develop in all patients. The average life expectancy of patients is 6 months. The main causes of death are infectious complications, severe hemorrhagic syndrome, neuroleukemia.

To determine the tactics of treatment and prognosis, the allocation of the stages of acute leukemia is important. During acute leukemia, the following clinical stages can be distinguished (table.).

Table Criteria for evaluating the effectiveness of treatment of acute leukemia

Lack of effect

Progression of the process or worse results than with clinical and hematological improvement

The initial stage of acute leukemia: often diagnosed retrospectively; more often, the clinician is faced with the first acute period of the disease (the first attack of the disease), which is characterized by severe inhibition of normal hematopoiesis, high red bone marrow blastosis, and severe clinical manifestations.

Complete remission: conditions in which the number of blast cells in bone marrow punctures does not exceed 5%, or the total number of lymphoid cells is less than 30%, of which blast cells are less than 5%. Peripheral blood counts are close to normal. Leukopenia of at least 1.5 × 10 9 / L and thrombocytopenia of at least 100 × 10 9 / L are possible with a tendency to an increase in the content of granulocytes and platelets. There are no clinical signs of leukemic infiltration of the liver, spleen and other organs.

Incomplete remission is characterized by positive dynamics of the disease during treatment: the number of blast cells in the bone marrow is not more than 20%, the disappearance of blasts from peripheral blood, the elimination of clinical manifestations of neuroleukemia, the incomplete suppression of extra-cerebral foci of leukemic infiltration.

Recovery: complete remission for 5 years or more.

Relapse: conditions in which there is an increase in the number of blast cells in puncture of the red bone marrow (more than 5%) and / or the appearance of extra-cerebral foci of blood formation. If the patient has a number of blast cells in the red bone marrow of more than 5%, but less than 10%, an absolutely normal blood test and a normal ratio of sprouts in bone marrow puncture, relapse is not detected. In such cases, repeated puncture is performed after 1-2 weeks; if blastosis in the red bone marrow persists and exceeds 5%, relapse is diagnosed.

The terminal stage of acute leukemia is characterized by the ineffectiveness of cytostatic therapy, and against this background, anemia, granulocytopenia, thrombocytopenia increase, and tumor growths increase.

Updated: 2019-07-09 21:42:43

• To determine the "individual minute" you need to pick up a stopwatch and press the start button of the second hand. Without looking at her
• Indications: preparations of the highlander are used for hemorrhoids and uterine bleeding, to strengthen the gums, treatment of atonic constipation, wounds

The formation of lymphoblasts occurs many times faster than normal white blood cells. At a certain stage of leukemia, they replace most of the usual white blood cells, leading to dire consequences such as anemia, bleeding and infection. They migrate with blood, creating lymphoblastic foci throughout the body.

Acute Leukemia: Stages

The debut of the disease - the initial stage of acute leukemia has many symptoms. In the general analysis of red blood, no significant changes were noted. In rare cases, a decrease in the number of red blood cells and hemoglobin can be detected. In white blood, either a decrease or increase in the level of leukocytes is detected. The number of "blast" cells exceeds the norm, slightly. Thrombocytopenia can sometimes be seen - a decrease in platelet count. More significant for the diagnosis of leukemia is a bone marrow biopsy. At the same time, a significant increase in the number of progenitor cells is detected in the bone marrow. The early stage of acute leukemia is almost always diagnosed at the end, when it goes to the next.

Stage of complete clinical development

Its first signs are most often found in a blood test. It is characterized by a significant increase in the blood of immature forms of white blood cells and the appearance of "blast" cells. There are several clinical options for this stage:

• the patient feels well, does not complain about anything, but characteristic changes are found in the blood test;
• the patient has some complaints, but the blood test is normal.

The stage of complete clinical development is manifested by three syndromes:

1. Infectious toxic. Inflammation occurs in different organs.
2. Hemorrhagic. There is a tendency to bleeding. In this case, possible significant loss of blood.
3. Anemic. The amount of hemoglobin and red blood cells decreases. The skin and mucous membranes turn pale, the patient complains of increased fatigue, a feeling of lack of air, dizziness. The work of the heart is defective.

Remission stage

In this case, remission is complete or partial. The stage of complete clinical remission is characterized by the absence of a clinical picture and complaints, and no more than 5% of “blast” cells are found in bone marrow tissue. A blood test without pathological changes. If remission is partial, the patient feels well, while more than 5% of immature pathological cells are observed in the bone marrow.

Relapse stage

An increase in the content of “blast” cells in the blood and bone marrow, against the background of the general poor health of the patient, indicates the return of leukemia. Each subsequent relapse is more dangerous than the previous one and more often gives complications. The stage of relapse ends in terminal or goes into remission.

Terminal stage

The last stage is characterized by polyclonal tumor progression and severe malignancy of the process. Almost all normal cells are replaced by abnormal ones, which leads to complications and a serious condition of the patient. In many organs, ulcerative necrotic processes are observed.

The stages of leukemia in the acute period are very similar, they have more common symptoms than differences. But for the appointment of adequate treatment, determining the exact stage of leukemia is of great importance.

Stage of chronic leukemia: initial

The period preceding the expanded clinic lasts from six to twelve months. In the early stage of chronic leukemia, the patient often does not feel like a sick person, but minimal deviations are determined in the blood test. In rare cases, patients feel:

• general malaise;
• constant weakness that does not go away after rest;
• lack of appetite.

Every third has an expansion of the borders of the liver, spleen. In the blood, neutrophilic leukocytes are many times higher than the normal value, the platelet level increases. An important diagnostic criterion is the determination of the amount of alkaline phosphatase in white blood cells. In chronic leukemia, its amount is several times less than normal.

The number of red blood cells and hemoglobin is within the normal range. ESR is often normal, its acceleration is extremely rare. The platelet count is slightly higher than normal. When examining bone marrow punctate, a slight increase in the number of immature white blood cells can be detected.

The stages of chronic leukemia: detailed

The period in which the disease is diagnosed not only by blood tests. It has a clinical picture characteristic of acute leukemia. In the expanded stage, there is an almost complete inhibition of the formation of normal blood cells. The patient's condition worsens. It can last from three to five years, sometimes even longer.

A distinctive feature is the detection of an enlarged spleen. Sometimes it increases to such a gigantic size that the doctor can feel it in the small pelvis. The abdomen is significantly enlarged. The patient notes a feeling of heaviness in the abdomen due to compression of the adjacent organs by the spleen. The liver also enlarges. But its size is still several times smaller than the spleen.

One of the first signs of this stage may be general weakness, sweating, weight loss. Sometimes the patient notes a constant increase in temperature. The patient is emotionally unstable, it is difficult for him to work, he does not sleep well. In some cases, there may be allergic reactions on the skin. Bones and joints begin to hurt.

The level of leukocytes is sharply increased, blast cells are found in large numbers in peripheral blood. Many immature forms come to light. The level of lymphocytes is significantly reduced. The number of eosinophils is also increasing. Platelets are within normal limits or increase, which is very rare. ESR is accelerating. Many “blast” cells are found in bone marrow tissue.

Chronic leukemia stages: terminal stage

The steady progression of the disease ends in a terminal period. In the last stage, tumor cells fully show their malignancy. The patient's condition is severe or very serious. Malignant cells come out of the bone marrow and spread through the bloodstream through the systems and settle in vital organs.

The terminal stage occurs very unexpectedly. With treatment failure, the patient lives for a maximum of six months. It begins with a sharp increase in the level of white blood cells. The treatment that helped earlier does not give anything. Complete remission can be achieved only in every fifth patient. In most cases, partial remissions are observed, the duration of which is a maximum of a month.

The patient further decreases weight and is depleted. Due to anemia, the skin is pale. Damage to the heart in the form of arrhythmias is possible. So-called leukemids are formed on the skin from “blast” cells. They are very painful, the skin over them is slightly reddened. Lymph nodes increase in size. Bones and joints are so sore that without an anesthetic the patient cannot even fall asleep. As a result of an almost complete lack of immunity, severe inflammatory processes of parenchymal organs are possible.

A blast crisis is a characteristic sign of a critical stage. With it, the number of malignant cells in the blood exceeds 10%, and in the bone marrow - 20%, and this indicator is constantly growing. The disease can be slow for a long time, remain in a slow-flowing state for decades. But then it goes into a fast terminal stage, which ends in a fatal outcome.

Symptoms of acute leukemia in adults and life prognosis

So, when passing the next examination, the attending physician makes you a terrible diagnosis of Leukemia, acute or chronic, - do not despair, because there are many new different treatment methods, drugs, which allows you to optimistically look at the prognosis of treatment for this serious disease. In our article, we will try to figure out what this disease is and how to treat it.

What is acute leukemia

Leukemia (another name - leukemia) is a malignant disease of a person’s bone marrow, and it is popularly called “blood cancer”. The root cause of the disease is a violation of the hematopoiesis process in the body: immature blood cells, called blast cells, are produced in the bone marrow. As a rule, these are the precursors of white blood cells. Blast cells, due to uncontrolled reproduction, as they accumulate, prevent the bone marrow from producing normal blood cells. These malignant cells accumulate in the kidneys, liver, spleen and other organs and cause a violation of the blood supply to organs.

Due to the fact that in the human body there are 2 different lines of hematopoiesis, there are two main types of leukemia:

• Lymphoblastic, because formed by blast cells, lymphocyte precursors;
• Myeloid, because based on white blood cell precursors.

The term acute leukemia means an aggressive form of the course of the disease, when the disease develops rapidly.

The most common disease is acute lymphoblastic leukemia, which accounts for about three quarters of all malignant diseases of the hematopoietic system. Acute and chronic leukemia occur on average in four cases per 100 thousand people. Children make up about a quarter of the total number of cases. The vast majority of children suffer from this disease until the age of 14, boys are more susceptible to it.

Stages of leukemia

There are three stages of acute leukemia:

• Initial - the symptoms are not expressed or “masked” by other diseases, for example, acute respiratory viral infections.
• Expanded - all typical symptoms of the Acute Leukemia disease are available, the symptoms are pronounced. At this stage, basically, there is a remission or a complete cure of the disease.
• Terminal - a stage of deep oppression of blood formation functions.

Disease factors

In general, the causes of this disease, unfortunately, were not found. There are a number of dependencies on factors that are the causes of the disease in some cases:

• Conducted chemotherapy to treat another type of cancer increases the risk of the disease.
• Heredity - increases the likelihood of the disease due to the presence of genetic disorders and the presence of the disease in relatives.
• Smoking.
• Radiation exposure, etc.

However, there are many patients with leukemia who did not have risk factors established for the disease; the causes of the disease remain undetected. Science does not stand still and perhaps in the near future, scientists will find an answer to the question about the causes of the disease.

Acute Leukemia Symptoms

Symptoms in adults and children are practically the same. The only difference is that in adults with acute leukemia it most often acquires a chronic form, which means that the onset of the disease is often camouflaged and is expressed only in increased fatigue and frequent infectious diseases.

Common symptoms

Common symptoms characteristic of any stage are:

• Weight loss without any reason.
• Complaints about the deterioration of health, the patient often gets tired.
• Attacks of weakness, apathy, the patient may suddenly want to sleep.
• A feeling of heaviness in the abdomen, mainly in the left hypochondrium.
• More frequent infectious diseases.
• Increased sweating.
• Unreasonable increase in body temperature.

Associated symptoms

Such symptoms do not directly indicate that a person is sick with leukemia, as they are also characteristic of other ailments, but they are included in the clinical picture of the disease:

• Pale skin (due to anemia).
• Dyspnea.
• Gums can bleed, bruises on the body, blood can suddenly run through the nose.
• Headache.
• Visual impairment.
• Nausea and convulsions.
• Poor coordination when walking.
• Pain in bones and joints.

Diagnostics

With the diagnosis of Acute Leukemia, the diagnosis is carried out in several stages.

The first and most obvious step in diagnosing leukemia is through a clinical blood test. Decoding the hemogram shows how far the progress of the disease has gone. The blood picture shows the presence of pathological changes in the composition of the blood: a low level of red blood cells and platelets, the presence of blast cells.

At the second stage, the patient is hospitalized and the attending physician prescribes a puncture of bone marrow and cerebrospinal fluid for laboratory studies of their composition.

The third stage is to identify the effect of the disease on other human organs through ultrasound, computed tomography, etc.

Treatment

Treatment of acute leukemia, as a rule, consists of three stages:

• Achieving a reduction in the number of blast cells to a level safe for health and the onset of remission. Chemotherapy is carried out with special drugs (cytostatics) lasting several weeks, which destroy malignant blood cells.
• Destruction of residual abnormal blast cells in order to avoid relapse of the disease.
• Conducting maintenance therapy.

Unfortunately, acute leukemia, despite the treatment, has an unpleasant feature - relapses of the disease, which are quite common, in which case bone marrow transplantation is used as the most effective treatment.

Complications

Although chemotherapy is highly effective, it does have a number of side effects. So, when it is carried out, hematopoiesis is suppressed, the number of human platelets drops sharply and bleeding may occur. In order to prevent such problems, transfusions of donated blood and their components - platelets, red blood cells - are performed. Among the side effects, patients often complain of nausea, vomiting, hair loss, allergic reactions to chemotherapy drugs.

During treatment, the body's resistance to various infections sharply decreases and patients are prevented with infectious diseases with antibiotic courses, etc. For such patients, any infections are dangerous, as a result of which, patients are limited in contact with the outside world.

Forecast

Key questions in the diagnosis of Acute Blood Leukemia: How many live with such a disease? Can it be cured? However, the answer to them is not so simple at first glance. With a diagnosis of acute leukemia, the prognosis of life expectancy depends on many reasons: this is the type of leukemia, the stage of the disease, the age of the patient, the susceptibility of the body to chemotherapy treatment, the presence of concomitant diseases, etc.

For children, the prognosis for treatment is more favorable. Firstly, they are more often examined, which makes it possible to identify signs of the disease in the early stages. Secondly, the young body is more susceptible to chemotherapy and the treatment results will be much better and, thirdly, the vast majority do not have already accumulated diseases.

A characteristic feature of acute leukemia is its rapid development and, the longer a person does not take actions to treat him, the less likely he will survive in the future.

In general, the disease is characterized as severe, but at present they have learned to cure it, while about 90% of patients manage to achieve complete remission. However, it is important to understand that during a period of complete remission, there may be relapses of the disease that occur in approximately 25% of cases. In the absence of relapse within 5 years, it is believed that the disease was completely cured.

Acute leukemia

The most common type of hemoblastosis, in which the formed elements of the blood are gradually replaced by immature blast cells. It occurs in 3 people per hundred thousand people, and, according to statistics, adults are sick three times more often than children.

Types of Acute Leukemia

International FAB-classification differentiates acute leukemias according to the type of tumor cells into two large groups - lymphoblastic and non-lymphoblastic. In turn, they can be divided into several subspecies:

1. Acute lymphoblastic leukemias:

• pre-B-form
• B-form
• pre-T-form
• T-shape
• Other or neither T nor B-form

1. Acute non-lymphoblastic or, as they are also called, myeloid leukemias:

Acute myeloid, which is characterized by the appearance of a large number of precursors of granulocytes

Acute monoblastic and acute myelomonoblastic, which are based on active reproduction of monoblasts

Acute megakaryoblastic - develops as a result of active reproduction of platelet precursors, the so-called megakaryocytes

Acute erythroblastic, characterized by increased levels of erythroblasts

1. A separate group is acute undifferentiated leukemia

Symptoms of acute leukemia

Acute myeloid leukemia

Acute myeloid leukemia is characterized by a slight enlargement of the spleen, high body temperature and damage to internal organs.

So, for example, with leukemic pneumonitis, the focus of infiltration and inflammation is in the lungs, causing characteristic symptoms - coughing and fever.

Every fourth patient with myeloid leukemia has leukemic meningitis with severe headaches, fever, chills and neurological symptoms.

At a severe stage in the course of the process, leukemic infiltration of the kidneys may develop, leading to serious renal failure, up to complete urinary retention.

Specific leukemides appear on the skin - pink or light brown formations, the liver enlarges and becomes dense.

With intestinal damage, bloating, stool dilution is observed, severe, unbearable pain appears. In severe cases, ulcers form, cases of perforation are possible.

Acute lymphoblastic leukemia

This variant of the disease is characterized by an increase in the spleen and lymph nodes. As a rule, the pathological process is recorded in the supraclavicular region, first on one side, and then on both. The lymph nodes are dense, painless, and when adjacent organs are compressed, characteristic symptoms may occur.

For example, with an increase in lymph nodes in the mediastinum, a cough may appear, as well as respiratory distress in the form of shortness of breath. The defeat of the mesenteric nodes in the abdominal cavity leads to the appearance of pain in the abdomen. Men may experience induration and pain in the ovaries, most often on one side.

Acute erythromyeloblastic leukemia

In acute erythromyeloblastic leukemia, anemic syndrome comes to the fore - a pronounced decrease in the level of erythrocytes and hemoglobin in the blood, manifested by weakness, pallor and increased fatigue.

Stages of acute leukemia

Doctors-oncologists distinguish five stages of the disease, proceeding with characteristic symptoms:

The initial stage of acute leukemia

This period often runs latently, without pronounced clinical manifestations. It lasts from several months to several years - at this time the pathological process is just beginning, the level of leukocytes changes insignificantly (and their number can both increase and decrease), immature forms appear and anemia develops.

A blood test at this stage is not as informative as a bone marrow study, which allows detecting a large number of blast cells.

Advanced stage of acute leukemia

At this stage, the true symptoms of the disease appear, due to the inhibition of hematopoiesis and the appearance of a large number of immature cells in the peripheral blood.

In the advanced stage of acute leukemia, two variants of the course of the disease can be distinguished:

The patient feels satisfactory, there are no complaints, but at the same time, characteristic signs of leukemia are found in the blood test

The patient has a significant deterioration in well-being, but at the same time without pronounced changes in the peripheral blood

Remission, that is, the period of exacerbation subsiding, can be complete and incomplete.

Complete remission is characterized by the absence of symptoms of the disease, as well as blast cells in the blood. In the bone marrow, the level of immature cells should not exceed 5%.

With incomplete remission, the patient may feel relieved and feel better, but the level of blast cells in the bone marrow remains elevated.

Recurrences of acute leukemia can occur directly in the bone marrow, as well as outside it.

This stage is characterized by a large number of immature leukocytes in the peripheral blood and is accompanied by inhibition of the function of all vital organs. Most often ends in death.

Diagnostics of the acute leukemia

The doctor may suspect the diagnosis of acute leukemia by changes in the blood test, but the key criterion is an increase in blast cells in the bone marrow.

Changes in peripheral blood count

In most cases with acute leukemia, patients develop anemia with a sharp decrease in the level of erythrocytes and hemoglobin. A drop in the level of platelets is also noted (it is restored in the stage of remission and falls again with an exacerbation of the pathological process).

As for leukocytes, a double picture can be observed - both leukopenia, that is, a decrease in the level of leukocytes, and leukocytosis, that is, an increase in the level of these cells. As a rule, pathological blast cells are also present in the blood, but in some cases they may be absent, which does not exclude leukemia.

Leukemia, in which a large number of blast cells are fixed in the blood, is called "leukemic", and leukemia with the absence of blast cells is called "aleukemic".

Changes in the red bone marrow

The study of red bone marrow is the most important criterion for the diagnosis of acute leukemia.

The disease is characterized by a specific picture - an increase in the level of blast cells and inhibition of the formation of erythrocytes.

Another important diagnostic technique is bone trepanobiopsy. Bone sections are sent for biopsy, which in turn allows to identify blast hyperplasia of the red bone marrow and confirm the disease.

Diagnostic criteria for acute leukemia:

30% or more of all cellular elements of the red bone marrow account for blasts

The level of erythrokaryocytes is more than 50%, blasts - not less than 30%

In acute promyelocytic leukemia, the appearance in the bone marrow of specific hypergranular atypical promyelocytes

Treatment of acute leukemia

The treatment regimen for acute leukemia depends on the age and condition of the patient, the type and stage of development of the disease, and is always calculated individually in each case.

There are two main types of therapy for acute leukemia - chemotherapy and surgical treatment - bone marrow transplantation.

Chemotherapy consists of two sequential stages:

The first step is to induce remission. Chemotherapy helps oncologists reduce blast cell levels

The consolidation stage required to kill the remaining cancer cells

Re-induction, as a rule, completely repeating the scheme (drugs, dosages, frequency of administration) of the first stage

In addition to chemotherapy drugs, cytostatics are present in the general treatment regimen.

According to statistics, the total duration of chemotherapy treatment for acute leukemia is about 2 years.

Chemotherapy in combination with cytostatics is an aggressive method of action, causing a number of side effects (nausea, vomiting, deterioration of health, hair loss, etc.). In order to alleviate the patient's condition, concomitant therapy is prescribed. In addition, depending on the condition, antibiotics, detoxification agents, platelet and erythrocyte mass, blood transfusion can be recommended.

Bone marrow transplant

Bone marrow transplantation provides the patient with healthy stem cells, which later become the ancestors of normal blood cells.

The most important condition for transplantation is complete remission of the disease. It is important that the bone marrow cleared of blast cells is refilled with healthy cells.

In order to prepare the patient for the operation, special immunosuppressive therapy is performed. This is necessary to destroy leukemic cells and suppress the body's defenses to reduce the risk of transplant rejection.

Contraindications for bone marrow transplantation:

Dysfunction of internal organs

Acute infectious diseases

Recurrence of acute leukemia that does not translate into remission

Disease prognosis

According to statistics, the prognosis in children with acute leukemia is better than in adults. So, child survival rate for 5 years is%, adult - from 20 to 40%.

Acute myeloid leukemia is potentially more dangerous, in its case the five-year survival rate in patients under 55 years of age is 40-60%, and in the elderly only 20%.

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Leukemia (leukemia): types, signs, prognosis, treatment, causes

Leukemia is a serious blood disease that refers to neoplastic (malignant). In medicine, it has two more names - white blood or leukemia. This disease does not know age restrictions. Children of different ages suffer from it, including infants. It can occur in youth, and in middle age, and in old age. Leukemia equally affects both men and women. Although, according to statistics, people with white skin color get sick much more often than black people.

Types of Leukemia

With the development of leukemia, a certain type of blood cells degenerates into malignant. The classification of the disease is based on this.

1. When passing into the leukemia cells of lymphocytes (blood cells of the lymph nodes, spleen and liver), it is called LYMPHOLEUCOSIS.
2. The degeneration of myelocytes (blood cells formed in the bone marrow) leads to MYELOLEukOSIS.

The degeneration of other types of white blood cells, leading to leukemia, although it occurs, is much less common. Each of these species is divided into subspecies, of which there are many. Only a specialist can understand them, armed with modern diagnostic equipment and laboratories equipped with everything necessary.

The division of leukemia into two fundamental types is explained by violations during the transformation of different cells - myeloblasts and lymphoblasts. In both cases, instead of healthy white blood cells, leukemia cells appear in the blood.

In addition to classification by the type of lesion, acute and chronic leukemia are distinguished. Unlike all other diseases, these two forms of bleeding have nothing to do with the nature of the course of the disease. Their peculiarity is that the chronic form almost never becomes acute and, conversely, the acute form cannot under any circumstances become chronic. Only in isolated cases, chronic leukemia can be complicated by an acute course.

This is due to the fact that acute leukemia occurs during the transformation of immature cells (blasts). At the same time, their rapid reproduction begins and enhanced growth occurs. This process cannot be controlled, therefore, the probability of death in this form of the disease is high enough.

Chronic leukemia develops when the growth of altered fully matured blood cells or those in the stage of maturation progresses. It differs in the duration of the course. Supportive therapy is sufficient for the patient to remain stable.

Causes of bleeding

What exactly causes the mutation of blood cells has not yet been fully clarified. But it is proved that one of the factors causing bleeding is radiation exposure. The risk of the disease appears even with small doses of radiation. In addition, there are other causes of leukemia:

• In particular, leukemia can be caused by leukemia drugs and some chemicals used in everyday life, such as benzene, pesticides, etc. Leukemogenic drugs include penicillin antibiotics, cytostatics, butadione, levomycetin, as well as drugs used in chemotherapy.
• Most infectious and viral diseases are accompanied by the invasion of viruses into the body at the cellular level. They cause a mutational transformation of healthy cells into pathological ones. Under certain factors, these mutant cells can transform into malignant, leading to leukemia. The largest number of leukemia diseases was noted among HIV-infected people.
• One of the causes of chronic leukemia is a hereditary factor that can manifest itself even after several generations. This is the most common cause of leukemia in children.

Etiology and pathogenesis

The main hematological signs of leukemia are a change in blood quality and an increase in the number of young blood cells. In this case, ESR increases or decreases. Thrombocytopenia, leukopenia and anemia are noted. Leukemia is characterized by abnormalities in the chromosome set of cells. Based on them, the doctor can make a prognosis of the disease and choose the best treatment methodology.

Common symptoms of leukemia

With leukemia, the correct diagnosis and timely treatment are of great importance. At the initial stage, the symptoms of blood leukemia of any kind are more like colds and some other diseases. Listen to your well-being. The first manifestations of bleeding are manifested by the following symptoms:

1. A person experiences weakness, malaise. He constantly wants to sleep, or, conversely, the dream disappears.
2. Brain activity is disrupted: a person hardly remembers what is happening around him and cannot concentrate on elementary things.
3. The skin turns pale, bruises appear under the eyes.
4. Wounds do not heal for a long time. Possible bleeding from the nose and gums.
5. For no apparent reason, the temperature rises. She can stay at a level of 37.6º for a long time.
6. Slight bone pains are noted.
7. Gradually, an increase in the liver, spleen and lymph nodes occurs.
8. The disease is accompanied by increased sweating, palpitations are becoming more frequent. Dizziness and fainting are possible.
9. Colds occur more often and last longer than usual, chronic diseases worsen.
10. The desire to eat disappears, so a person begins to lose weight dramatically.

If you notice the following symptoms, do not delay the visit to the hematologist. It is better to play it safe a bit than to treat a disease when it is started.

These are common symptoms characteristic of all types of leukemia. But, for each species there are characteristic signs, features of the course and treatment. Consider them.

Video: leukemia presentation (eng)

Lymphoblastic acute leukemia

This type of leukemia is most common in children and young men. Acute lymphoblastic leukemia is characterized by impaired blood formation. An excessive amount of pathologically altered immature cells - blasts is produced. They precede the appearance of lymphocytes. Blasts begin to multiply rapidly. They accumulate in the lymph nodes and spleen, preventing the formation and normal functioning of ordinary blood cells.

The disease begins with a prodromal (latent) period. It can last from one week to several months. A sick person has no specific complaints. He just feels a constant feeling of fatigue. He has a malaise due to a temperature elevated to 37.6 °. Some notice that they have enlarged lymph nodes in the neck, armpits, and groin. Slight bone pains are noted. But at the same time, the person continues to fulfill his labor duties. After some time (it is different for everyone), a period of pronounced manifestations sets in. It occurs suddenly, with a sharp increase in all manifestations. In this case, various options for acute leukemia are possible, the occurrence of which is indicated by the following symptoms of acute leukemia:

• Sore throat (ulcerative-necrotic), accompanied by severe sore throat. This is one of the most dangerous manifestations in malignant disease.
• Anemic. With this manifestation, hypochromic anemia begins to progress. The number of white blood cells in the blood increases sharply (from several hundred in one mm³ to several hundred thousand per mm³). About proteinuria is evidenced by the fact that more than 90% of the blood consists of progenitor cells: lymphoblasts, hemohistoblasts, myeloblasts, hemocytoblasts. The cells on which the transition to mature neutrophils (young, myelocytes, promyelocytes) depends. As a result, the number of monocytes and lymphocytes is reduced to 1%. The platelet count is also reduced.

Hypochromic leukemia anemia

• Hemorrhagic in the form of hemorrhages on the mucous membrane, exposed skin. Blood flows from the gums and nose, uterine, renal, gastric and intestinal bleeding are possible. In the last phase, pleurisy and pneumonia may occur with the release of hemorrhagic exudate.
• Splenomegaly - a characteristic enlargement of the spleen caused by increased destruction of mutated white blood cells. In this case, the patient experiences a feeling of heaviness in the abdomen on the left side.
• There are frequent cases when a leukemic infiltrate penetrates the bones of the ribs, clavicle, skull, etc. It can affect the bones of the eye cavity. This form of acute leukemia is called chlorleukemia.

Clinical manifestations can combine various symptoms. For example, acute myeloid leukemia is rarely accompanied by swollen lymph nodes. This is not typical for acute lymphoblastic leukemia. Lymph nodes become hypersensitive only with ulcerative necrotic manifestations of chronic lymphoblastic leukemia. But all forms of the disease are characterized by the fact that the spleen takes on a large size, blood pressure decreases, and the pulse quickens.

Acute leukemia in childhood

Acute leukemia most commonly affects childhood organisms. The highest percentage of the disease is between the ages of three to six years. Acute leukemia in children is manifested by the following symptoms:

1. The spleen and liver are enlarged, so the child has a large belly.
2. The size of the lymph nodes also exceeds the norm. If the enlarged nodes are located in the chest area, the child is tormented by a dry, debilitating cough, shortness of breath occurs when walking.
3. With the defeat of the mesenteric nodes, pain appears in the abdomen and lower legs.
4. Mild leukopenia and normochromic anemia are noted.
5. The child quickly gets tired, the skin is pale.
6. Symptoms of acute respiratory viral infections with fever are clearly pronounced, which can be accompanied by vomiting, severe headache. Often there are seizures.
7. If leukemia reaches the spinal cord and brain, then the child may lose balance while walking and often fall.

Treatment of acute leukemia

Treatment of acute leukemia is carried out in three stages:

• Stage 1. The course of intensive therapy (induction), aimed at reducing the number of blast cells in the bone marrow to 5%. At the same time, they should be completely absent in normal blood flow. This is achieved by chemotherapy using multicomponent cytostatic drugs. Based on the diagnosis, anthracyclines, glucocorticosteroid hormones and other drugs can also be used. Intensive therapy provides remission in children - in 95 cases out of 100, in adults - in 75%.
• Stage 2. Fixing remission (consolidation). It is carried out in order to avoid the likelihood of a relapse. This stage can last from four to six months. During its implementation, careful monitoring by a hematologist is required. Treatment is carried out in a clinical setting or in a day hospital. Chemotherapeutic drugs are used (6-mercaptopurine, methotrexate, prednisone, etc.), which are administered intravenously.
• Stage 3. Maintenance therapy. This treatment lasts for two to three years, at home. 6-mercaptopurine and methotrexate are used in tablet form. The patient is in the hematological clinic. He should periodically (the date of visits is prescribed by the doctor) undergo an examination in order to control the quality of the blood composition

If chemotherapy is not possible due to a serious complication of an infectious nature, acute blood leukemia is treated by transfusion of donor erythrocyte mass - from 100 to 200 ml three times in two to three to five days. In critical cases, bone marrow or stem cell transplantation is performed.

Many are trying to treat leukemia with folk and homeopathic remedies. They are quite acceptable in chronic forms of the disease, as an additional restorative therapy. But in acute leukemia, the faster the intensive drug therapy is carried out, the higher the chance of remission and a better prognosis.

Forecast

If the beginning of treatment is very late, then the death of a patient with bleeding can occur within a few weeks. This is dangerous acute form. However, modern medical techniques provide a high percentage of improvement in the patient's condition. At the same time, stable remission is achieved in 40% of adults, with the absence of relapse for more than 5-7 years. The prognosis for acute leukemia in children is more favorable. Improvement in the age of up to 15 years is 94%. In adolescents over 15 years of age, this figure is slightly lower - only 80%. Recovery of children occurs in 50 cases out of 100.

An unfavorable prognosis is possible in infants (up to a year) and over ten years of age (and older) in the following cases:

1. A large degree of spread of the disease at the time of accurate diagnosis.
2. Strong enlargement of the spleen.
3. The process reached the mediastinal nodes.
4. The functioning of the central nervous system is disrupted.

Chronic lymphoblastic leukemia

Chronic leukemia is divided into two types: lymphoblastic (lymphocytic leukemia, lymphatic leukemia) and myeloblastic (myelogenous leukemia). They have various symptoms. In this regard, each of them requires a specific treatment technique.

Lymphatic Leukemia

The following symptoms are characteristic of lymphatic leukemia:

1. Loss of appetite, sudden weight loss. Weakness, dizziness, severe headaches. Sweating enhancement.
2. Enlarged lymph nodes (from the size of a small pea to a chicken egg). They are not associated with the skin and are easily rolled upon palpation. They can be felt in the groin, neck, armpits, sometimes in the abdomen.
3. With an increase in the lymph nodes of the mediastinum, vein compression occurs and swelling of the face, neck, and hands occurs. Perhaps their blue color.
4. The enlarged spleen protrudes 2-6 cm from under the ribs. About the same goes beyond the edges of the ribs and an enlarged liver.
5. There is a frequent heartbeat and sleep disturbance. Progressing, chronic lymphoblastic leukemia in men causes a decrease in sexual function, in women - amenorrhea.

A blood test with such leukemia shows that the number of lymphocytes in the leukocyte formula is sharply increased. It ranges from 80 to 95%. The number of leukocytes can reach 1 mm³. Blood platelets are normal (or slightly underestimated). The number of hemoglobin and red blood cells is significantly reduced. The chronic course of the disease can be extended for a period of three to six to seven years.

Lymphocytic leukemia treatment

The peculiarity of chronic leukemia of any kind is that it can last for years, while maintaining stability. In this case, the treatment of leukemia in the hospital can not be carried out, just periodically check the blood condition, if necessary, engage in strengthening therapy at home. The main thing is to follow all the doctor’s instructions and eat right. Regular follow-up is an opportunity to avoid a difficult and unsafe course of intensive care.

Photo: an increased number of white blood cells in the blood (in this case, lymphocytes) with leukemia

If there is a sharp increase in leukocytes in the blood and the patient's condition worsens, then there is a need for chemotherapy using the drugs Chlorambucil (Leikeran), Cyclophosphamide, etc. The monoclonal antibodies Campas and Rituximab are also included in the treatment course.

The only way that makes it possible to completely cure chronic lymphocytic leukemia is bone marrow transplantation. However, this procedure is very toxic. It is used in rare cases, for example, for people at a young age, if the sister or brother of the patient acts as a donor. It should be noted that a full recovery is provided exclusively by allogeneic (from another person) bone marrow transplant with leukemia. This method is used to eliminate relapses, which, as a rule, are much harder and more difficult to treat.

Chronic myeloid leukemia

Myeloblastic chronic leukemia is characterized by a gradual development of the disease. The following symptoms are observed:

1. Decreased weight, dizziness and weakness, fever and increased sweat.
2. With this form of the disease, gingival and nosebleeds, pallor of the skin are often noted.
3. The bones begin to hurt.
4. Lymph nodes, as a rule, are not enlarged.
5. The spleen significantly exceeds its normal size and occupies almost the entire half of the inner cavity of the abdomen on the left side. The liver also has enlarged sizes.

Chronic myeloid leukemia is characterized by an increased number of leukocytes - 1 mm3 dov, decreased hemoglobin and a reduced number of red blood cells. The disease develops within two to five years.

Myelosis treatment

Therapeutic treatment of chronic myeloid leukemia is selected depending on the stage of development of the disease. If it is in a stable state, then only general strengthening therapy is carried out. The patient is recommended good nutrition and regular medical examination. A course of general strengthening therapy is carried out by the drug Mielosan.

If white blood cells began to multiply intensively, and their number significantly exceeded the norm, radiation therapy is performed. It is aimed at irradiating the spleen. Monochemotherapy is used as the primary treatment (treatment with Myelobromol, Dopan, Hexaphosphamide). They are administered intravenously. A good effect is given by polychemotherapy according to one of the TsVAMP or AVAMP programs. The most effective treatment for leukemia today is bone marrow and stem cell transplantation.

Juvenile myelomonocytic leukemia

Children between the ages of two and four years often experience a special form of chronic leukemia called juvenile myelomonocytic leukemia. It is one of the rarest types of bleeding. Most often they get sick boys. The cause of its occurrence is considered to be hereditary diseases: Noonan syndrome and type I neurofibromatosis.

The development of the disease is indicated by:

• Anemia (pallor of the skin, increased fatigue);
• Thrombocytopenia, manifested by nose and gingival bleeding;
• The child does not gain weight, lags behind in growth.

Unlike all other types of leukemia, this variety occurs suddenly and requires immediate medical attention. Myelomonocytic juvenile leukemia is practically not treated with conventional therapeutic agents. The only way that gives hope for recovery is an allogeneic bone marrow transplant, which is desirable to be performed as soon as possible after diagnosis. Before this procedure, the child undergoes a course of chemotherapy. In some cases, there is a need for splenectomy.

Myeloid non-lymphoblastic leukemia

The progenitors of the blood cells that form in the bone marrow are stem cells. Under certain conditions, the stem cell maturation process is disrupted. They begin uncontrolled division. This process is called myeloid leukemia. Most often, adults are affected by this disease. In children, it is extremely rare. The cause of myeloid leukemia is a chromosomal defect (mutation of one chromosome), which is called the "Philadelphia Rh chromosome."

The disease is slow. Symptoms are unclear. Most often, the disease is diagnosed by chance when a blood test is performed during the next physical examination, etc. If there is a suspicion of leukemia in adults, then a direction is given for a biopsy study of the bone marrow.

Photo: biopsy for the diagnosis of leukemia

There are several stages of the disease:

1. Stable (chronic). At this stage, the number of blast cells in the bone marrow and total blood flow does not exceed 5%. In most cases, the patient does not need hospitalization. He can continue to work by providing supportive anti-cancer pill therapy at home.
2. Acceleration of the development of the disease, during which the number of blast cells increases to 30%. Symptoms manifest as increased fatigue. The patient develops nose and gingival bleeding. Treatment is carried out in a hospital, by the intravenous administration of anti-cancer drugs.
3. Blast crisis. The onset of this stage is characterized by a sharp increase in blast cells. To destroy them requires intensive care.

After the treatment, remission is observed - a period during which the number of blast cells returns to normal. PCR diagnostics indicate that the Philadelphia chromosome no longer exists.

Most types of chronic leukemia are being treated successfully. For this, a group of experts from Israel, the USA, Russia and Germany developed special treatment protocols (programs), including radiation therapy, chemotherapy, stem cell treatment and bone marrow transplantation. People who are diagnosed with chronic leukemia can live long enough. But with acute leukemia, very few live. But in this case, it all depends on when the treatment course was started, its effectiveness, individual characteristics of the body and other factors. There are many cases when people "burned out" in a few weeks. In recent years, with proper, timely treatment and subsequent maintenance therapy, the life span in the acute form of leukemia increases.

Video: lecture on myeloid leukemia in children

Hairy Cell Lymphocytic Leukemia

An oncological blood disease, the development of which the bone marrow produces an excessive amount of lymphocytic cells, is called hairy cell leukemia. It occurs in very rare cases. It is characterized by a slow development and course of the disease. The leukemia cells in this disease with multiple enlargement look like small bodies overgrown with “hair”. Hence the name of the disease. This form of leukemia occurs mainly in elderly men (after 50 years). According to statistics, women make up only 25% of the total number of cases.

There are three types of hairy cell leukemia: refractory, progressive and untreated. Progressive and untreated forms are the most common, since the main symptoms of the disease, most patients associate with signs of impending old age. For this reason, they go to the doctor very late when the disease is already progressing. The refractory form of hairy cell leukemia is the most complex. It occurs as a relapse after remission and practically does not respond to treatment.

Leukocyte with “hairs” in hairy cell leukemia

Symptoms of this disease do not differ from other varieties of leukemia. This form can only be detected by biopsy, blood test, immunophenotyping, computed tomography and bone marrow aspiration. A blood test for leukemia shows that white blood cells are tens (hundreds) times higher than normal. In this case, the number of platelets and red blood cells, as well as hemoglobin, are reduced to a minimum. All these are the criteria that are characteristic of this disease.

• Chemotherapeutic procedures using cladribine and pentosatin (anti-cancer drugs);
• Biological therapy (immunotherapy) with Interferon alfa and Rituximab;
• Surgical method (splenectomy) - excision of the spleen;
• Stem cell transplant;
• Restorative therapy.

The effect of leukemia in cows per person

Leukemia is a common disease in cattle (cattle). There is speculation that the leukemia virus may be transmitted through milk. This is evidenced by experiments conducted on lambs. However, studies on the effects of milk from animals infected with leukemia in humans have not been conducted. The pathogen of cattle leukemia itself is considered dangerous (it dies when the milk is heated to 80 ° C), but carcinogenic substances that cannot be destroyed by boiling. In addition, the milk of a patient suffering from leukemia of the animal helps to reduce human immunity, causes allergic reactions.

It is strictly forbidden to give milk from cows with leukemia to children, even after heat treatment. Adults can eat milk and meat of animals with leukemia only after treatment with high temperatures. Only internal organs (liver) are utilized, in which leukemic cells are mainly propagated.