Chronic lymphocytic leukemia is a disease in which an excessive amount of white blood cells is produced in the body. A similar disorder develops mainly in people after 60 years. The disease develops very slowly and in the first few years, no characteristic signs may appear.
Lymphocytic leukemia is distinguished by the degree of maturity of the malignant cells. With the occurrence of such a pathology, damage to the bone marrow is primary, and the leukocytes developing in it are the nutritional basis for this.
The cause of the disease is still unknown. Many doctors believe that the disease is genetic in nature. It is important to recognize the course of the disease in a timely manner, to conduct diagnosis and subsequent treatment.
Features of the disease
Lymphocytes - a type of white blood cells that belong to the functional element of the immune system. Healthy lymphocytes degenerate into a plasma cell and produce immunoglobulins. Such antibodies eliminate toxic, pathogenic microorganisms that are foreign to the human body.
Chronic lymphocytic leukemia (ICD-10 code - C91.1) is a tumorous disease of the circulatory system. With the course of the disease, leukemic lymphocytes continuously multiply and accumulate in the bone marrow, spleen, blood, liver, lymph nodes. It should be noted that the higher the rate of cell division, the more aggressive the course of pathology.
Chronic lymphocytic leukemia is a disease that affects mainly the elderly. Often the disease develops very slowly and is almost asymptomatic. It is discovered quite by accident when conducting a general blood test. In appearance, abnormal lymphocytes do not differ from normal ones, however, their functional value is impaired.
Patients have a reduced level of resistance to pathogens. The cause of the disease is not yet fully known, however, aggravating factors are considered to be the impact on the body of viruses and a genetic predisposition.
Flow stages
To select the most optimal treatment methods, as well as to determine the prognosis of the disease, several stages of chronic lymphocytic leukemia are distinguished. At the very beginning of the development of the disease, only lymphocytosis is determined in the blood in the laboratory. On average, patients with this stage live more than 12 years. The degree of risk is considered minimal.
At stage 1, an increase in lymph nodes joins lymphocytosis, which can be determined by palpary or instrumental. The average life expectancy is up to 9 years, and the degree of risk is intermediate.
With the course of stage 2, in addition to lymphocytosis, when examining a patient, splenomegaly and hepatomegaly can be determined. On average, patients live up to 6 years.
At stage 3, hemoglobin sharply decreases, and steady lymphocytosis and an increase in lymph nodes in size are also observed. The life expectancy of the patient is up to 3 years.
With the course of 4 degrees, thrombocytopenia joins all these manifestations. The risk level in this case is very high, and the average life expectancy of patients is less than one and a half years.
Disease classification
Chronic lymphocytic leukemia (ICD-10 code - C91.1) is divided into several groups, based on what kind of blood cells began to multiply very quickly and almost uncontrollably. It is on this parameter that the disease is divided into:
- megakaryocytic leukemia;
- monocytic;
- myeloid leukemia;
- erythromyelosis;
- macrophage;
- lymphocytic leukemia;
- erythremia;
- mast cell;
- hairy cell.
Benign chronic lesion is characterized by a slow increase in leukocytosis and lymphocytes. The increase in lymph nodes is negligible and there is no anemia or signs of intoxication. The patient's well-being is quite satisfactory. Special treatment is not required, the patient is only recommended to observe a rational regime of rest and labor, the consumption of healthy foods rich in vitamins. It is recommended to abandon bad habits, avoid hypothermia.
The progressive form of chronic lymphocytic leukemia is classical and is characterized by the fact that the increase in the number of leukocytes occurs regularly, every month. Lymph nodes gradually increase and signs of intoxication are observed, in particular, such as:
- fever;
- weakness;
- losing weight;
- excessive sweating.
With a significant increase in the number of leukocytes, specific chemotherapy is prescribed. With proper treatment, it is possible to achieve prolonged remission. The tumor form is characterized by the fact that leukocytosis in the blood is negligible. In this case, there is an increase in the spleen, lymph nodes, tonsils. For treatment, combined chemotherapy courses are prescribed, as well as radiation therapy.
Splenomegaly type of chronic lymphocytic leukemia (according to ICD-10 - C91.1) is characterized by the fact that leukocytosis is moderate, lymph nodes are slightly enlarged, and the spleen is large. For treatment, radiation therapy is prescribed, and in severe cases, removal of the spleen is indicated.
The bone marrow form of chronic lymphocytic leukemia is expressed in a slight increase in the spleen and lymph nodes. When conducting blood tests, lymphocytosis is detected, a rapid decrease in platelets, red blood cells and healthy white blood cells. In addition, there is increased bleeding and anemia. A chemotherapy course is prescribed for treatment.
The pro-lymphocytic type of chronic lymphocytic leukemia (according to ICD-10 - C91.3) is characterized by the fact that patients have increased leukocytosis with a significant increase in the spleen. She does not respond well to standard treatment.
The hairy cell type of the disease is a special form in which leukemic pathological lymphocytes have characteristic features. With its course, the lymph nodes do not change, the liver and spleen increase, and patients also suffer from various infections, bone damage and bleeding. The only method of therapy is removal of the spleen, and chemotherapy is also performed.
Main symptoms
Chronic lymphocytic leukemia develops over a long period, and symptoms may not appear for a long time, only blood counts change. Then, iron levels gradually decrease, resulting in signs of anemia. Initial signs can be a manifestation of leukemia at the same time, but often they go unnoticed. Among the main features can be identified such as:
- pallor of the skin and mucous membranes;
- weakness;
- sweating
- shortness of breath with increased physical exertion.
In addition, temperature can rise and rapid weight loss can begin. A large number of lymphocytes affect the bone marrow and gradually settle in the lymph nodes. It is worth noting that the lymph nodes increase significantly and remain painless. Their consistency is somewhat reminiscent of soft dough, and their sizes can reach 10-15 cm. Lymph nodes can squeeze vital organs, provoking cardiovascular and respiratory failure.
Together with the lymph nodes , the spleen begins to increase in size, and then the liver. These two organs generally do not grow to significant sizes, but there may be exceptions.
Chronic lymphocytic leukemia provokes various kinds of immune disorders. Leukemic pathological lymphocytes cease to fully produce antibodies, which become insufficient for the body to resist pathogens and various infections, the frequency of which increases sharply. Respiratory organs are often affected, resulting in severe bronchitis, pleurisy, and pneumonia.
There are frequent cases of urinary tract infection or damage to the skin. Another consequence of a decrease in immunity is the formation of antibodies to their own red blood cells, which provokes the development of hemolytic anemia, which manifests itself in the form of jaundice.
Diagnostics
For the diagnosis of chronic lymphocytic leukemia, a blood test is performed first. At the initial stage of the course of pathology, the clinical picture may vary somewhat. The severity of leukocytosis largely depends on the stage of the course of the disease.
Also, with the occurrence of chronic lymphocytic leukemia in blood tests, a deficiency of red blood cells and hemoglobin is detected. Such a violation can be triggered by the displacement of tumor cells from the bone marrow by their cells. The level of platelets in the initial stages of the course of the disease often remains within the normal range, however, as the pathological process develops, their number decreases.
To confirm the diagnosis, examination methods such as:
- biopsy of the affected lymph node;
- bone marrow puncture;
- determination of the level of immunoglobulins;
- cell immunophenotyping.
Cellular research of blood and bone marrow allows us to determine the immunological markers of the disease in order to exclude the occurrence of other diseases and make a prediction regarding its course.
Treatment features
Unlike many other malignant processes, the treatment of chronic lymphocytic leukemia at the initial stage is not carried out. Basically, therapy begins when there are signs of disease progression, which include such as:
- a rapid increase in the number of abnormal white blood cells in the blood;
- significant growth of lymph nodes;
- progression of anemia, thrombocytopenia;
- enlargement of the spleen in size;
- the occurrence of signs of intoxication.
The treatment technique is selected purely individually, based on accurate diagnostic data and patient characteristics. Basically, therapy is aimed at eliminating complications. By itself, this disease is still incurable.
Chemotherapy drugs are used in minimal dosages of toxic substances and often they are prescribed to prolong the patient's life and get rid of unpleasant symptoms. Patients should always be under the strict supervision of a hematologist-oncologist. A blood test should be carried out 1-3 times over 6 months. If necessary, special supportive cytostatic therapy is prescribed.
Conservative therapy
Treatment of chronic lymphocytic leukemia is carried out after identifying all possible complications, establishing the form, stage and diagnosis. Diet and drug therapy have been shown. With a severe course of the disease, a bone marrow transplant is required, as this is the only possible way to achieve complete cure.
At the very beginning of the course of the disease, dispensary observation is indicated, and if necessary, the doctor prescribes antibacterial drugs. When an infection is attached, antiviral and antifungal agents are required. In the following months, a course of chemotherapy aimed at the rapid elimination of cancer cells from the body is indicated. Radiation therapy is used when it is necessary to quickly reduce the size of the tumor and there is no possibility of exposure to it with chemotherapy drugs.
The use of medications
Reviews of chronic lymphocytic leukemia in fifty percent of cases are positive, because due to proper treatment it is possible to normalize the patient's well-being. Many patients say that during chemotherapy in the initial stages, life can be significantly extended and its quality improved.
In the absence of concomitant diseases, if the patient is under 70 years old, a combination of such drugs as Cyclophosphamide, Fludarabine, Rituximab is mainly used. In case of poor tolerance, other drug combinations may be used.
For the elderly or in the presence of concomitant diseases, more gentle combinations of drugs are prescribed, in particular, Obinutuzumab with Chlorambucil, Rituximab and Chlorambucil or Cyclophosphamide with Prednisolone. With a steady course of disorders or relapse, patients can change the regimen. In particular, it may be a combination of "Idealisib" and "Rituximab."
Very weak patients with severe concomitant diseases are prescribed mainly monotherapy, in particular, drugs that are relatively easily tolerated. For example, such as "Rituximab", "Prednisone", "Chlorambucil."
Power Features
All patients with chronic lymphocytic leukemia need a rational distribution of rest and work, as well as proper nutrition. In the usual diet, animal products should prevail, and fat intake should also be limited. Necessarily requires the consumption of fresh fruits, herbs, vegetables.
With anemia, foods with a high iron content will be useful for normalizing hematopoiesis factors. In the diet, you regularly need to add the liver, as well as vitamin teas.
Prognosis for the patient
For most patients suffering from such a violation, the prognosis after treatment is quite good. At the initial stage of the course of chronic lymphocytic leukemia, the life expectancy is more than 10 years. Many may well do without special treatment. Despite the fact that the disease is incurable, the initial stage can continue for a long time. Treatment often leads to sustained remission. Only the attending doctor can give a more accurate prognosis.
For treatment, there are many modern techniques. Newer, more advanced medications and treatment approaches are emerging all the time. New drugs that have appeared in the past few years help to significantly improve treatment prognosis.
There is no specific prophylaxis of lymphocytic leukemia. Self-medication can only significantly aggravate the situation and can be deadly for the patient.