Subleukemic myelosis is one of the representatives of the group of slow chronic leukemia, in which a pathological change in the myelocyte progenitor cell becomes the cause of the disease. Along with violations of the process of maturation of hematopoietic cells in this disease, reactive fibro-sclerotic lesions develop in the bones of the skeleton with concomitant compression of the bone marrow and proliferative changes in the spleen and liver. That is why subleukemic myelosis is classified as myeloproliferative leukemia.
Causes of myelofibrosis and options for the course of the disease
In the vast majority of cases, this disease occurs in patients who are already 50 years old or older, therefore, a certain importance is attached to genetic malfunctions in the nuclear material of progenitor stem cells, autoimmune disorders, and viral infections. The morphological substrate of myelosis is a change in all three sprouts of hematopoiesis - granulocytic, megakaryocytic and erythroid. It is on the severity of these disorders that the course of the disease and prognosis depend.
In the vast majority of cases, subleukemic myelosis is quite benign, and there is a direct correlation between the age of the patient at the time of the onset of the disease and the prognosis - the younger the patient, the more severe myelofibrosis occurs. In the terminal stage of the disease, which can develop in 5-15, or even 20 years after the first symptoms are detected, patients develop blast crises. Then the disease takes on the features of acute leukemia: a large number of blasts appear in the peripheral blood. Symptoms of this development of the disease are fever, signs of intoxication, anemic and hemorrhagic syndrome. In this case, the spleen and liver often increase . Some patients may experience rapid progression of the disease with an early appearance of bleeding syndrome and patient anemia.
The clinical picture of subleukemic myelosis
Most often, patients are worried about severe general weakness, heaviness in the abdomen, which increases with movement and especially after eating (it is explained by a significant increase in the spleen and liver). There are complaints of headache, pain in the bones and spine. Very rarely, in the terminal stage of the disease, the patient may develop severe sensitivity disorders. The doctor must necessarily exclude funicular myelosis - a pathological condition of the nervous system that occurs with some megaloblastic anemia. This condition most often occurs with anemia, which occurs in patients with insufficient intake of vitamin B12 in the body.
In addition, thrombosis often occurs, the cause of which is an increased number of platelets in the peripheral blood in general and blood clotting disorders. The latter may be due to the morphological immaturity of even a sufficiently large number of platelets. Sooner or later, thrombocytosis leads to the development of splenomegaly, but not only platelets, but also erythrocytes begin to actively break down in the spleen, which causes anemia.
Patient Examination Program and Treatment Options
The diagnosis of "Subleukemic myelosis" should be made not on the basis of a clinical blood test, but on the results of sternal puncture or trepanobiopsy of the ilium. Changes in the blood test are largely nonspecific, and only on the detection of an increased or decreased number of blood cells and a change in their percentage cannot be diagnosed with Subleukemic myelosis.
The treatment of the disease also depends on the condition of the bone marrow and existing violations of the bone structure. In some cases, dynamic monitoring of the patient is sufficient, while with rapidly progressive myelofibrosis, chemotherapy drugs are necessary.
In the terminal stage of the disease, in some cases it is necessary to conduct radiation therapy, a massive prescription of chemotherapy drugs according to the treatment program for acute myelogenous leukemia, removal of the spleen - but in each case of the disease, the treatment should be prescribed by a qualified hematologist.