Chronic leukemia

Chronic myelogenous leukemia (synonym: myeloid leukemia, mieloz, myeloid leukemia) is peculiar to the change of blood in the form of hyperproliferative and violations of differentiation at the level of promielozitov and plasmic order has been revealed. In the initial stage of the disease other sprouts blood (except granulopoiesis) can develop normally. As the development process erythroblastosis Rostock bone marrow sharply narrows, and granulocyte mielopoez and megakaryocytic sprouts are expanding. This myeloid leukemia infiltrates beyond the bone marrow and are developing in the spleen and liver. Myeloid metaplasia in the lymph nodes expressed little. As the disease progresses in developing resistance to the modern methods of treatment all the more there is a tendency to dedifferentiate myeloid elements up to genocidalists and reticular cells, and then the process is acquiring the features of acute leukemia - genocidalists or reticulata.

peripheral blood in chronic myelogenous leukemia
Fig. 3. Peripheral blood in chronic myeloid leukemia before treatment.

In the period of the initial manifestations of chronic myeloid leukemia patient feels quite well, liver and spleen are not enlarged, anemia not. Symptoms of General intoxication is not expressed. Diagnosis is for the most part by random exploration of blood. Discover a moderate increase in the number of cells (up to 15 000-20 000) with a shift in the hemogram to plasmic order has been revealed. Gradually increase the size of the spleen, develops General weakness, periodically temperature increases. In the spleen developing heart attacks, periplaneta. Develops functional failure of the liver, kidneys, heart, associated with the changed conditions of supply and circulation, sometimes with leukemic infiltration in these organs. In the blood often steadily increases the number of leukocytes (printing. table, Fig. 3)mainly immature granulocytes, increases anemia that develops in some cases hyperchromatic, others thrombocytopenia with related complications.
For some patients the number of leukocytes in the peripheral blood for the whole period of the disease remains subleikemical level (60 000 to 75 000). This is often combined with the development of focal myelofibrosis and pronounced splenomegaly. Gradually increasing depletion due to protein deficiency and chronic leukemia intoxication, activated related chronic infection. These symptoms characterize the period deployed clinical manifestations chronic myeloid leukemia, which is then replaced by a third terminal, a period when the cell anaplasia expressed as a maximum, and a malignancy of blood-forming tissue reaches the limit, almost incompatible with life. In the vast majority of agencies are leukemic expansion, consisting, as a rule, from genocidalists and reticular cells that are resistant to all therapies. The composition of the blood characterized by prevalence among nuclear forms of genocidalists and myeloblasts (blastny kriz), expressed anemia and thrombocytopenia. Bone marrow biopsy reveals the almost total genoticamente its transformation. Increases-intoxication of an organism products of abnormal cell metabolism, there is a sharp exhaustion, fever, absolute neopredelennosti all kinds of trivial infections. Pneumonia, abscesses, tuberculosis, candidiasis become fatal to the patients in this age. Increasing cardiovascular insufficiency, anoxia, bleeding. Almost all therapies become ineffective, and the patient dies. The average duration of life from the moment of detection of the disease, according to the summarized data of various authors, 3 - 3,5 years; in rare cases it is 12 years.
Treatment of patients with chronic myeloid leukemia should begin, when not yet fully unfolded the clinical picture of disease; should not be too long a period of non-interference and to wait for the pronounced deterioration of the process. The most effective treatment of chronic myeloid leukemia is mielosan. The daily dose at the beginning of treatment varies from 4 to 8 mg (reception 2-4). It depends on the degree myeloid metaplasia of bone marrow and leukemic infiltration of the authorities, which is reflected in the pattern of blood (the total number of cells and the percentage of promielozitov), the size of the spleen and liver. As improvement and reducing the number of leukocytes dose of Malasana reduced to a 4-2 mg per day, and at achievement of a number of leukocytes in the blood of 10 000-12 000 1 mm3 product repeal. In the future you must try to dose mielosan to maintain the level of blood within 10 000-20 000 1 mm3.
With the development refrakternosti mielosan with acute disease can be used in other chemical protiwaritmicescie drugs (Doan, 6-mercaptopurine)and radiotherapy on the region of the spleen. Dopan recommended in cases myeloid leukemia occurring with sharply expressed splenomegaly, with relatively low leukocytosis. The preparation appoint 5-10 mg per one reception at intervals of 3 to 5 and 10 days, depending on the rapidity of decrease in leukocytosis.
Antineoplastic antibiotics (aurantis, actinomycin, and others) have found very limited use in the clinic mainly as a means of preparing patients for subsequent therapy. Urethane and embihin (nowambien) currently do not apply.
In some cases of chronic myeloid leukemia, when the spleen is waste of mammoth proportions with a repeat heart attacks and periplaneta and complications of the disease. spleen used to splenectomy. With the development of power crises in the course of chronic myeloid leukemia therapy is conducted according to the rules of the treatment of acute genocidalists.