Chronic lymphocytic leukemia

Chronic lymphocytic leukemia (synonym: lymphatic leukemia, leukemia lymph! chronic lymphoid leukemia) can be defined as system-proliferation elements lymphatic tissue with lymphoid metaplasia kostnomozgovy blood. Against all other forms of leukemia, he has a number of characteristics. First, given that the main feature of each of leukemic process is morphological anaplasia cells and their gradual dedifferentiate as the disease progresses, it is unusual is the fact that chronic lymphocytic leukemia occurs with constantly Mature cellular composition of blood and leukemic infiltration of the bone marrow and organs. In other words, unlike chronic myeloid leukemia, which can detect all transitional forms from genocidalist to Mature granulocytes, chronic lymphatic leukemia in remission and exacerbation of the process is different for purely clinical signs and the degree of anemia, and not according to morphological characteristics of blood cells and bone marrow. Perhaps morphological structure of lymphoid elements determined by conventional methods microscopy, does not correspond to their degree of maturity. This is confirmed by clinical observations of transition of chronic lymphocytic leukemia in terminal stages in retikulez characterized by infiltrating the growth of leukemic infiltration, which indicates the acquisition of malignant features.
Secondly, chronic lymphocytic leukemia sick only people over the age of 40-45 years, representing, apparently, about the importance of hormonal changes in the body at the origin of this disease.
And, third, in the development of chronic lymphocytic leukemia especially big role belongs to various immunological disorders. In this form of leukemia, as never, under any other, often autoimmune hemolytic anemia and thrombocytopenia. In this disease in many patients develop various allergic reactions until the reaction type of the secondary collagenosis. A sharp decline in protective immune antibacterial and anti-virus reactions reflected in the decrease of gamma globulin protein fraction, and in extreme inclinations and low resilience to these patients to such diseases as pneumonia, tuberculosis, piodermia, candidiasis, etc., and also to giperergicakie reaction in response to vaccinations (smallpox, polio vaccine and other). Among the causes of death are often featured phenomena, not only directly connected with the very leukemic process, but such concomitant diseases as pneumonia, tuberculosis, autoimmune hemolytic anemia, etc.
Clinical picture and diagnosis of chronic lymphocytic leukemia is not difficult. The disease occurs with the widespread proliferation of lymphoid tissue in connection with unrestrained proliferation of lymphoid elements. Because normal limfopoez concentrated in the lymph nodes, the disease usually begins with their increase. Sick for a long time, sometimes several years, remain quite active and able-bodied, with only some inconvenience in connection with the enlargement of the lymph nodes. The nodes are usually not very dense, mobile, painless; the spleen and liver increased moderately. Blood found a General increase in the number of leukocytes and content of lymphocytes.

peripheral blood in chronic lymphocytic leukemia
Fig. 4. Peripheral blood in chronic lymphocytic leukemia.

The disease, however, is slowly progressing. Lymph nodes gradually become very large. Sometimes the increase in the mediastinum leads to the compression of the trachea and large vessels. Develop severe hacking cough, shortness of breath, cyanosis of the face, hands, neck. If you have such symptoms, timely action is not taken, the patient may develop shortness of breath caused by compression of the trachea or pulmonary edema, which leads to death. The expansion of the conglomerates of the lymph nodes in the abdomen is determined in large tumor entities with the feeling of the abdomen. These conglomerates can compress the intestines, stomach and cause of the phenomenon of partial obstruction of the intestines, severe constipation, bloating, pain. With the development of the disease and of total lymphoid metaplasia bone marrow develop anemia and thrombocytopenia with symptoms of bleeding, which warns about the necessity of immediate measures. The blood in chronic lymphocytic leukemia in the period of the expressed clinical manifestations characterized by anemia, more or less marked leukocytosis with absolute domination in the hemogram lymphocytes (printing, table, Fig. 4). There is often thrombocytopenia.
Autoimmune complications are possible at any stage of the disease: first, sometimes even before a clear manifestation of the leukemic process, at the stage of Frank clinical and hematological manifestations and the terminal period. Therefore, when suddenly developing anemia or jaundice; patient with chronic lymphocytic leukemia gets blood testing for the presence of anti-erythrocytary antibodies (direct sample Kumbsa), and for thrombocytopenia - antiplatelet antibodies. Terminal period, usually characterized by severe depletion, recurrent pneumonia, fever and development of pustular and fungal infections of the skin and mucous membranes. Sometimes there is tumor growth of leukemia infiltrates with penetration into neighboring organs, with lesions of bones and shells brain, which is evidence of the transition process in tumor retikulez. For some patients to chronic lymphocytic leukemia joins skin cancer, bronchus, stomach and other organs.
Clinical management of patients with chronic lymphocytic leukemia depends on the individual characteristics of the flow process. With slowly progressive variants of disease special treatment is administered.

Use vitamins, hemostimulating, ascorbic acid.
Pronounced enlargement of the lymph nodes in a particular region or spleen, causing discomfort or compression of the vital organs, requires the use of local radiotherapy, if the number of leukocytes in the blood exceeds 50 000 - 70 000 and the number of platelets is not below 100 000 to 1 mm3. X-ray treatments combined with corticosteroid therapy (50-60 mg prednisolone for 10-12 days), blood transfusions and vitamin C. With significant generalized enlargement of lymph nodes shown chemotherapy.
Hlorbutin (synonym: chlorambucil, leykeran SV-1348, chloramination) are usually appointed by 0.2 mg, and in severe anemia and thrombocytopenia - 0.1 mg per 1 kg of body weight of the patient. Daily dose on average 6-12 mg, the total 400-500 mg per course, in some cases, possible maintenance therapy. Therapeutic effect is usually observed not earlier than in 2 - 3 weeks. At the end of the course may come neutropenia, thrombocytopenia, which is an indication for the drug.
Migranal apply for 50-100 mg a day, the average of 600-800 mg per course. Although migranal has less depressive effect on haematopoiesis, some patients may rapid development of hypoplastic blood. Therefore, require close monitoring of blood counts even after the course of treatment.
Dipin, tidied, thiotepa less effective than hlorbutin and degrada.
Very widespread in the treatment of chronic lymphocytic leukemia received corticosteroid hormones - prednisolone, triamcinolone, dexamethasone. Corticosteroid therapy is indicated for:
1) symptomatic of autoimmune hemolytic anemia and thrombocytopenia (50-70 mg prednisone per day with a gradual reduction of dose and subsequent use in maintenance therapy);
2) subleikemical and leikemicakih variants of the disease, occurring with a pronounced increase in lymph nodes, liver and spleen, when it is impossible to implement only radiotherapy or chemotherapy; 3) forms that are resistant to cytotoxic therapy.
With the development of banal acute infectious and viral diseases prescribe antibiotics, serotherapy (gamma globulin 12-15 ml intramuscularly in a day or plasma transfusion), autoimmune conflicts beyond the effect of corticosteroids,a splenectomy.