Can acute leukemia exist without fever? Acute blood leukemia, acute leukemia: what it is, treatment, symptoms, causes, signs. Bone marrow and peripheral blood stem cell transplantation

– tumor lesion hematopoietic system, the morphological basis of which is immature (blast) cells, displacing normal hematopoietic germs. Clinical symptoms acute leukemia is represented by progressive weakness, unmotivated rise in temperature, arthralgia and ossalgia, bleeding various localizations, lymphadenopathy, hepatosplenomegaly, gingivitis, stomatitis, tonsillitis. To confirm the diagnosis, it is necessary to study a hemogram and punctate bone marrow, biopsy ilium and lymph nodes. The basis of treatment of acute leukemia is chemotherapy courses and accompanying therapy.

General information

Causes of acute leukemia

The primary cause of acute leukemia is a mutation in a hematopoietic cell that gives rise to a tumor clone. Mutation of a hematopoietic cell leads to disruption of its differentiation into early stage immature (blast) forms with further proliferation of the latter. The resulting tumor cells replace normal hematopoietic sprouts in the bone marrow, and subsequently enter the blood and spread to various tissues and organs, causing their leukemic infiltration. All blast cells carry the same morphological and cytochemical characteristics, which indicates their clonal origin from a single parent cell.

The reasons that trigger the mutation process are not known. In hematology, it is customary to talk about risk factors that increase the likelihood of developing acute leukemia. First of all, this is a genetic predisposition: the presence of patients with acute leukemia in the family practically triples the risk of the disease in close relatives. The risk of acute leukemia increases with certain chromosomal abnormalities and genetic pathologies- Down's disease, Klinefelter's syndrome, Wiskott-Aldrich and Louis-Barr syndrome, Fanconi anemia, etc.

It is likely that activation genetic predisposition occurs under the influence of various exogenous factors. Among the latter may be ionizing radiation, chemical carcinogens (benzene, arsenic, toluene, etc.), cytostatic drugs used in oncology. Often, acute leukemia becomes a consequence of antitumor therapy for other hemoblastoses - lymphogranulomatosis, non-Hodgkin's lymphoma, myeloma. A connection between acute leukemia and previous viral infections that suppress the immune system has been noted; concomitant hematological diseases (certain forms of anemia, myelodysplasia, paroxysmal nocturnal hemoglobinuria, etc.).

Classification of acute leukemia

At the core hemorrhagic syndrome there is severe thrombocytopenia. The range of hemorrhagic manifestations ranges from small single petechiae and bruises to hematuria, gingival, nasal, uterine, gastrointestinal bleeding, etc. As acute leukemia progresses, bleeding can become more massive due to the development of disseminated intravascular coagulation syndrome.

Hyperplastic syndrome associated with leukemic infiltration of both bone marrow and other organs. In patients with acute leukemia, enlargement of lymph nodes (peripheral, mediastinal, intra-abdominal), hypertrophy of the tonsils, and hepatosplenomegaly are observed. Leukemic infiltrates of the skin (leukemids), meninges (neuroleukemia), damage to the lungs, myocardium, kidneys, ovaries, testicles and other organs may occur.

Complete clinical and hematological remission is characterized by the absence of extramarrow leukemic foci and the content of blasts in the myelogram is less than 5% (incomplete remission is less than 20%). The absence of clinical and hematological manifestations for 5 years is regarded as recovery. If the increase in blast cells in the bone marrow is more than 20%, their appearance in peripheral blood, as well as identifying extramarrow metastatic foci, a relapse of acute leukemia is diagnosed.

The terminal stage of acute leukemia is stated when chemotherapy treatment is ineffective and it is impossible to achieve clinical and hematological remission. Signs of this stage are progression of tumor growth, development of dysfunctions incompatible with life internal organs. The described clinical manifestations include hemolytic anemia, repeated pneumonia, pyoderma, abscesses and phlegmon of soft tissues, sepsis, progressive intoxication. The cause of death of patients is intractable bleeding, cerebral hemorrhages, and infectious and septic complications.

Diagnosis of acute leukemia

The diagnosis of acute leukemia is based on the assessment of the morphology of peripheral blood and bone marrow cells. The hemogram for leukemia is characterized by anemia, thrombocytopenia, high ESR, leukocytosis (less commonly leukopenia), the presence of blast cells. The phenomenon of “leukemic gaping” is indicative - there are no intermediate stages between blasts and mature cells.

In order to confirm and identify the type of acute leukemia, a sternal puncture with morphological, cytochemical and immunophenotypic examination of the bone marrow. When studying the myelogram, attention is paid to an increase in the percentage of blast cells (from 5% and above), lymphocytosis, inhibition of the red germ of hematopoiesis (except in cases of o. erythromyelosis) and an absolute decrease or absence of megakaryocytes (except in cases of o. megakaryoblastic leukemia). Cytochemical marker reactions and immunophenotyping of blast cells make it possible to accurately determine the form of acute leukemia. If there is ambiguity in the interpretation of the bone marrow analysis, they resort to trepanobiopsy.

In order to exclude leukemic infiltration of internal organs, a spinal puncture is performed with examination of the cerebrospinal fluid, radiography of the skull and organs chest, Ultrasound of lymph nodes, liver and spleen. In addition to a hematologist, patients with acute leukemia should be examined by a neurologist, ophthalmologist, otolaryngologist, and dentist. To assess severity systemic violations It may be necessary to study a coagulogram, biochemical blood test, electrocardiography, echocardiography and other bedsores, toilet of the genital organs after physiological functions; organization of high-calorie and fortified nutrition.

Direct treatment of acute leukemia is carried out sequentially; The main stages of therapy include achieving (induction) of remission, its consolidation (consolidation) and maintenance, and prevention of complications. For this purpose, standardized polychemotherapy regimens have been developed and used, which are selected by a hematologist taking into account the morphological and cytochemical form of acute leukemia.

If the situation is favorable, remission is usually achieved within 4-6 weeks of intensive therapy. Then, as part of the consolidation of remission, another 2-3 courses of polychemotherapy are carried out. Maintenance anti-relapse therapy is carried out for at least 3 years. Along with chemotherapy for acute leukemia, it is necessary to carry out accompanying treatment aimed at preventing agranulocytosis, thrombocytopenia, disseminated intravascular coagulation syndrome, infectious complications, neuroleukemia (antibiotic therapy, transfusion of red blood cells, platelets and fresh frozen plasma, endolumbar administration of cytostatics). For leukemic infiltration of the pharynx, mediastinum, testicles and other organs, X-ray therapy of the lesions is performed.

When successful treatment the destruction of the clone of leukemia cells is achieved, the normalization of hematopoiesis is achieved, which contributes to the induction of a long relapse-free period and recovery. To prevent recurrence of acute leukemia, bone marrow transplantation may be performed after preconditioning by chemotherapy and total radiation.

According to available statistical information, the use of modern cytostatic agents leads to the transition of acute leukemia into remission in 60-80% of patients; Of these, 20-30% manage to achieve full recovery. In general, the prognosis for acute lymphoblastic leukemia is more favorable than for myeloblastic leukemia.

Acute leukemia is dangerous form cancer that affects lymphocytes, which accumulate primarily in the bone marrow and circulatory system. This disease is difficult to cure and often leads to fatal outcome, salvation in many cases can only be a bone marrow transplant. Fortunately, the disease is quite rare, with no more than 35 cases of infection per 1 million population recorded every year. Who is more likely to face such an unpleasant diagnosis, children or adults?

What is the survival rate among patients, and which specific organs are affected by leukemia in the very first weeks - we will try to answer these questions in detail in our article. In addition, we will explain in detail what features are characteristic of this disease, what symptoms it is associated with, and how it can be diagnosed. We will also share useful information about the types of leukemia and how to modern world treat people with this diagnosis.

What is leukemia?

Acute leukemia is one of the most difficult oncological diseases, which has many types and subspecies. This is a malignant pathological condition of white blood cells, which first of all affects the bone marrow, and then very quickly infects many other tissues and organs, penetrating the blood, affecting the liver, spleen and lymph nodes. Acute leukemia is especially dangerous because in a short period of time it can severely damage the central nervous system, inhibiting it from the first days of infection.

This malignant disease circulatory system is very aggressive, it is characterized by pathological process division, subsequent growth and reproduction of bone marrow cells. Often, foci of pathological hematopoiesis can be found in other parts of the body and human organs. In other words, in a person who has leukemia, malignant bone marrow cells very quickly and in large volumes begin to penetrate into the general circulatory system human, displacing healthy leukocytes.

The causes of leukemia, as well as the conditions for the formation of this disease, are difficult to identify, just like most tumor diseases. The acute form of leukemia is unable to transform into a chronic form, or vice versa. The only exception is acute myeloblastic leukemia, in various forms of which the blood is saturated with cancer cells in an amount from 30 to 90%.

How does chronic leukemia differ from acute leukemia?

According to the form of spread of the disease, all leukemias are divided into two groups - acute and chronic. The disease can be classified into the first or second group if it is determined at what speed cancer cells grow and multiply.

Chronic form

This is a pathology of the development of lymphatic tissue, which is characterized by slow tumor growth, while infected leukocytes accumulate in the periphery of the circulatory system, lymph nodes and the bone marrow itself. With this form, significant disturbances in the functioning of the circulatory system can only be noticed on late stages diseases. At chronic leukemia new population cancer cells is gradually replacing healthy cells.

Acute form

This form of leukemia is different in that it is already initial stage diseases in human blood are concentrated a large number of cancer cells. At the same time, they hardly develop, but even immature cancer cells can interfere with the normal functioning of the circulatory system. As we noted earlier, different forms of leukemia are unable to transform into each other. In this form of the disease, the number of affected cells increases at a very high rate.

Diagnosis of leukemia

Before the doctor puts final diagnosis his patient and begins appropriate treatment, he must prescribe a number of mandatory diagnostic procedures:

1. Medical examination.
2. Carry out calculations within .
3. Examine the bone marrow and determine the affected area.
4. Immunophenotyping can recognize specific immune markers that correspond to a particular form.
5. A biopsy is also required lymph nodes, if the defeat affected them too.
6. Determination of β2-microglobulin level.
7. Cytogenetic analysis, with which you can find out the most detailed characteristics of cancer cells.
8. Having found out how high the level of immunoglobulin in the blood is, you can accurately say whether there is a risk of complications infectious nature at the patient.

Types of acute leukemia

Among leukemias acute form the most common are acute lymphoblastic leukemia and acute myeloblastic leukemia. What symptoms and features of the disease do acute lymphocytic leukemia and acute myeloid leukemia have?

Lymphoblastic leukemia in acute form

Acute lymphoblastic leukemia can be characterized by damage, first of all, to the bone marrow, and a little later to the lymph nodes, as well as the thymus and spleen. If acute leukemia is diagnosed in children, then most often it is lymphocytic leukemia; children aged from one to six years are at risk. This disease greatly affects the child’s nervous system, but not immediately; most often this happens after a course of chemotherapy or during the next relapse.

When children get sick lymphoblastic leukemia, cancer cells can be found not only in the bone marrow, but also in the peripheral blood, as well as in other systems and organs child's body. Moreover, these infected cells correspond to the type of lymphoblasts, which is why this type of disease has such a name. Tumor-like cells have PAS-positive granules in the cytoplasm and do not contain lipids. If we examine the different phenotypes of diseased cells, we can divide acute lymphoblastic leukemia into two forms:

1. Acute lymphocytic leukemia B-form, the patient survival rate with it is 30% in adults and 60% in children.
2. T-group acute lymphoblastic leukemia has a much worse survival prognosis for patients of all ages.

Acute myeloblastic leukemia

Acute myeloblastic leukemia most often affects the body in the adult population. It is worth noting that acute myeloid leukemia has a more optimistic prognosis for the patient than acute lymphoblastic leukemia: in most cases, partial remissions occur - up to 80%, complete remissions are observed in a quarter of patients. Acute myeloid leukemia is characterized by the following parameters of cancer cells:

1. The cytoplasm is PHIK-positive and, in addition, diffusely stained.
2. They contain lipids, peroxidase, and esterases, which is not typical for acute lymphoblastic leukemia.
3. In acute myeloid leukemia, tumor cells fill primarily the bone marrow, which, during the infection process, acquires a macroscopic pyoid appearance.
4. Later, cancer cells affect the liver and spleen, as well as the lymph nodes.
5. The mucous membranes of the stomach and intestines are often affected, which causes serious complications illnesses, including stomach ulcers.
6. Acute myeloblastic leukemia is also characterized by damage to the lungs, in in rare cases- meninges.

What are the symptoms of acute leukemia?

As a rule, the specific form of the disease is established after a long course of diagnostic manipulations. But regardless of which form has affected the human circulatory system, lymphoblastic or acute myeloid leukemia, the first symptoms of the disease will be similar.

General symptoms

With leukemia, even at the initial stage, the following symptoms will definitely occur:

1. A person suddenly begins to lose weight, but this is not associated with diet or intense physical activity.
2. General health worsens significantly, the patient becomes more and more tired every day.
3. During the initial stage of the disease, you may feel unexpected weakness, reluctance to do anything, and drowsiness.
4. Regardless of the calorie and fat content of the food consumed, the patient may feel heaviness in the abdomen, especially in the left part under the ribs.
5. If previously the patient rarely encountered infectious diseases, but in Lately I have become more and more prone to them, it is worth visiting a doctor.
6. In patients with leukemia, regardless of the form and stage of infection, excessive sweating bodies.
7. A person may suddenly lose their appetite, and there may also be an increase in body temperature.

Nonspecific symptoms

The deterioration of the patient’s condition is explained by the fact that the amount in his blood drops sharply, as healthy bone marrow cells are replaced by cancer cells. As a result of this replacement, in all patients there is much less and, and, in the blood, which cannot fully perform their functions. Previously we indicated general symptoms diseases, but with leukemia, nonspecific symptoms often appear, which, when discovered, may not immediately be correlated with cancer:

1. Since the number of red blood cells in the blood decreases every day of the disease, a person begins to suffer from anemia. As a result, the skin becomes pale, the patient quickly gets tired, and has shortness of breath.
2. Since the content of platelets in the blood also decreases, the patient may develop bruises, gums will begin to bleed, and sometimes nosebleeds are observed.
3. If, in addition to the bone marrow, leukemia begins to affect other organs, then a variety of disturbances in their activity may appear, including headaches and general weakness, vomiting and convulsions, blurred vision and disruption of normal gait.
4. Among the symptoms and aching pain bones and joints that are affected by cancer cells.
5. Leukemia causes enlargement of not only the lymph nodes, but also the liver and spleen.
6. Acute myeloid leukemia can also affect the gums, they will become swollen and painful, and may even develop a rash.
7. Acute lymphocytic leukemia affects and thymus gland, it increases, as a result of which the patient has difficulty breathing and may experience shortness of breath.
8. In rare cases, swelling of the face and hands is observed; such symptoms are among the most dangerous, as they indicate a violation of the blood supply to the brain. In this case, treatment should be started immediately.

Causes of leukemia

For what reasons are some people prone to leukemia and others not? It is almost impossible to answer this question unambiguously, since the causes of the disease have not yet been identified. But medicine knows risk factors that can increase the likelihood of the disease:

1. Everyone knows that smoking can cause lung cancer, but not everyone understands that this bad habit can negatively affect the condition of those tissues and organs that do not come into contact with cigarettes and smoke. It has been scientifically proven that smoking increases the risk of acquiring acute myeloid leukemia.
2. The same type of leukemia as caused by smoking can be provoked by prolonged contact of the patient with gasoline.
3. High doses of radiation exposure can cause acute lymphoblastic leukemia.
4. Those at risk are those who have already undergone treatment malignant tumors other parts of the body. It has been confirmed that leukemia, as leukemia is otherwise called, can appear within nine years after treatment of another tumor.
5. The number of cases has increased among those who have additional rare diseases and are also infected with the virus

   Treatment of leukemia with this method involves the destruction of cancer cells using special drugs, which can be used orally and intravenously. Chemotherapy is considered the most effective way fight against tumor cells. But despite obvious benefit This method of treatment has a strong negative effect on the patient’s body.

   When leukemia cells are destroyed, they die big number and healthy cells, primarily those that differ high speed growth. Among them are bone marrow cells directly, hair follicles, intestinal mucosa and oral cavity. After this procedure, the patient may not only become completely bald, but also suffer from vomiting and may lose appetite for a long time. As a rule, before a course of chemotherapy, the patient is prescribed strong antibiotics that will prevent the development of infectious processes in a weakened body.

   Stem cell transplant method

   This treatment method is used in conjunction with the previous one; it is designed to compensate for the lack of destroyed stem cells. Cells transplanted into the patient's bone marrow promote the rapid restoration of healthy cells that produce blood cells. Most often, in such cases, stem cells are taken from a healthy donor, and they enter the body of a leukemia patient in the form of a regular blood transfusion. It is worth considering that this method also has many serious contraindications and side effects.

   Radiation therapy

   This treatment method is used much less frequently, mainly if the central nervous system or testicles of a male patient are affected.

Acute leukemia ( acute leukemia) is a severe malignant disease that affects the bone marrow. The pathology is based on a mutation of hematopoietic stem cells - precursors shaped elements blood. 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 formed elements (erythrocytes, leukocytes, platelets) in it decreases.

As the disease progresses, tumor cells move beyond the bone marrow and penetrate other tissues, resulting in the development of so-called leukemic infiltration of the liver, spleen, lymph nodes, mucous membranes, skin, lungs, brain, and other tissues and organs. The peak incidence of acute leukemia occurs at the age of 2-5 years, then there is a slight increase at 10-13 years; boys are affected more often than girls. In adults, the dangerous period for the development of acute leukemia is the age after 60 years.

Depending on which cells are affected (myelopoietic or lymphopoietic lineages), there are two main types of acute leukemia:

• ALL– acute lymphoblastic leukemia.
• AML– acute myeloblastic leukemia.

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

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

Causes of acute leukemia

Studying 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. What is clear is that the development of the disease is closely related to factors that can cause cell mutation. These factors include:

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

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

There are five stages during acute leukemia:

• Preleukemia, which often goes undetected.
• The first attack is the acute stage.
• Remission (complete or incomplete).
• Relapse (first, repeated).
• Terminal stage.

From the moment of mutation of the first stem cell (namely, everything begins with one cell) until the appearance of symptoms of acute leukemia, on average, 2 months pass. During this time, blast cells accumulate in the bone marrow, preventing normal blood cells from maturing and entering the bloodstream, as a result of which characteristic clinical symptoms of the disease appear.

The first signs of acute leukemia may be:

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

These signs are very similar to acute viral infection, therefore, patients are often treated for it, and during the examination (including general analysis blood) reveal a number of changes characteristic of acute leukemia.

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

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

In addition, very often acute leukemia develops infectious complications, the cause of which is immunodeficiency (there are not enough mature lymphocytes and leukocytes in the blood), less often - neuroleukemia (metastasis of leukemic cells to the brain, which occurs as meningitis or encephalitis).

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

Diagnosis of acute leukemia consists of several stages:

There are two methods of treating acute leukemia: multicomponent chemotherapy and bone marrow transplantation. Treatment protocols (prescription regimens medicines) for ALL and AML, different ones are used.

The first stage of chemotherapy is the induction of remission, the main goal of which is to reduce the number of blast cells to undetectable available methods level diagnostics. The second stage is consolidation, aimed at eliminating the remaining leukemia cells. This stage is followed by re-induction - a repetition of the induction stage. Besides, mandatory element Treatment is maintenance therapy with oral cytostatics.

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

Criteria for complete remission of acute leukemia (all of them must be present at the same time):

• absence clinical symptoms illness;
• detection in the bone marrow of no more than 5% of blast cells and a normal ratio of cells of other hematopoietic germs;
• absence of blasts in peripheral blood;
• the absence of extramedullary (that is, located outside the bone marrow) lesions.

Chemotherapy, although aimed at curing the patient, has a very negative effect on the body because it is toxic. Therefore, against its background, patients begin to lose hair, experience nausea, vomiting, and disturbances in the functioning of the heart, kidneys, and liver. To promptly identify side effects treatment and monitor the effectiveness of therapy, all patients must undergo regular blood tests, bone marrow tests, biochemical analysis blood, ECG, EchoCG, etc. After completion of treatment, patients should also remain under medical supervision (outpatient).

Of no small importance in the treatment of acute leukemia is concomitant therapy, which is prescribed depending on the symptoms that appear in the patient. Patients may require blood transfusions, antibiotics, and detoxification treatment to reduce intoxication caused by the disease and the chemotherapy drugs used. In addition, if indicated, prophylactic irradiation of the brain and endolumbar administration of cytostatics are performed to prevent neurological complications.

Also very important proper care for the sick. They must be protected from infections by creating living conditions that are as close to sterile as possible, excluding contact with potentially infectious people, etc.

Patients with acute leukemia undergo bone marrow transplantation, because only it contains stem cells that can become the ancestors of blood cells. Transplantation performed in such patients must be allogeneic, that is, from a related or unrelated compatible donor. Shown this medical procedure both in ALL and AML, and it is advisable to perform a transplant during the first remission, especially if there is high risk relapse – return of the disease.

At the first relapse of AML, transplantation is generally the only salvation, since the choice 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 required - immunosuppressive therapy designed to destroy remaining leukemia cells and create deep depression immunity, which is necessary to prevent transplant rejection.

Contraindications for bone marrow transplantation:

• Serious dysfunction of internal organs.
• Acute infectious diseases.
• Relapse of leukemia that is untreatable.
• Elderly age.

Prognosis for leukemia

The following factors influence the forecast:

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

The prognosis for children with acute leukemia is much better than for adults. This is due, firstly, to the higher reactogenicity of the child’s body to treatment, and secondly, to the presence of mass in elderly patients concomitant diseases that do not allow full-fledged chemotherapy. In addition, adult patients often turn to doctors when the disease is already advanced, while parents usually take a more responsible approach to the health of children.

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

To summarize, I would like to note that acute leukemia is a serious disease, but it is curable. The effectiveness of modern protocols for its treatment is quite high, and relapses of the disease after a five-year remission almost never occur.

Zubkova Olga Sergeevna, medical observer, epidemiologist

Acute blood leukemia is a pathology in which malignant degeneration of immature lymphocytes - blasts - occurs in the red bone marrow. These are cells that normally provide human immunity. Mutated blasts spread with the lymph flow throughout the body, affecting various organs and systems: lymph nodes, heart, kidneys, etc. Acute leukemia progresses quite quickly, causing disruption of hematopoietic function. This pathology requires long-term and complex therapy in a specialized medical clinic.

Acute leukemia is one of the most unfavorable types of oncology. It is characterized by rapid current and high level malignancy. In a sick person, mutated cells quickly spread throughout the body, while the number of healthy leukocytes is constantly decreasing, and the number of affected ones is increasing.
According to statistics, about 35 people out of a million people are affected by the disease. The exact causes of acute leukemia have not yet been established. Experts only talk about factors that can provoke the development of pathology:

1. Hereditary predisposition. People whose close relatives suffered from leukemia, pernicious anemia, idiopathic bone marrow disorders and various chromosomal abnormalities are most susceptible to acute leukemia.
2. Living in areas with increased background radiation.
3. Work in companies involved in chemical industry or involving exposure to ionizing radiation.
4. In some cases, the disease may manifest itself as a reaction to the use of cytostatic drugs for plasmacytoma, lymphogranilematosis, etc.
5. The causes of leukemia may be a history of severe viral disease or a pathology that suppresses the immune system: HIV or AIDS, various shapes thrombocytopenia and hemoglobinuria.

To date, research is underway to identify the mutant gene that provokes the development of the disease.

Symptoms

Clinical symptoms of acute leukemia appear quite quickly. Unlike chronic form, this variety pathology proceeds more aggressively and is characterized by the following primary symptoms:

1. The appearance of hematomas and local hemorrhages are one of the early signs of leukemia. The patient may complain of increased bleeding of the gums when brushing teeth, and frequent nosebleeds. In women, the disease often manifests itself as metrorrhagia - acyclic uterine bleeding.
2. Weight loss, which in the absence of timely treatment can lead to cachexia - exhaustion.
3. With acute leukemia, a person constantly feels tired, sleepy, and weak. He may complain of confusion, tremors in the limbs, and difficulty trying to concentrate. The main reason for this condition is a sharp suppression of the immune system and defeat nervous system characteristic of this disease.
4. Increased tendency to colds, difficult to treat. Acute leukemia in children is often characterized by the appearance of prolonged bronchitis or tracheitis, and susceptibility to any infections.
5. Constant low-grade hyperthermia, that is, an increase in body temperature to 37.5-38°C, fever, chills. In addition to these symptoms, patients also complain of excessive sweating.
6. Lack of appetite. Similar manifestation The disease occurs due to several factors: digestive disorders, a feeling of constant fatigue and a feeling of heaviness in the left hypochondrium.

Leukemia is also called leukemia. This term is due to the fact that with this pathology, the number of red blood cells in the patient’s blood sharply decreases, since the bone marrow stops producing healthy cells. Over time, due to the development of the disease, the body also begins to produce less lymphocytes and platelets. Because of this, signs appear that not many patients mistake for allergies, inflammatory process, osteoporosis and other pathologies.

The most common complaints among patients are bone fragility, discomfort in the muscles, nausea. During examination, specialists usually note a purple rash on the skin and mucous membranes of patients and lymphadenopathy - enlarged lymph nodes.

Hemorrhagic syndrome, that is, local hemorrhages, can lead to the appearance of severe complications: internal bleeding, ruptures large vessels, cerebral hemorrhages.

Stages of the disease

As the disease progresses, its symptoms become more pronounced. For ease of classification, experts have identified next stages acute leukemia:

1. Initial stage. Usually the disease develops quite aggressively, so the patient immediately develops characteristic clinical signs of leukemia.
2. Remission phase. During this period, the patient’s well-being improves significantly, bone marrow samples are close to normal.
3. Partial remission phase. The person’s condition stabilizes as a result of treatment with cytostatics, but tumor markers are still detected in the blood.
4. The terminal stage develops if treatment for acute leukemia fails. Gradually, the pathological process spreads throughout the body, blood counts and red bone marrow characteristics drop.

Treat the patient with terminal stage leukemia pharmacological drugs doesn't make sense. The only way therapy in in this case– bone marrow transplantation.

Prevalence of pathology

Acute leukemia – quite rare disease. Most often similar diagnosis given to preschool or younger children school age and persons over 50-55 years old. It is assumed that this pattern of morbidity is associated with weakness immune system in people of these age groups.

Acute leukemia is rare in middle-aged adults, with equal frequency in men and women. In this case, the disease, as a rule, begins in an erased form, develops longer and is less aggressive than in children and adolescents.

Diagnostics

Diagnosis of acute leukemia is based on the study of various parameters of the patient’s blood. A sternal biopsy is also required: a specialist inserts a needle into the cavity of the sternum and takes a sample of red bone marrow to study its characteristics.

If leukemia has led to complications, the doctor will prescribe a number of additional tests: magnetic resonance imaging, tissue biopsy of lymph nodes, ultrasonography internal organs, etc.

When diagnosing, specialists can determine the presence of one of two types of acute leukemia:

1. Lymphoblastic leukemia. The most severe form of the disease. In the vast majority of cases, it occurs in children under 5-6 years of age. It has an aggressive course and a weak response to chemotherapy treatment.
2. Myeloblastic leukemia is more often detected in adults, especially in people over 40-45 years of age. It responds quite well to therapy and is characterized by a high percentage of long-term remissions.

The doctor selects the therapy, taking into account the identified type of leukemia and the individual characteristics of each patient.

Therapy

Treatment of acute leukemia is based on the use of cytostatics. The dosage and type of drugs are determined by the attending physician. The specialist must take into account the age and health status of the patient, the form of the disease, the presence of complications, etc.

Chemotherapy for acute leukemia destroys malignant cells, but also has a detrimental effect on healthy ones. Administration of cytostatics can lead to adverse consequences for the patient’s body: baldness, brittle nails and teeth, pain in bones and muscles, indigestion and other complications. To minimize by-effect medications, the patient is advised to take vitamin-mineral complexes, follow a diet, drink nutritional cocktails, and perform strengthening exercises.

The radical treatment method is bone marrow transplantation. This method is used if chemotherapy does not give the desired result. Transplantation is considered dangerous procedure, since the risk of complications is very high, therefore it is carried out only if other treatment options are not effective.

Forecast

No specialist can say for sure how long people live with acute blood leukemia. It depends on the individual characteristics human health, stage of the disease and duration of remissions.

Today, the prognosis for acute leukemia is quite favorable: more than 60% of patients overcome the threshold of five-year survival, and with myeloblastic leukemia, approximately 80% of patients enter a state of long-term or lifelong remission.

Prevention

Unfortunately, there are no universal methods for preventing leukemia. Modern science It has not yet been possible to establish which factors lead to the development of pathology. However, you can reduce the risk of developing the disease by avoiding radioactive areas, giving up smoking and alcohol abuse, and regularly undergoing preventive medical examinations.

Acute leukemia is a rather severe and difficult to treat disease. If you experience any symptoms indicating the presence of this pathology, you should definitely consult a doctor and undergo an examination. Early diagnosis And timely treatment significantly increase the likelihood of successfully combating the disease.

Why is blood leukemia so dangerous pathology? main reason This is due to the rapid development of leukemia, as well as the absence of pronounced symptoms in initial stages diseases. Malignant cells begin to penetrate the blood as soon as the disease begins, and therefore it manifests itself acutely, violently and often ends in death.

Here are the signs of leukemia, ignoring which is deadly. Remember them and tell others about them.

Dangerous symptoms of leukemia

There are somatic and hematological signs of leukemia. TO somatic manifestations leukemia include:

And 3 more hematological signs of leukemia

Increased number of leukocytes in the blood (leukocytosis of any kind);

Decreased hemoglobin concentration in the blood (anemia).

Reader Questions

18 October 2013, 17:25 Hello. Dear doctor, please tell me! The child is 3.9 (before this age they were very rarely sick). The first time they got sick on July 25, the temperature rose to 39, there were no more signs, they called a doctor. She examined her throat, it was clear, there was no cough, she decided that she prescribed acyclovir for ARVI, the UBC and urine were normal, although esonophils were slightly elevated in the blood. They were treated for a week and discharged from sick leave. One day we went to the garden, again the temperature was 39, rose to 39.6. They donated blood, CBC, blood biochemistry, feces, urine, leukocytes were elevated in the urine, an infection was diagnosed urinary tract They did an ultrasound of the kidneys and all internal organs, everything was normal there. We drank Suprax. We go to the garden for a week and again heat 39.7, although this time the neck was a little red. They diagnosed ARVI + urinary tract infection (as protein was found in the urine). They drank Flemoxide Solutab. A week passes again and the temperature is 39, the throat is reddish, they diagnose a sore throat, they prescribed Sumamed for 4 days, we took it, on the last day of admission the temperature was 39 again. We did an ECG, everything is normal. We again took the blood test, urine, and blood biochemistry tests. Hemoglabin in the blood is 125. The doctor said all the indicators are more or less normal, but nevertheless says that the blood is viral. We don’t know what to do anymore. What’s wrong with the child? We are afraid that in 10 days the temperature will rise again. And I’ll also add that when my daughter was sick for the third time, my temperature also rose to 39 and did not subside for 2 days. Now she is sick for the 4th time and my temperature has risen to 37.5. Could this be somehow related? Doctor, please tell me, could the child have leukemia?