Acute leukemia. Symptoms of the primary active phase of leukemia. Symptoms that should prompt you to consult a doctor

Acute blood leukemia is a serious disease. The pathology consists of dangerous changes occurring in the bone marrow and peripheral blood of a person, as a result of which internal organs are affected.

Types of blood leukemia

There are two types of leukemia, depending on the blood cells affected:

• acute lymphoblastic leukemia (ALL).

AML is more susceptible to older people who have damage to the myeloid line of hematopoiesis.

There are several options for this type:

• with minimal signs of differentiation;
• promyelocytic;
• myelomonoblastic;
• monoblastic;
• erythroid;
• megakaryocytic.

Acute blood leukemia affects mainly children under 15 years of age in 85% of cases, and adults in 15%. Men are affected by the disease 50% more often. Tumors arise due to disorders of the lymphoid line of hematopoiesis.

The incidence of two types of acute leukemia is 35 people per 1 million inhabitants.

Causes of blood cancer

Modern medicine has not established the exact prerequisites for the appearance of blood leukemia, but has discovered the following factors that cause malignant mutation of cells:

• influence of chemical carcinogens. For example, benzene, cigarette smoke;
• hereditary predispositions. Illness of several family members is not uncommon;
• chromosomal transformations (Klinefelter, Down syndromes);
• viral infections, that is, an abnormal response to them;
• excess radioactive, electromagnetic exposure;
• immunodeficiency states;
• carrying out chemotherapy or radiation.

Chromosomal changes in acute lymphoblastic leukemia are:

• primary - with a violation of the properties of the blood-forming cell and the formation of monoclonal leukemia;
• secondary, which manifest themselves as malignant polyclonal forms.

Manifestations of acute lymphoblastic leukemia

Acute leukemia goes through several stages:

• the first is initial (usually not detected);
• full manifestation of signs of leukemia;
• remission (partial or not);
• relapse;
• state of decline of body functions.

Acute lymphoblastic leukemia exhibits several syndromes:

• Anemic, causing muscle weakness, palpitations, shortness of breath, pale skin, drowsiness.
• Immunodeficiency, which accelerates bacterial, fungal, and viral infections of the patient.
• Hemorrhagic, expressed by a skin rash, hematomas, deterioration of blood clotting, nosebleeds.
• Osteoarticular, characterized aseptic necrosis, osteoporosis, infiltration of the joint capsule and periosteum.
• Proliferative. Its signs are: enlargement of the thymus gland in children, liver and spleen in adults, inflammation of the lymph nodes.
• Intoxication, when there is a deterioration in appetite, an increase in temperature to 40 ° C, sweating, and loss of body weight.
• Neuroleukemia is a metastasis in the brain that causes impaired speech, coordination of movements, and headaches. Observed in ALL.

The set of blood leukemia syndromes manifests itself differently in men and women.

Two months pass from the onset of mutation of the first stem cell to the manifestation of clinical symptoms of the disease. Blood leukemia develops gradually or suddenly. Signs of illness are similar to an acute viral infection.

Diagnosis of leukemia in adults

Based on the symptoms of the disease, the doctor prescribes to confirm or refute the suspicion of blood cancer.

Acute lymphoblastic leukemia in adults is detected by diagnostics consisting of three stages:

• General blood analysis. An alarming result is a decrease in the number of platelets, hemoglobin levels, a high level of leukocytes, and an increase in young blood cells - blasts.
• Biopsy of lymph nodes and bone marrow in the oncohematology department to analyze the type and degree of development of the disease. Leukemia is confirmed when 20% of abnormal cells are detected. Additionally prescribed microbiological assessment patient material and peripheral blood to identify the disease and chromosomal mutations.
• Check the level of pathology internal organs the patient using ultrasound (ultrasound), magnetic resonance imaging (MRI), x-ray, electrocardiogram of the heart. A lumbar puncture is performed to test the cerebrospinal fluid.

Treatment methods for acute forms of blood leukemia

Therapy for acute blood leukemia is carried out immediately on the basis of diagnostics carried out in oncohematology centers according to established drug prescription schemes - protocols, observing the periods, volumes, and timing of the study for each type of blood cancer.

The main goal of treating acute leukemia is to:

• restore healthy hematopoiesis;
• achieve long-term remission;
• restore full health;
• prevent relapses of the disease.

The following factors influence the selection of the protocol:

• genetic manifestations of leukemia;
• patient's age;
• response to previous therapy;
• number of leukocytes in a blood test.

The main methods of treating acute lymphoblastic leukemia:

• Chemotherapy is the main way to fight two types of leukemia. Combination cytoplastic drugs are administered to destroy blasts in spinal canal, intravenously over several years in a course taking into account the patient’s weight and blood mutation level. A new type of chemotherapy is being introduced - targeted, when they use the drugs Imatinib and Herceptin, which detect unhealthy cells and suppress their growth. The effectiveness of chemotherapy for AML is 85%, ALL – 95%.
• Biological – the technique serves to stimulate the body’s defenses and remove unusable cells using two types of antibodies, as well as Interferon, which are administered intravenously.
• Radiation method for the treatment of acute leukemia, which uses radiotherapy - the effect on the bone marrow under control computed tomography. Usually used before transplantation. As well as radioimmunotherapy with irradiated particles attached to antibodies using the drugs Bexxar based on the iodine isotope and Zevalin.
• Surgical route - bone marrow transplantation is indicated for AML and ALL during the initial weakening of the disease. Before surgery, the infected areas are destroyed by irradiation of the body and a high dose of chemotherapy.

Therapeutic transplantation

Transplantation of healthy stem cells from a compatible donor is considered the most effective method treatment of acute leukemia. It occurs by introducing donor material into the cervicothoracic area, which allows the dose of drugs to be increased during chemotherapy. The process is accompanied by taking medications that prevent the rejection of foreign cells, which after 14–20 days begin to produce leukocytes, red blood cells, and platelets.

The main condition for the operation is complete remission of leukemia. To prevent graft rejection, a conditioning procedure is performed before this, which eliminates the remaining blasts.

Before transplantation, you should consider the following contraindications:

• elderly age of the patient;
• dysfunction of internal organs;
• relapse of blood leukemia;
• acute infectious diseases.

Therapy for acute lymphoblastic leukemia occurs in several stages:

• Remission is developed and recorded by eliminating leukemia cells in the blood using the drugs Prednisolone, Cytarabine or their analogues.
• Having achieved a stable weakening of the process, the return of leukemia is prevented with the drugs Puri-netol and Methotrexate, which remove the remnants of blasts.
• The achieved result is recorded by destroying the remains of cancer cells with consolidating treatment.
• Recurrence of acute leukemia is prevented by long-term use of low-dose chemotherapy with the drugs Cytosar and Prednisolone.
• Complete remission is secured with chemotherapy drugs Mercaptopurine and Cyclophosphamide, which increase the number of leukocytes.

Remission rates for acute leukemia:

• cytogenetic, which results in complete cure.
• hematological – clinical, in which the composition of the bone marrow and peripheral blood returns to normal, the clinical signs of the disease disappear, and there are no foci of leukemia outside the bone marrow.
• molecular, when blasts cannot be found using molecular genetic analysis.

Principles of concomitant treatment of blood leukemia

Successful recovery depends on many factors. Prevention of infections is the main condition for patient survival. Often the doctor prescribes additional measures:

• detoxification drugs;
• cytostatics: Busulfan, Nimustine to counteract malignant neoplasms;
• blood transfusions to replace blood cells lost during chemotherapy;
• brain irradiation;
• broad-spectrum antibiotics for fever - Tienam, Meronem;
• creating a sterile environment in the patient’s room: quartzing, ventilation, wet cleaning 5 times a day, using disposable instruments;
• isolation of the patient from contact with possible carriers of infection;
• medications Granocyte and Neupogen for low levels of neutrophils in the blood.

Proper nutrition during leukemia is a component of successful recovery. It is necessary to completely eliminate fried and smoked foods and limit salt intake. The diet to maintain immunity should consist of a large amount of vitamins, carbohydrates, proteins, microelements and fats. Vegetables and fruits should be consumed boiled or stewed.

Consequences of blood leukemia

It can develop rapidly, and without timely treatment leads to death.

The prognosis of acute lymphoblastic leukemia in adults depends on the following factors:

• types of disease;
• patient's age;
• prevalence of the lesion;
• the body's reaction to chemotherapy;
• timing of diagnosis;
• cytogenetic features of leukemia.

For men over 60 years of age, the predicted 5-year survival rate for ALL is 20–40%, for AML it is 20%, and for people under 55 years of age it is 60%. Up to 25–35% of patients are free of relapse within 24 months, and some are completely cured. However, adults are less likely to get ALL than AML.

Chemotherapy has a particularly negative effect on the human body, causing the following consequences:

• vomiting, nausea, lack of appetite;
• damage to blood cells, resulting in anemia, bleeding, and frequent infections;
• disruption of the functioning of internal organs (kidneys, intestines, heart, liver);
• hair loss.

Biological methods of getting rid of leukemia give rise to:

• skin itching;
• flu-like symptoms;
• epidermal rash.

The result of radiotherapy may be redness and a feeling of fatigue.

A donor bone marrow transplant has serious consequences on a person. Its result is irreversible damage to the gastrointestinal tract, skin, and liver. The recovery rate reaches only 15%.

In order to promptly prevent adverse manifestations of acute lymphoblastic leukemia, adults are required to systematically undergo bone marrow and blood diagnostics, conduct an electrocardiogram of the heart, and other tests prescribed by a doctor.

- a disease that causes severe consequences. It is important to undergo regular preventive examinations to detect symptoms of blood cancer and timely treatment of this deadly disease.

Leukemia is a systemic blood disease characterized by a return to metaplasia and hyperplasia of hematopoiesis with a sharp delay in cell differentiation. Based on the severity of their course, leukemia is divided into acute and chronic. The latter differ in predominant defeat germ of hematopoiesis. Typical changes are detected in the leukocyte formula (the appearance of young cells of the myeloid or lymphocytic series).

There are acute lymphoblastic and myeloblastic leukemias.

Acute lymphoblastic and myeloblastic leukemia can develop during the transformation of chronic myeloid leukemia or secondary to a previous myodysplastic syndrome, and also arise de novo.

In acute leukemia, insufficient cell maturation occurs. Proliferation of cells incapable of maturation leads to the accumulation of non-functioning cells that progressively fill the bone marrow space, displacing normal elements of hematopoiesis. Eventually this proliferation breaks out into the blood. In adults, acute myeloid leukemia is reported approximately four times more often than acute lymphoblastic leukemia. In children, the ratio is opposite; lymphoblastic leukemia is more typical for them. Clinical manifestations are usually related to bone marrow failure (anemia, bleeding, or infection).

Symptoms and signs of acute leukemia

The main manifestation of acute leukemia is pancytopenia. Patients may feel pale, tired, or have rapid breathing. Thrombocytopenia can lead to bleeding, and neutropenia can lead to infection. Often the symptoms are mild and difficult to separate from general complaints such as fatigue and signs of a lingering viral infection. Clarifies the situation clinical analysis blood.

The clinical picture is characterized by an acute, violent onset, often with septic manifestations (high temperature). The liver, spleen and lymph nodes are not enlarged. In most cases, there are bruises and bruises on the body.

In peripheral blood - anemia, often leukopenia.

BM transplantation is actively used.

Chronic myeloid leukemia is characterized by a calm course in the first stage of the disease. Unreasonable weakness and bruises on the body are observed. Then abdominal pain appears. Upon examination, enlarged (moderate) lymph nodes are detected in different locations.

When examining peripheral blood - anemia, leukocytosis, leukocyte formula.

Chronic lymphocytic leukemia belongs to a large group of lymphoproliferative diseases. In its classical form, this disease is characterized by a sharp proliferation of B- and, less commonly, T-lymphocytes.

The patient develops progressive weakness, all lymph nodes begin to enlarge, which is noted by the patient himself. An objective examination showed that all lymph nodes were enlarged, of medium density, and smooth. The spleen is sharply enlarged, the organ is dense and painless. Occasionally, due to inflammatory processes, perisplenitis may develop, which is manifested by a friction noise over the spleen area.

A blood test revealed leukocytosis, later normocytic anemia. IN leukocyte formula a large number (up to 90%) of lymphocytes. The same picture is revealed in the bone marrow punctate.

In the acquired variant, the autoimmune genesis of the disease associated with taking medications is identified.

Acute lymphoblastic leukemia

• Usually B-cell, sometimes T-cell.
• Mostly children and young people are affected.

ALL can be pre-B-cell or T-cell type (Chapter 4 discusses the physiology lymphoid tissue). In both cases, immature lymphoblasts are produced. There are 2 classifications of ALL: morphological (FAB) and immunological. The FAB classification is not widely used and does not reflect the immunological nature of the ALL subtypes, which is very important. Let's give an example. It is known that morphologically, lymphoblastic cells of the L3 variant are often detected in a disease similar to ALL, such as non-Hodgkin lymphoma of small non-split cells, or Burkitt lymphoma. However, the treatment of the latter differs from the treatment of ALL. Immunological classification is very useful for differentiating these diseases.

Acute myeloblastic leukemia

There are 7 types (M1-M7).

Mostly adults, including the elderly, are affected.

Poor prognostic factors:

• Age (prognosis worsens with age).
• High leukocytosis at the time of patient's admission.
• Preexisting myelodysplastic syndrome.
• Acute leukemia with detection of the Philadelphia chromosome.
• The prognosis is determined by the type of leukemia, determined on the basis of morphology, chromosomal abnormalities and cell surface markers.

Damage to the erythrocyte germ.

Anemia. It occurs as a result of inhibition of erythropoiesis by leukemic cells, as well as as a result of bleeding against the background of thrombocytopenia and coagulation disorders. The average cell volume is usually normal or increased unless blood loss predominates. Damage to the leukocyte lineage.

Pneumonia caused by leukemia: fever, malaise, pain in muscles and joints.

Neutropenia: occurs secondarily as a consequence of infiltration of the bone marrow (hereinafter referred to as BM) by leukemic cells.

Because the term myeloid is sometimes used to designate only the neutrophilic lineage, in the past this group of leukemias was called acute nonlymphocytic leukemias, but the term acute myeloid leukemia is now preferred. Subtypes M1, M2 and M3 represent various stages myeloblast differentiation. M0 AML can be identified by the myeloid nature of cell surface markers, such as CD33, but blasts in this disease do not produce myeloid enzymes, which is why histochemical staining for myeloperoxidase is negative. In the M1-MZ subtypes, the degree of primary granulation gradually increases so that the M3 subtype represents acute promyelocytic leukemia. M4-M5 AML are monoblastic leukemias with or without myeloid elements, respectively. M6 AML is erythroleukemia, and M7 is megakaryoblastic leukemia. AML subtypes differ in morphology, histochemical staining, karyotype, and immunophenotype of pathological cells. The listed methods also help to distinguish AML from ALL with ambiguous cell morphology.

Because of the need for cells to self-replicate and reproduce throughout a person's life, blasts are not programmed to die. Mature descendants (erythrocytes, neutrophils, platelets) have a finite life span, and their death is predetermined.

In most cases, the cause of AML is unknown, but a number of etiological factors have been identified. Radiation is a weak but reliable leukosogen. Leukemia is also caused by some chemotherapeutic agents. In addition, AML can develop as a consequence of previous hematological disorders.

Damage to the platelet lineage

Thrombocytopenia develops as a result of inhibition of the myeloid lineage of hematopoiesis against the background of leukemic infiltration of BM. The functional usefulness of the resulting platelets is impaired. The risk of bleeding increases when the platelet count decreases below 10x109/l, and with concomitant sepsis and coagulopathy - below 20x109/l.

Changes in blood clotting

Vary from prolongation of prothrombin time to disseminated intravascular coagulation syndrome: may be a consequence of sepsis or leukemia itself, especially in acute promyelocytic leukemia (M3).

Diagnostics

Diagnosis of AML or ALL requires identification of leukemic blasts. Even when blasts are found in the peripheral blood, a bone marrow examination is always performed to confirm leukemic infiltration. The presence of more than 30% blasts is the standard criterion for diagnosing AML (as opposed to myelodysplastic syndromes, discussed below).

Often blasts can be identified as belonging to the myeloid or lymphoid series according to their morphological characteristics. Myeloblasts are larger than lymphoblasts, have very thin strands of nuclear chromatin and large prominent nucleoli. Lymphoblasts are smaller in size, with less cytoplasm and less prominent nucleoli. Often, a patient's blasts cannot be clearly attributed to the myeloid or lymphoid lineage and require further investigation. Myeloid blasts of type M1-M4 are stained in the test for myeloperoxidase, and blasts of type M4-M5 are stained for nonspecific esterase. Some M6 blasts exhibit a PAS response, and some M7 blasts exhibit a response to factor VIII antigen. Blasts in ALL do not stain for myeloperoxidase or nonspecific esterase, but sometimes they contain large PAS-positive granules. When immunophenotyping, belonging to myeloid blasts is established by the presence of CD33 and other myeloid antigens, and to lymphoid blasts - by CD 19 and CD10 (CALLA). In difficult cases, at the final stages of examining the patient for staging final diagnosis Cytogenetic testing should be performed. Obtaining cytogenetic data often requires considerable time.

Diagnosis confirmation

They collect a complete history of the disease and try to find out the etiological factors. The duration of the disease is established (whether its development was preceded by chronic condition, for example myelodysplasia), past illnesses(Down syndrome, radiation or chemotherapy). They find out the patient’s occupation (possibility of radiation exposure, contact with benzene and other factors that cause mutations), family history (rare hereditary diseases, such as Fanconi anemia).

The patient is examined to identify additional information to establish a diagnosis (lymphadenopathy, hepatosplenomegaly, gingival hyperplasia) and to detect possible sources of infection (caries, skin lesions, etc.).

The final confirmation of the diagnosis is based on the results of a bone marrow puncture. The obtained material should be sent for morphological examination, chromosomal analysis and identification of surface cellular markers.

Research

Blood tests usually reveal anemia with normal or elevated MCV. The number of leukocytes can be different: from low - 1x109/l to high - 500x109/l and higher. Most often, patients are diagnosed with leukocytosis below 100x109/l. Severe thrombocytopenia is typical, but its magnitude is variable. The usual diagnosis is the detection of blast cells in a blood smear.

Bone marrow analysis is the most valuable diagnostic method, and at the same time it makes it possible to obtain material for cytological, cytogenetic and immunological phenotyping. If bone marrow cannot be obtained, a trephine biopsy is necessary. The bone marrow is usually hypercellular with replacement of normal elements by leukemic blast cells in varying degrees(but more than 20%). The presence of Auer rods in the cytoplasm of blast cells indicates the myeloblastic type of leukemia.

Priority areas of therapy

• Stabilize the patient's condition.
• Treatment of emergency conditions, such as bleeding or sepsis, is initiated.
• Confirm the diagnosis.
• Determine the treatment strategy.

Acute leukemia: treatment

• Stabilization of the patient's condition.
• Airways. Stridor occurs with obstruction of the upper respiratory tract at the level of the mediastinum in certain types of leukemia, especially T-lymphoblastic. If stridor is detected, an anesthesiologist is immediately called and the patient is transported to the intensive care unit.
• Breath. Shortness of breath can be a consequence of infection (including atypical), leukostasis (high white blood cell count), severe anemia, heart failure (leukostasis, severe sepsis), pulmonary hemorrhage. Oxygen therapy is started: if possible, oxygen saturation is monitored using a pulse oximeter and do not resort to arterial puncture to study blood gases if the patient has thrombocytopenia.
• Circulation. Typically, shock in patients with leukemia occurs due to sepsis, but blood loss should be excluded if the patient has thrombocytopenia and coagulopathy, as well as heart failure due to leukostasis.
• Replenish the bcc.
• If sepsis is suspected, broad-spectrum antibiotics are immediately administered (after blood is taken for culture).
• Seek advice from a hematologist.

IN last years the prognosis for acute leukemia has improved and began to depend on accurate diagnosis. Currently, about 80% of children with acute lymphoblastic leukemia are cured, while among adults the recovery rate for acute myeloid leukemia does not exceed 30%. The diagnosis of leukemia is extremely stressful for young patients and their families, and the doctor must spend a lot of time discussing the questions and problems that arise in this regard. Before starting chemotherapy, you need to know the following points.

Sperm preservation

Almost all types of chemotherapy lead to high frequency to infertility. If the patient wishes, before starting chemotherapy, everything possible should be done to preserve sperm and its subsequent storage. Unfortunately, in practice, with leukemia, sperm becomes non-viable, and the need for rapid initiation of chemotherapy makes subsequent collection and storage of sperm useless.

Discussion of side effects

The patient should be warned about hair loss, infertility, vomiting (with the use of antiemetic drugs, vomiting may be less pronounced, although its occurrence is determined individual characteristics), infectious complications, bleeding, inflammation of the mucous membranes, etc. It may be helpful to provide patient-centered literature on acute leukemia and its chemotherapy.

Other provisions requiring discussion

Carrying out a spinal puncture to exclude damage to the central nervous system by the pathological process is indicated for:

• acute lymphoblastic leukemia;
• acute myeloblastic leukemia;
• the presence of neurological symptoms in a patient with leukemia.

Due to the possible need for BM transplantation in the future, HLA typing is required. However, this study is usually performed at a later stage after clinical remission has been achieved.

It is necessary to determine whether the patient is infected with CMV, and in the future, when treating CMV-negative patients, use only CMV-negative drugs, especially if BM transplantation is planned.

Before starting chemotherapy

Allopurinol is prescribed 24 hours before the start of chemotherapy. At high risk Tumor lysis syndrome is treated with rasburicase.

Prescribe regular (4-5 times a day) antiseptic treatment of the oral cavity in combination with antifungal drugs (nystatin suspension, amphotericin tablets, fluconazole for oral administration).

The patient is adequately hydrated, providing him with 3 l/day of fluid.

Before starting chemotherapy, antiemetic drugs are prescribed; the patient must take them regularly throughout the course of chemotherapy:

• ondansetron 4-8 mg intravenously or orally 2 times a day;
• metoclopramide intravenously or orally with dexamethasone.

Therapy for acute myeloid leukemia

If left untreated, patients with AML quickly die due to uncontrolled infection or bleeding. Basic treatment consists of intensive chemotherapy, leading to bone marrow hypoplasia and the release not only of intact blasts, but also of normal cells, which should ensure the restoration of normal hematopoietic sprouts. Often used regimens include a combination of anthracyclines (daunorubicin or idarubicin) and Ara-C (cytarabine). With this treatment, in approximately 65% ​​of patients the disease goes into remission, and more often in young people. A distinction should be made between remission and recovery. Remission merely reflects the absence of visible leukemic blasts; and if treatment is stopped after its induction, a small number of patients will remain in remission and actually be cured. Post-remission intensive therapy increases the duration of remission and the cure rate. However, even with intensive consolidation therapy (amplification therapy), only 30-40% of patients are cured using standard chemotherapy.

Acute promyelocytic leukemia. It has been shown that oral administration of the trans-isomer of retinoic acid can stimulate the differentiation of APML cells and lead to complete histological and cytogenetic remission. Unfortunately, remission is not long-term; in addition, standard chemotherapy is necessary. However, establishing that treatment< ATRA вызывает дифференцировку и подавление злокачественного клона, стало ключевым компонентом современной терапии этого заболевания.

Treatment of acute lymphoblastic leukemia

For adult patients with ALL, therapeutic regimens used in children are ineffective: much more intensive treatment is required; and even then, only 35-50% of patients are cured with standard chemotherapy. The most encouraging data were obtained in patients under 30 years of age; in patients over 60 years of age, survival rates were significantly reduced. As previously emphasized, patients with true B-cell ALL (L3) are treated according to protocols for the treatment of small non-Hodgkin's lymphomas of small non-split cells (Burkitt's lymphoma). Patients with ALL with the Philadelphia chromosome have an extremely poor prognosis and, if a compatible donor is available, should undergo BMT during first remission.

Treatment of emergency conditions

• Infection. Until the results of a complete blood count are obtained, the patient should be considered neutropenic and aggressive treatment for the infection should be initiated.
• Bleeding.
• Transfusion of compatible blood (if possible free of CMV) is carried out. Take precautions when the leukocyte count is high.
• If the platelet count is below 20x109/L, one dose of platelet concentrate is prescribed. Its administration is also indicated when bleeding occurs in patients with a platelet count below 50x109.
• When the prothrombin time is prolonged (more than 1.5 times compared to the control value), 4-5 doses of fresh frozen plasma are administered.
• If fibrinogen levels decrease, additional cryoprecipitate may be required.
• Transfusions with hyperleukocytosis are dangerous and can provoke complications of leukemia.
• Hyperleukocytosis. Discuss treatment tactics with a hematologist. Urgent leukapheresis may be required, preferably in an intensive care unit.

The first question is whether specific treatment is necessary. It is quite aggressive, has many side effects and may not be suitable for elderly patients or patients with other serious illnesses. Such patients can only be offered supportive therapy, which can significantly improve the patient's condition.

Specific therapy

Treatment of acute leukemia: specific therapy

• Detection and treatment of infectious diseases (urinary tract infections, oral candidiasis, infections of teeth, gums and skin).
• Correction of anemia with red blood cell infusions.
• Stopping thrombocytopenic bleeding using platelet transfusion.
• If possible, install a central venous catheter for chemotherapy.
• Carefully inform the patient and obtain his consent.

If you decide to start specific therapy, the patient must be prepared for it in accordance with the measures. It is unwise to undertake aggressive treatment of acute leukemia unless adequate supportive care is provided. The goal of treatment is to destroy the leukemic clone without damaging the remaining stem cells from which hematopoietic tissue will be restored. Treatment consists of three phases.

• Induction of remission. In this phase, combination chemotherapy destroys the tumor. The patient goes through a period of severe bone marrow hypoplasia, requiring intensive care and support in a hospital setting with specially trained medical personnel.
• Consolidation of remission. If remission has been achieved through induction therapy, the residual effects of the disease are suppressed in the consolidation phase. It consists of several courses of chemotherapy, which again cause bone marrow hypoplasia. For leukemia with a poor prognosis, stem cell transplantation is possible.
• Maintaining remission. If, with lymphoblastic leukemia, the patient remains in remission after the consolidation phase, they begin maintenance therapy, consisting of repeated courses of drug treatment. This can last for 3 years in the absence of exacerbation and is usually outpatient. Then specific therapy is stopped and the patient is observed. (It is believed that the maintenance phase is not needed for patients with acute myeloid leukemia who have achieved complete remission after the induction and consolidation phases.)

Treatment of ALL should be aimed at preventing damage to the central nervous system, since this is a special zone where conventional drugs do not penetrate. It consists of a combination of radiation to the head, intrathecal chemotherapy and high doses of methotrexate, which crosses the blood-brain barrier.

Detailed descriptions of treatment regimens can be found in special manuals. If the first induction course does not lead to remission, an alternative combination of drugs can be resorted to, but if there is no remission on the second attempt, a poor prognosis is obvious. If a relapse occurs during or soon after treatment, the prognosis is poor and treatment is difficult. The longer the remission lasts and no exacerbation occurs, the greater the chance of further treatment being effective.

Maintenance treatment

Intensive and potentially curative therapy is exacerbated by periods of severe bone marrow suppression and is impossible without adequate and skilled supportive care. The following problems usually occur.

Anemia. Anemia is treated with red blood cell infusion to maintain hemoglobin levels >100 g/L.

Bleeding. For recurrent thrombocytopenic bleeding, platelet infusion is necessary. Prophylactic platelet infusion is necessary to maintain platelet count >10x109/L. Emerging coagulation disorders require accurate diagnosis and, if appropriate treatment is necessary, fresh frozen plasma is usually used.

Infection. Fever (>38°C) lasting >1 hour in a patient with neutropenia indicates possible sepsis. Parenteral treatment with broad-spectrum antibiotics is important. Empirically, a combination of aminoglycosides (eg, gentamicin) with broad-spectrum penicillins (eg, piperacillin/tazobactam) is used. This combination is synergistic in its mechanism of bactericidal action, and treatment can be continued for at least 3 days after the fever has resolved. The microorganisms most often associated with severe neutropenia are the gram-positive bacteria St. aureus and St. epidermidis, which are present on the skin and penetrate into the human body through intravenous catheters and transfusion systems. Gram-negative microbes most often originate from the gastrointestinal tract and are activated in chemotherapy-induced mucositis. Escherichia coli, Pseudomonas and Klebsiella are more likely to lead to rapid deterioration of the patient's condition and require immediate empirical treatment. Gram-positive infections require treatment with vancomycin.

Patients with acute lymphocytic leukemia are susceptible to infection with Pneumocystis carinii, which causes severe pneumonia. Prophylaxis with cotrimoxazole is carried out during chemotherapy. Diagnosis can be difficult and may require either bronchoalveolar lavage or open lung biopsy. Treatment is carried out with high doses of cotrimoxazole, first intravenously, followed by switching to oral administration at the first opportunity.

Oral and pharyngeal candidiasis are common. If local infection is detected, fluconazole is effective. During intensive chemotherapy, systemic mycoses are usually prevented with fluconazole or itraconazole.

For systemic fungal infections of Candida and aspergillosis, intravenous amphotericin-B is required for at least 3 weeks, but the drug is nephro- and hepatotoxic. In this regard, the state of kidney and liver function is monitored, especially if the patient receives an antibiotic with the same nephrotoxic effect. As a rule, it is necessary to administer additional potassium. For patients who have experienced nephrotoxicity when treated with standard amphotericin-B, or those who require high doses of the drug to treat aspergillosis, a lipid form of amphotericin can be recommended without the risk of kidney damage. New ones have now been added to treat fungal infections. antifungal drugs caspofungin and voriconazole.

Herpes simplex on the face around the lips and nose often occurs during ablative treatment of acute leukemia and is treated with acyclovir. If the patient's history notes herpetic rashes, or increased titers of antibodies to herpes simplex, the drug can be prescribed prophylactically. Herpes zoster manifests itself as chicken pox or, if reactivated, herpes zoster. It must be treated immediately with high doses of acyclovir, as it can be fatal in immunocompromised individuals.

The value of isolated equipment and services, such as laminar airflow rooms, is debated, but may help build awareness of the need for a strong barrier in nursing practice. This isolation is often psychological stress for the patient.

Metabolic problems. Along with constant monitoring of kidney and liver function and homeostasis indicators, it is necessary to monitor the fluid balance in the body. Patients often suffer from severe anorexia as a side effect of treatment; Due to difficulties with fluid intake, intravenous administration of fluids and electrolytes is necessary. Kidney toxicity occurs as a result of the use of antibiotics (for example, aminoglycosides) and antifungals (amphotericin). Cell destruction during the period of induction of remission sharply increases the production of uric acid, which can lead to renal failure. By monitoring biochemical parameters, allopurinol is used and solutions are administered intravenously to prevent these complications. Sometimes hemodialysis may be necessary.

Psychological support. It forms a key aspect of treatment. The patient should be fully informed, all questions should be answered and, as far as possible, his fears should be dealt with. The optimistic attitude of doctors is vitally needed. During periods of severe bone marrow failure and septic episodes, mania, hallucinations and paranoia are common and must be met with patience and understanding.

Alternative therapy. Mild chemotherapy, not designed to achieve remission, can be used to control excess tumor proliferation. The drugs used for this are hydroxyurea and mercaptopurine. The goal is to reduce the number of white blood cells without developing bone marrow failure.

Bone marrow and peripheral blood stem cell transplantation

Traditionally, only blood and bone marrow transplantation (BMT) offer hope of a “cure” for various hematological diseases. With the progress of treatment standards, indications for TCM are becoming more precise. The type of transplantation is determined depending on the donor and source of stem cells. In allogeneic BMT, stem cells are taken either from a relative (usually an HLA-matched sibling) or from an unrelated volunteer donor carefully matched by HLA. During autotransplantation, stem cells are taken from the patient and stored until the desired moment in the gas phase of liquid nitrogen. Stem cells can be taken from either bone marrow or blood.

Self-transplantation of bone marrow

General indications for bone marrow allotransplantation

• Neoplasia caused by totipotent or pluripotent stem cells (eg, leukemia).
• Diseases accompanied by insufficiency of hematopoiesis (for example, aplastic anemia).
• Severe hereditary defects in blood cell production (for example, thalassemia, immunodeficiencies).
• Inborn errors of metabolism with loss of enzymes or cell lines

Healthy stem cells from the donor's bone marrow or blood are injected intravenously into the blood of a suitably "prepared" recipient. Preparatory treatment (chemotherapy with radiation treatment or without it) destroys malignant cells and suppresses the recipient’s immunity as well as it destroys its hematopoietic tissue. The injected donor cells “settle” in the bone marrow, take root and produce a sufficient number of red blood cells, granulocytes, and platelets that the patient needs over the next approximately 3-4 weeks. During the aplasia period, there is a risk of infection and bleeding, and intensive supportive care as described above is necessary. It takes several years to restore normal immunity, and the patient remains at risk of possible infections, especially in the first year. The advantage of receiving donor stem cells is that the donor's immune system can recognize the recipient's remaining malignant cells and destroy them. The immunological graft-versus-disease effect is a powerful tool against many hematological tumors. In post-plantation relapse, it can be enhanced by an infusion of donor T cells, called donor lymphocyte infusion.

Patients tolerate BMT with difficulty, and the operation is accompanied by high mortality. The most top scores obtained from patients with minimal remnants of the disease and from persons under the age of 20 years who have an HLA-identical relative donor. Older patients also undergo transplantation, but the results get progressively worse with age, and the upper limit for its use is 55 years. The risks and outcomes of transplantation depend on several factors that are related to both the patient and the disease. A total of 25% of patients die from transplantation-related complications, such as graft-versus-host conflict, and the rest from a significant risk of disease relapse. The long-term survival rate of patients with acute leukemia who underwent BMT is about 50%.

Complications of bone marrow allotransplantation

• Mucositis.
• Chronic graft-versus-host conflict.
• Infections.
• Bleeding
• Infertility.
• Education against the master."
• Acute conflict “transplant cataracts.
• Pneumonitis.
• Secondary malignant diseases

Graft-versus-host disease

The graft-versus-host conflict arises due to the cytotoxic activity of donor T-lymphocytes, which are sensitized to the new host, perceiving it as a foreign object. There are acute and chronic forms of conflict.

Acute form. In approximately one third of patients, the graft-versus-host conflict develops in the first 100 days after transplantation. It can affect the skin with rashes, the liver with jaundice, and the intestines with diarrhea, and ranges in severity from moderate to fatal. Prevention - selection of a donor according to the HLA system, immunosuppressants, including methotrexate and cyclosporine, as well as antithymocyte globulin. More severe forms difficult to treat and, despite high doses of corticosteroids, can lead to death.

Chronic form. It follows the acute form or occurs independently and later than the acute form. It often resembles a connective tissue disease, although in mild cases it only appears as a rash. Chronic graft-versus-host conflict is usually treated with corticosteroids and long-term immunosuppression, such as cyclosporine. The chronic form can be combined with a “graft-versus-leukemia” effect, which reduces the frequency of disease relapses.

Infection

Infections are another major problem encountered during the recovery period after BMT.

Reduced intensity bone marrow transplantation

The concept of reduced-intensity BMT developed as an attempt to reduce the mortality of allotransplantation. Instead of intensive preparation that worsens the patient's condition due to organ damage, relatively low doses of drugs such as fludarabine and cyclophosphamide are used to immunosuppress the patient, which allows the donor cells to engraft. The emerging donor immune system then eliminates malignant cells through a graft-versus-disease effect, which after transplantation can be enhanced by the selective use of donor T-lymphocyte infusions. This type of transplantation is less toxic and allows BMT to be performed in older patients. However, relapses and post-transplant infections continue to be a concern; the role of this type of transplantation is still under study.

Autologous bone marrow transplantation

In this procedure, the patient's own stem cells are first obtained and frozen. After preparatory treatment, autologous stem cells are reinfused to rescue the patient's bone marrow damage and aplasia caused by chemotherapy. Autologous bone marrow transplantation can be used for diseases that do not primarily affect hematopoietic tissue, or in patients who have achieved very good remission. The preferred source of stem cells for autotransplantation is peripheral blood. These stem cells engraft faster; Bone marrow recovery occurs within 2-3 weeks. In this case, the risk of graft-versus-host conflict is eliminated and immunosuppression is not required. Autologous stem cell transplantation compared to allogeneic BMT provides lower mortality - about 5%, but the relapse rate is higher. Whether stem cells require special treatment (“purification”) to remove remaining leukemia cells is debated.

Prognosis for acute leukemia

Without treatment, the average life expectancy of patients with acute leukemia is about 5 weeks. It can be extended to several months with maintenance treatment. Patients who achieve remission with specific treatment have a better outcome. Approximately 80% of adult patients with ALL or AML under the age of 60 years achieve remission. Remission rates are lower in older patients. The number of relapses remains high.

National and international research has led to sustained improvements in leukemia survival. Achievements have been achieved with the introduction of drugs such as ATRA (all-trans retinoic acid) for acute promyelocytic leukemia, which is expressed by a sharp decrease in the number of deaths from bleeding in this leukemia. The goal of the current trials is to improve survival, especially in ordinary or high-risk diseases, and to determine the site of transplantation.

Leukemia is a hemoblastosis, which is a tumor disease, with a characteristic displacement of normal, healthy sprouts of the hematopoietic system. Leukemia originates in cells of the peripheral blood and/or bone marrow. Taking into account the morphological features cancer cells, this tumor disease is divided into two forms: acute and chronic.

Acute forms of leukemia are characterized by poorly differentiated (blast) cells, while chronic leukemia is characterized by the bulk of malignant cells being represented by such mature forms as plasma cells, granulocytes, lymphocytes and erythrocytes. Thus, the duration of the disease is not considered fundamental in dividing the pathology into acute or chronic leukemia. Therefore the first form cancer, never develops into a second one.

Leukemia is characterized by initial germination into bone marrow cells, and then slowly begins the processes of replacing healthy hematopoietic germs. Thus, this is what leads to a sharp decrease in hematopoietic cells, which cause increased bleeding, frequent hemorrhages, decreased immunity and the addition of various complications of infectious etiology.

With leukemia, the spread of metastases is observed, which is accompanied by leukemic infiltrates in many somatic organs and lymph nodes. Thus, changes develop in them that clog the vessels with malignant cells, causing complications of ulcerative-necrotic properties and heart attacks.

Leukemia causes

Currently, the exact causes involved in the development of leukemia have not been established. There are suggestions that the source of the disease is bone marrow mutant cells, which are formed at different stages of the formation of hematopoietic stem cells. Such mutations occur in various precursor cells such as lymphopoiesis and myelopoiesis. These mutations can be provoked by ionizing radiation, unfavorable heredity, and contact with various types of carcinogenic substances. Today, there is evidence of an increased incidence of leukemia among people who were exposed to benzene and those patients who received cytotoxic drugs. These are immunosuppressants such as Mustargen, Leukeran, Imuran, Cyclophosphamide and Sarcozoline.

There are known cases of the development of myeloblastic leukemia and acute erythromyelosis after the use of long-term treatment with chemotherapy drugs, diseases such as myeloma, Wapdenström's macroglobulinemia, etc.

A presumptive role in the formation of leukemia is given to hereditary defects in lymphatic and myeloid tissues. There are also descriptions of observations that speak of dominant and recessive inheritance of chronic leukemia. In addition, among some ethnic groups there is a low incidence of this pathology, while among others it is increased. As a rule, in such cases, leukemia itself is not inherited, but instability in the chromosome set is detected, which predisposes the initial changes in myeloid or lymphatic cells to leukemic transformations.

Using chromosomal analysis, it was determined that with leukemia of any type, a clone of cancer cells spreads throughout the body, i.e. descendants of only one mutant cell. And the unstable state of the genotype of leukemia cells leads to the formation of new clones, among which only the most autonomous ones remain. This is facilitated by the vital activity of the body, and even by the influence of medicinal drugs. This phenomenon is explained by the progression of leukemia and the inability of cytostatics to control its course.

Leukemia symptoms

The disease can begin with a sudden appearance of weakness in the body, general signs of malaise, a rise in body temperature with the possible simultaneous development of a sore throat.

Leukemia is also characterized by a severe form or hemorrhagic diathesis, which is characterized by subcutaneous or mucous hemorrhages. When examining the patient, an increase in varying degrees of lymph nodes, liver and spleen is detected. Frequent forms of skin hemorrhages are also characteristic. Both stomatitis and necrotic etiology may occur.

During laboratory tests, anemia, thrombocytopenia can be observed, and the number of leukocytes in leukemia will range from moderate to significant increases. Also, with certain types of leukemia, blast cells and small amounts of mature forms of granulocytes can be detected in the blood, which indicates a leukemic failure.

Very often there are complications in the form of cerebral hemorrhages, bleeding of different nature and infectious and septic diseases.

In addition, the symptoms of the disease will largely depend on the stage and form of leukemia. Therefore, at the beginning of the disease, patients do not show any special complaints at all. Upon examination, they may have a single enlargement of the lymph nodes, as well as the spleen and liver. A moderate increase in leukocytes is visible in the blood, but lymphoid metaplasia is determined in the bone marrow. Thrombocytopenia and anemia are not detected.

At the stage with extensive signs, extensive enlargement of the lymph nodes and significant enlargement of the spleen are detected. In the blood there is lymphocytosis with leukocytosis, and platelets and erythrocytes are moderately reduced.

The terminal stage of leukemia is mainly characterized by an enlargement of the spleen and lymph nodes with the addition of symptoms of hemorrhagic diathesis, thrombocytopenia and anemia. A symptom of hemolysis is detected, which is accompanied by yellowness of the skin, increased bilirubin (indirect) and increased anemia. Very often, repeated pneumonia, soft tissues, etc. develop. As a rule, such complications or intoxications of a progressive nature result in death for patients.

In chronic forms, the onset of leukemia is usually missed. Only during a random examination by a doctor or medical examination of the patient are changes in the blood count, which is characterized by leukocytosis and neutrophilia, as well as the formation of myelocytes, detected. The study of bone marrow material helps to identify myeloid-type metaplasia. All common symptoms of leukemia are accompanied by a painful condition of the bones when they are tapped.

Leukemia can occur in waves, i.e. exacerbations give way to remissions and vice versa. During exacerbations, weakness sharply increases, the temperature begins to rise, hemoglobin levels decrease and hemorrhagic diathesis reappears. The most important sign of a crisis in leukemia is the appearance of blast leukocytes in the blood of the peripheral system. Then anemia and thrombocytopenia increase, and the spleen becomes greatly enlarged. Complications arise in the form of purulent-septic character and bleeding, from which many patients die.

Acute leukemia

Such a malignant anomaly belongs to a heterogeneous group of cancer pathologies of the hematopoietic system, i.e. hemoblasts, which manifest themselves as primary forms of bone marrow damage by immature blood cells (blasts) with subsequent displacement of healthy elements in tissues and organs. All acute forms of leukemia are considered clonal, since they are formed from a single cell that has undergone mutation. The clinical course of the disease, treatment and its effectiveness, as well as prognosis are largely determined by the belonging of immature cells to a specific hematopoietic system and the degree of their differentiation.

Acute leukemia is a fairly rare disease and represents about 3% of human tumor pathologies. But among hemoblastoses, acute leukemia is in first place in terms of detection frequency. This disease occurs in a ratio of 5:100,000 per year and almost 75% affects the adult population. But the predominance of myeloid type leukemia over lymphoid type is 6:1. Lymphoblastic leukemia is observed in 85% of children, and after forty years, on the contrary, 80% of patients with acute leukemia are diagnosed with the myeloid form.

Acute leukemia is considered one of the diseases that develops as a result of damage to the genetic material of a blood cell, which leads at the molecular level to disturbances in the control of the cell cycle, changes in transcription processes and the products of certain proteins. As a result of this, pathological cells accumulate, but the specific reasons for the formation of acute leukemia have not been clarified.

There are some predisposing factors that significantly increase the risk of developing this disease. For example, patients with chromosomal instability are more susceptible to developing acute leukemia. Among such diseases are: congenital agranulocytosis, Wiskott-Aldrich syndrome, Bloom's syndrome, Fanconi anemia, Ellis-van Creveld syndrome, celiac disease, etc.

Evidence for a viral etiology of this disease in adults concerns only the T-cell type. This form of leukemia occurs mainly in Japan and in the Caribbean.

There is also a connection between ionizing radiation, chemotherapy, radiotherapy and the development of acute leukemia. Some studies suggest that 20% of acute myeloid leukemia is the result of smoking. Benzene, in high concentrations, causes a leukemogenic effect on the human body. When receiving radiation treatment in combination with Mustargen, the risk of acute leukemia increases to 10%. Drugs such as Etoposide, Erocarbazine, Lomustine, Chlorbutin, Teniposide and Cyclophosphamide also have a mutagenic effect.

Relapses of acute leukemia in 85% are observed within ten years after cessation of therapy.

This malignant disease is diagnosed only after identifying blast cells in the bone marrow and peripheral blood. Over the past decades, developed and improved new techniques have become widely used in the diagnosis of acute leukemia. These include: immunophenotyping of markers using monoclonal and polyclonal antibodies, molecular biological analysis of altered chromosomes in acute myeloid leukemia, as well as chromosome analysis.

Any form of acute leukemia is characterized by both common features that are characteristic of all leukemias and significant features that influence the course of the disease, the choice of treatment tactics and its effectiveness.

In all acute leukemia, granulocytopenia, anemia and thrombocytopenia are observed; infiltration into various organs and production of cytokines. The onset of acute leukemia includes: a significant rise in temperature, severe weakness, intoxication, bleeding and severe infections.

Elderly patients develop angina and heart rhythm disturbances, which is a consequence of hospitalization in the cardiology department.

When examining patients, objective symptoms may not be observed. However, enlarged peripheral lymph nodes, liver and spleen are often detected. This is mainly observed in acute lymphoblastic leukemia, but sometimes also in the myelomonoblastic form. In addition, gum hyperplasia, skin infiltration, hemorrhagic syndrome with varying degrees of severity, bone pain, neurological symptoms and arthralgia.

Three-line cytopenia is determined in the blood: either leukocytosis, or anemia, or leukopenia. Chief cells may make up 90% of leukocytes or be completely undetectable. The diagnosis of acute leukemia becomes obvious after morphological confirmation of bone marrow or peripheral blood cells for the presence of a cancerous abnormality.

In acute leukemia, lesions of an extramedullary nature are also observed. Special attention deserves neuroleukemia, which occurs as a result of metastases of tumor cells into the membranes of the spinal cord and brain. Neuroleukemia is characterized by meningeal hypertensive syndrome, which is manifested by vomiting, constant headache, lethargy, swelling of the optic nerves, strabismus, Kernig's syndrome, and stiff neck muscles. Acute leukemia of an extramedullary nature can also affect the skin, retina, gums, ovaries, testicles, lymph nodes, lungs, intestines, and heart muscle.

Acute leukemia can occur in several stages, such as manifestation, remission, and then relapse. The onset of the disease begins with severe inhibition of hematopoiesis, hemorrhagic syndrome and infectious complications. Generally, acute leukemia manifests itself asymptomatically, and the diagnosis is made by chance.

The main goal in the treatment of acute leukemia is to eradicate the leukemic cell clone, restore hematopoiesis, and achieve long-term and relapse-free survival of patients. All this is achieved by modern treatment methods using antitumor myelotoxic drugs, with the help of which the volume of the malignant mass is reduced, while causing bone marrow aplasia.

Blood leukemia

This pathological change blood, called leukemia, leukemia, or blood cancer. It is a clonal neoplastic disease of the hematopoietic system. Blood leukemia is part of a large group of pathologies that differ in their etiology.

The causes of blood leukemia are not fully understood. But medical scientists suggest that ionizing radiation, smoking, and some medications and carcinogenic substances.

In blood leukemia, the malignant clone is formed from hematopoietic immature cells of the bone marrow. Depending on the progression of the disease, blood leukemia can occur in two forms: acute and chronic.

Acute blood leukemia is a disease that develops quite rapidly, in which immature blast cells accumulate uncontrollably in the bone marrow and peripheral blood. And this leads to a disruption in the ability to produce healthy hematopoietic cells. Thus, a rapid process of bone marrow replacement with pathological cells occurs.

The chronic form of blood leukemia can proceed for years and be completely asymptomatic, and in the future cause complications, as in the acute form.

The main symptoms of blood leukemia are a prolonged rise in temperature without visible reasons, the occurrence of frequent infectious diseases, enlarged lymph nodes, increased bleeding gums, joint pain, etc.

Used to diagnose blood leukemia various methods research. These include a detailed blood test, biopsy and aspiration of bone marrow cells, and cytogenetic studies.

Treatment tactics for blood leukemia will largely depend on the type of disease. And basically it includes the use of polychemotherapy, radiation, high-dose therapy followed by stem cell transplantation.

Leukemia in children

Based on research by foreign medical scientists, a disease such as childhood leukemia is observed in half of all cases of malignant pathologies. This disease is considered one of the main causes of death among children.

Leukemia in children is also called a white blood disease, because it is “white cells”, leukocytes, that play a protective role in the body. And with leukemia, these cells do not mature to the end, and therefore do not perform this function.

At the moment, the exact causes of leukemia in children are not known. There are suggestions that the disease develops as a result of mutations, the action of certain viruses and chemical substances. There are also statements by some authors that leukemia in children can be provoked by hereditary and cytogenetic factors. Therefore, this pathology can be found much more often in children who suffer from Down syndrome. In addition, the hereditary factor is evidenced by the fact that identical twins suffer from leukemia more often than fraternal twins.

The acute form of leukemia among children occupies one of the leading places, in contrast to the chronic form. Among the most common forms of leukemia one can distinguish acute lymphoid.

As a rule, the disease begins suddenly and progresses rapidly. The first clinical symptoms are noted in the form of high fever, sore throat, poor health, pallor and bleeding.

In some forms, in children the first symptoms of leukemia may develop much more slowly, and only then the children begin to complain of pain in the bones.

Very often, children with leukemia experience severe fatigue, numerous bruises appear on the body, frequent nosebleeds occur, appetite decreases, and vomiting and headaches become almost constant.

After necessary examinations Enlargement of the liver, lymph nodes and spleen is detected. If it is not possible to diagnose the disease on time and correctly, the child’s condition becomes extremely serious. Septic and necrotic foci appear. It is associated with agranulocytosis. Such children begin to breathe heavily, become capricious, lethargic. They develop shortness of breath and tachycardia. Pronounced local changes are caused by the proliferation of tumor cells. IN in this case In children, there is an increase in the parotid and submandibular glands. At the same time, the child’s appearance completely changes. And the cause of death can be anemic hypoxia, sepsis or bleeding. Today, modern treatment tactics make it possible to achieve stable remission, but, as a rule, they are always followed by relapse processes.

For leukemia, careful laboratory examination of bone marrow cells is used to make an accurate diagnosis in children. But the blood picture in children with this disease suggests that there is generally a reduced number of leukocytes and the predominant form is paraleukoblast. Such a pathologically immature cell is characteristic of lymphoblasts, less often myeloblasts. A typical sign of leukemia is the monotony of malignant cells.

The basis of treatment for children with leukemia is the ability to destroy all cancer cells. At the moment, the use of polychemotherapy is the most effective technique in the treatment of childhood leukemia.

When acute lymphoblastic leukemia is diagnosed, children are prescribed drugs such as Vincristine and Asparaginase in combination with Rubidomycin. During remission, treatment is carried out with Leupirin. Positive dynamics can be achieved with the prescription of Cytosine arabinoside, Leupirin, Rubidomycin with Prednisolone.

For bleeding and anemia, transfusions and platelet suspensions are prescribed. For meningeal leukemia - Amethopterin.

Thus, using modern methods diagnostics and correct treatment tactics, in most cases it is possible to achieve absolute recovery of the child.

Leukemia in adults

This disease differs from childhood leukemia in that most often all types of leukemia in adults occur in a chronic form. The clinical picture is characterized by a gradual onset, and the only signs over time are fast fatiguability and susceptibility to infections. With such a nonspecific picture, leukemia in adults remains undetected for a long time, especially among older people, and is detected some time after the onset of the first manifestations.

The cause of the development of adult leukemia remains unclear to date. However, for some types of this disease, oncogenes and peculiar mutations in chromosomes have been discovered, which are based on excessive and pathological growth of blood cells. For example, the chronic form of myeloblastic leukemia is closely associated with the transfer of a certain section of the ninth chromosome to the twenty-second. Such changes occur at the genetic level, i.e. before birth, but all the consequences of this exchange will become visible in the middle of a person’s life.

Leukemia can affect different age groups. People aged twenty to thirty years are more likely to suffer from acute myeloblastic leukemia, and from 40 to 50 years old – a chronic form of the same leukemia. But after fifty years or at an older age, this is a chronic form of lymphoblastic and hairy cell leukemia.

All names of such a malignant disease originate from the cellular type of blood, and the word “blast” indicates the immaturity of the precursor cells, which are ordinary bone marrow cells.

Myeloblastic leukemia is formed as a result of an excess number of myeloblasts. They normally must go through certain stages of maturation and enter the bloodstream as already mature leukocytes. But as a result of accelerated and excess growth myeloblasts, blast cells do not go through this cycle, i.e. they don't grow up. Therefore, the number of pathological cells increases, which displace healthy ones. Thus, there is a violation immune system body, which is protected by full-fledged leukocytes. As a result, the immune system suffers, and the entire clinical picture of myeloblastic leukemia in adults is associated with a small number of mature leukocytes against the background of blood viscosity.

The functions of organs such as the kidneys, lungs, and gastrointestinal tract are significantly reduced after the appearance of microinfarctions in them. The next symptom of leukemia in adults is splenomegaly. This is explained by the increased work of the organ as a result of the disease. Characteristic symptoms also include thrombocytopenia and anemia, as well as a general decrease in the body's resistance. However, all these symptoms are not as critical as in childhood forms of leukemia.

The second type of leukemia in adulthood is chronic lymphoblastic leukemia. It is usually diagnosed in older and older adults. His characteristic feature consists in the predominance of lymphocytes in the blood of the peripheral system. They can reach almost 98%, as opposed to the norm of 40%.

The disease usually proceeds sluggishly and the basis of all complaints is increased fatigue of the body. To clarify the diagnosis, a detailed blood test is prescribed.

The development of hairy cell leukemia is very common among older people. This name comes from the altered lymphocytes in the form of hairy or ragged cells, which are considered a characteristic feature of this leukemia in adults.

Chronic leukemia

Common chronic leukemias include myeloid leukemia, lymphocytic leukemia, erythremia and multiple myeloma, and less commonly, myelofibrosis, osteomyelosclerosis, Waldenström's macroglobulinemia and chronic monocytic leukemia.

As a rule, chronic myeloid leukemia is characterized by tumor lesions of granulocyte, erythrocyte, and platelet cells. The founding cell of a tumor is a myelopoiesis (progenitor cell). The pathological process can affect the main hematopoietic organs, and in the terminal stage penetrate into any tissue and organ.

The course of the chronic form of myeloid leukemia is characterized by an advanced stage and a terminal stage. At the beginning of the first stage (advanced), patients do not have any complaints, the spleen may be practically not enlarged, changes are observed in the composition of the blood. The diagnosis of leukemia at this stage can be established by analyzing leukocytosis to the levels of promyelocytes and myelocytes. In the bone marrow of the trepanate, even during this period, one can detect absolute displacement of all fat by myeloid tissue. This stage can last about four years. At proper treatment, the patients are in satisfactory condition, they are able to work and lead a normal lifestyle, but under the supervision of specialists and appropriate treatment.

Chronic myeloblastic leukemia in its terminal stage is characterized by malignant features. This is manifested by a rapid enlargement of the liver and spleen, high fever, bone pain, rapid progressive exhaustion, severe weakness, and sometimes enlarged lymph nodes. This stage is characterized by the development and increase of anemia, thrombocytopenia, which are complicated by hemorrhagic syndrome and granulocytopenia, resulting in infection, as well as various necrosis of the mucous membranes.

Blast crisis, in which the content of blast cells increases, is the main hematological symptom terminal stage. When carrying out karyological analysis at this stage, in almost 80% clones of hematopoietic cells are detected that contain an abnormal number of chromosomes. The life expectancy of patients in the terminal stage does not exceed one year.

The chronic form of lymphocytic leukemia is a benign tumor of the immune system. The pathology is based on mature lymphocyte cells. This disease, as a rule, is determined by complete health and no subjective manifestations of a slight increasing lymphocytosis of the blood. At first pathological process the number of leukocytes is normal, and a characteristic sign of leukemia is enlarged lymph nodes. Sometimes such increases are determined in conjunction with changes in the blood. In chronic lymphocytic leukemia, a frequent symptom is a significant enlargement of the spleen, and the liver becomes enlarged less frequently. Increased levels of lymphocytes, prolymphocytes and sometimes lymphoblasts are observed in the blood, which is explained by Gumprecht's shadows characteristic of this type of leukemia. The advanced stage of the disease is characterized by the normal content of hematopoietic cells during for long years. The presence of lymphocytes in the bone marrow in this disease constitutes a high percentage. Also, chronic lymphocytic leukemia has a reduced level of gamma globulins. But immunity, which is absolutely suppressed, is caused by frequent complications of an infectious nature, in particular pneumonia.

A frequent complication of this disease is cytopenia, which manifests itself much more often than thrombocytopenia and anemia. This is because autoantibodies appear that target red blood cells, platelets, megakaryocytes, and erythrokaryocytes. In addition, lymphocytes can suppress the actions of precursor cells for thrombocytopoiesis or erythropoiesis. The terminal stage of the disease, which can manifest as sarcoma growth or blast cell crisis, is characterized by infrequent observation of this pathology. In its development, it can sometimes occur with a change from lymphocytosis to neutrophilosis.

One form of chronic lymphoblastic leukemia is hairy cell leukemia. It is characterized by lymphocytes with a homogeneous nucleus and cytoplasm with villous outgrowths. Symptoms of the disease are severe cytopenia with a slight increase in lymph nodes in the periphery and spleen.

There is a separate type of chronic lymphocytic leukemia, which is characterized by skin lesions. This is Cesari's form. At the onset of the disease, the skin is affected, and significant infiltrates of lymphatic origin appear under the epidermis, which are characterized by totality. Then there is a gradual increase in lymphocytosis and pathological lymphocytes in the blood. There is evidence that T cells are malformed lymphocytes. But lymphadenopathy can have a mixed clinical picture. In the first case, the lymph nodes quickly enlarge as a result of skin infection, and in the other - under the influence of leukemic infiltration. Splenectomy occurs gradually with the progression of pathology.

Leukemia of the chronic monorite form is quite rare disease, which is characterized by high monocytosis in the blood of the peripheral system with a slight increase in leukocytes. Units of promonocytes are also noted in the blood, and in the trepanate there is hyperplasia of brain tissue and a general proliferation of monocyte elements. Only in 50% of patients it is possible to palpate the spleen. Chronic form monocytic leukemia proceeds well for a long time, and then the terminal stage suddenly begins with all its clinical features. And the advanced stage does not require specific treatment. Only for severe anemia are red blood cell transfusions prescribed, which is possible during outpatient treatment.

Hereditary neurotropenias are blood diseases with virtually absent neutrophils. The type of inheritance of these diseases is recessive. Clinical manifestations are due to a tendency to infections, as well as a severe form of alveolar pyorrhea from early childhood. The disease is characterized by periods of fever and infections, which alternate with days of neutropenia. Neutrophils are not observed in the blood, and monocytes and eosinophils are significantly increased. For the periodic form of the disease, these changes appear over several days with a clear time of occurrence. There is no thrombocytopenia or anemia.

Treatment of leukemia

To prescribe appropriate treatment for a patient with leukemia, it is necessary to correctly assess the patient's condition after careful medical examination oncologists. Also, to confirm the final diagnosis, a biochemical and general blood test is prescribed, and additionally, material for biopsy and puncture.

Choice of treatment tactics and medicines are carried out depending on the detected form of leukemia with constant monitoring and supervision of specialists.

At the moment, it is practically impossible to achieve a complete cure for malignant oncology. Therefore, treatment for leukemia may continue throughout the patient’s life.

Thus, appropriate treatment tactics are used for different forms of leukemia. When acute leukemia is diagnosed, patients are urgently hospitalized. In some cases, with a reliable diagnosis, treatment with cytostatic drugs is immediately prescribed on an outpatient basis.

To achieve positive remission, treatment with pathogenetic methods using combined polychemotherapy is used to eliminate all suspected and existing foci of the pathological process. However, sometimes pronounced hematopoiesis is observed. In acute leukemia, remission occurs when platelets and leukocytes increase, and the content of blasts in the bone marrow decreases to 5%, lymphocytes to 30%, and leukemic proliferations are not detected.

For the treatment of children with acute lymphoblastic leukemia, an effective combination of Vincristine and Prednisolone is prescribed. Using this therapy, remission can be achieved in almost 90% of children in an average of five months. And after remission is achieved, neuroleukemia is prevented. For the first spinal puncture, which is performed immediately after confirmation of the diagnosis, Methotrexate (Amethopterin) is administered intralumbarally. Such punctures are repeated every two weeks until positive result. In addition to the use of polychemotherapy, a special preventive course is started with irradiation of the head when the first and second cervical vertebrae are involved. A prerequisite for manipulation is the protection of the eyes, face, and mouth. At the same time, in within three weeks of irradiation, Methotrexate is administered.

If neuroleukemia is determined at the time of diagnosis, then radiation irradiation of the head is not performed. And when the drug is administered through lumbar puncture two more drugs are added, such as Methotrexate and Cytosar.

In children at the time of remission of the acute form of lymphoblastic leukemia, continuous treatment with cytostatic drugs using 6-Mercaptopurine, Cyclophosphamide and Metatrexate is carried out for four to five years.

For the treatment of acute lymphoblastic leukemia among adults and patients with an unfavorable outcome, Rubomycin, Prednisolone and Vincristine are prescribed, as well as one of the cytostatic regimens, such as POMP, CHOP or COAP. The SOAP regimen includes Cyclophosphamide, Cytosar, Vincristine, Prednisolone. The CHOP regimen is Prednisolone, Adriamycin, Cyclophosphamide and Vincristine. POMP regimen – Purinetol, Prednisolone, Methotrexate, Vincristine.

Any of these schemes is used at the very beginning of remission in order to consolidate it. And after an increase in the number of leukocytes, continuous maintenance therapy is carried out. For this purpose, drugs such as Cyclophosphamide, 6-Mercaptopurine and Methotrexate are prescribed.

For the treatment of patients with chronic lymphocytic leukemia, which is manifested by leukocytotic growth and lymphadenopathy, Chlorbutin is used. Cyclophosphamide is prescribed for significantly enlarged lymph nodes. Therapy using steroid drugs used to treat hemorrhagic syndrome, complications of autoimmune properties, as well as in case of ineffectiveness of some cytostatic drugs. To do this, combine Cyclophosphamide, Chlorbutin and Prednisolone. However, long-term treatment of chronic lymphocytic leukemia with steroids is contraindicated.

If the lymph nodes of the abdominal space are involved in the tumor process, then a combination of VAMP drugs is prescribed, as well as cytostatics such as Vinblastine, Cyclophosphamide, Vincristine and Prednisolone (CVP or COP). Then appointed radiation therapy with irradiation of the spleen, lymph nodes and skin.

Recently, leukocytopheresis has become widely used in the treatment of lymphocytic leukemia. And for hairy cell leukemia, splenectomy is effective in 75% of cases. For cytopenia that is not associated with an enlarged hematopoietic organ, such as the spleen or other changes, as well as lymphadenopathy, it is advisable to prescribe Interferon.

Leukemia prognosis

Factors of favorable and unfavorable prognosis for leukemia include the patient’s gender and age, the outcome of the somatic status, the characteristics of cancer cells (their clinical picture, morphology, cytogenetics, immunology), etc.

Also, palliative therapy cannot be started if there is an existing factor that indicates an unfavorable prognosis.

When diagnosing leukemia, all patients are divided into two risk levels: standard and high. The first degree of risk includes children under two years of age and over ten years of age, with enlarged lymph nodes at the time of disease prediction of more than two centimeters, and the liver and spleen - more than four centimeters.

With identified forms of leukemia, such as hyperleukocytosis or neuroleukemia, the prognosis is unfavorable.

The course of chronic leukemia can last quite a long time without treatment, so the prognosis is favorable. But leukemia, if left untreated, leads to fatal outcome within a short time.

But, as a rule, with timely and correct treatment there is every chance of a positive result.

Today, with the use of modern treatment tactics, complete remission can be achieved in almost 90% of patients. In 75% of patients, positive dynamics are observed over a five-year period without relapses.

If the disease does not recur for 6 or 7 years, then it is considered that leukemia has been overcome.

Leukemia is considered a cancer. This is a tumor characterized by the accumulation of a large number of mature lymphocytes in the blood. There are several types of leukemia: lymphocytic leukemia and myeloid leukemia, which, in turn, have chronic and acute forms. In this article we will look at the most common type of leukemia in adults, its symptoms - chronic lymphocytic leukemia (CLL).

According to the nature of the course, they are divided into acute and chronic. These forms cannot flow into each other.

Prognosis for life with acute form of the disease

When a patient is diagnosed with a chronic form of blood pathology, then with timely and correct therapy, medical statistics confirm about 85% of favorable prognoses. However, when acute leukemia is diagnosed, the life prognosis is less positive. If the patient refuses competent help, then the life expectancy with this disease does not exceed four months. Myeloblastic leukemia expects no more than three years of life expectancy, despite the age of the patient. In this case, there is only a 10% chance of recovery. Lymphoblastic leukemia is characterized by frequent relapses, which are observed over the course of two years. When remission lasts at least five years, the patient can be considered recovered (about 50% of cases are noted).

Symptoms of CLL

In some patients with chronic lymphocytic leukemia, the disease is detected at the initial asymptomatic stage only with a specialized blood test, and proceeds in the so-called smoldering mode, so there is no need for treatment. Doctors will talk about treatment for chronic leukemia if the following signs are present:

1. One or more symptoms of intoxication: for example, weight loss of at least 10% within six months, provided that the patient did not take any measures to lose weight; the level of sweating increases noticeably, especially at night, and sweat is not associated with infectious diseases; constant temperature fluctuations without signs of infection. All this leads to rapid and causeless fatigue, weakness, and decreased ability to work.
2. Increasing anemia and/or thrombocytopenia due to bone marrow infiltration, as well as resistance of these symptoms to prednisolone.
3. Clear enlargement of the spleen, more than 6 cm below the costal arch.
4. An enlarged appearance of the lymph nodes, while their volume increases en masse and progressively (neck, armpits, groin).
5. Increase in the number of lymphocytes in the blood by more than half in two months.

Chronic lymphocytic leukemia is incurable. The majority of patients are elderly people, although young people also get sick. The prognosis of the disease and the survival rate are determined not so much by the tumor itself, but by age, number and severity of concomitant diseases.

Complications of leukemia

1. The emergence of private infectious diseases, urethritis, cystitis.
2. Severe infectious diseases - meningitis, pneumonia, exudative pleurisy, herpes zoster.
3. Tinnitus, hearing disorder due to infiltration of the vestibulocochlear nerve.
4. Decrease in hemoglobin amount below 110 g per liter.

Ltreatment of the disease

Note! Before starting treatment, you need to make sure that the oncologist is highly specialized and has a certificate.

The therapy system depends on the patient’s age category, his physical condition, the severity of symptoms, more early treatment, the degree of its toxicity, possible complications, the presence of chronic diseases caused by the same pathogen. When treating patients with good somatic status, the physician should strive for stable remission, preferably at the molecular level; when treating elderly patients, tumor control, avoiding unnecessary toxicity. For patients old age trying to improve their quality of life as much as possible.

There are different variations of treatment. The main methods of treating the disease include:

Diagnosis of lymphocytic leukemia

The methods are laboratory tests.

1. A general blood test is taken.
2. Genetic testing is being carried out.
3. Blood chemistry. A laboratory diagnostic method that allows you to determine the quality of the functions of internal organs.
4. Ultrasound is an ultrasound examination this procedure It will also help determine the functioning of the internal organ system.
5. Tomography helps to see a layer-by-layer picture of the state of a person’s internal organs.
6. Computed tomography is a method of layer-by-layer diagnostics of the body, based on X-ray radiation.
7. Conducting scans of the skeletal and lymphatic systems.
8. Lymph node biopsy.

Important! The goal of prevention is regular visits to the doctor, identification of all abnormalities, and mandatory laboratory tests. In case of long-term infections of any kind, unexplained loss of strength and performance, also as an emergency, a visit to a specialist should be made.

Nutrition for leukemia

When fighting the disease, the patient loses a lot of strength and energy, side effects of radiation appear, and the diet during the disease does not differ much from the usual balanced diet. To support the immune system, patients are prescribed nutritional supplements and vitamins.

It is recommended to avoid fast food, fried and smoked foods, alcoholic beverages, and try to avoid excessive salt intake in your food. You need to give up caffeine, tea, and Coca-Cola; these products interfere with the absorption of iron, the lack of which is acute in leukemia. For this pathology, it is recommended to consume foods rich in antioxidants, namely: apples, carrots, berries, garlic.

Consume enough zinc, which ensures the most important processes of hematopoiesis. Include seafood in your diet: mussels, seaweed, beef liver. To fight the disease, the patient requires a large expenditure of strength and energy; it is advisable to consume fats and carbohydrates, whose concentration is in nuts, oily fish, avocado.

To get enough selenium, it is recommended to eat legumes. Buckwheat and oatmeal porridge. Selenium protects the body from toxic substances.

Important! The body must receive a sufficient amount of vitamin C, copper, cobalt, and manganese. They promote the regeneration of blood cells, which is important in treatment.

You can learn more about the causes of leukemia in adults from the video.

Video - Causes, symptoms and treatment of leukemia

Acute leukemia is an aggressive form of blood cancer. The prognosis for a patient’s recovery with this disease is influenced, first of all, by timely diagnosis and the correct course of treatment. We will talk about the symptoms, effective methods of diagnosis and treatment of leukemia.

Causes of leukemia development

Acute blood leukemia (leukemia) develops due to a mutation in the hematopoietic precursor cell of leukocytes, which rapidly proliferates. Tumor clones displace normal hematopoietic cells and the bone marrow is deprived of the ability to produce blood cells in the required volume. After the release of immature mutated cells into the bloodstream, they accumulate in the peripheral blood and cause leukemic infiltration of internal organs.

All atypical cells have the same cytochemical and morphological characteristics, which confirms their cancerous origin and status as clones of the same blast.

The exact causes of acute leukemia are not clear, but specialists who deal with diseases of the hematopoietic system (hematologists) have identified a number of risk factors. These include:

• hereditary predisposition (diagnosed cases of leukemia in close relatives);
• some chromosomal pathologies (Down syndrome, Klinefelter's disease, etc.);
• viral infections(there is a risk of an abnormal immune response to an infectious agent, mainly influenza);
• hematological diseases (myelodysplasia, some types of anemia);
• exposure to radiation and chemical carcinogens (benzene, toluene, arsenic compounds);
• cytostatic therapy for other types of cancer (lymphomas, multiple myelomas, lymphogranulomatosis).

In most cases of acute leukemia, there are several causes of cell mutation. For example, it is believed that the development of lymphoblastic leukemia in children is caused by the effect of unfavorable environmental factors on the body of the mother and child, the immune response to viral infections and hereditary predisposition. In some types of disease associated with a mutation of the MLL gene, the pathological change in blasts is completed even before the birth of the child.

Classification of acute leukemias

The acute form of the disease is diagnosed in 97% of all clinical cases of leukemia. The transition of acute leukemia to a chronic form is impossible, therefore the division according to the course of the disease does not correspond to a similar classification in another field of medicine.

“Exacerbation” of chronic leukemia is possible with prolonged exposure to carcinogenic factors that provoked the development of the disease. In this case, against the background of chronic leukemia, symptoms of acute leukemia are observed.

Morphologically, leukemias are divided into lymphoblastic (arising from lymphocyte precursor cells) and non-lymphoblastic. The second group combines all other forms of the disease.

Lymphoblastic leukemias, in turn, are classified according to the type of lymphocytes that gave rise to the process. There are pre-pre-B-lymphoblastic, pre-B-lymphoblastic, B-lymphoblastic and T-lymphoblastic forms of the disease.

Acute leukemias of the non-lymphoblastic type are divided into myeloblastic (develop from pre-granulocytes), mono- and myelomonoblastic (characterized by abnormal proliferation of monoblasts), megakaryoblastic and erythroblastic (develop from platelet and erythrocyte precursor cells, respectively).

In addition to lymphoblastic and non-lymphoblastic leukemia, undifferentiated leukemia is distinguished. This form of the disease is very aggressive, because division of tumor cells without certain morphological features occurs more actively than in more mature stages their development.

Acute leukemia in adults is usually of the non-lymphoblastic type. In most cases, they have a myeloblastic form of leukemia. At risk are mainly elderly patients and those who are constantly in contact with chemical carcinogens and ionizing radiation.

Acute lymphoblastic leukemia is typical for children. The peak incidence occurs between 2 and 5 years, with boys getting sick more often than girls. Leukemia can also be diagnosed in adolescents - a small spike in the graph of incidence versus age is observed around 10-13 years.

Precise definition morphological characteristics cells is important for selecting the correct treatment tactics. The degree of differentiation of tumor clones determines the aggressiveness of the cancer and affects the patient’s survival prognosis.

Stages of the disease

The course of leukemia is usually divided into five stages or stages:

• initial stage;
• expanded stage;
• complete or incomplete remission;
• relapse;
• terminal stage.

In a number of clinical cases, a latent (primary) period is also distinguished. This term refers to the time that passes from exposure to a carcinogenic factor to the appearance of the first symptoms of the disease. Depending on the morphological type cells it takes from several months to several decades. Clinical manifestations of the disease are caused by inhibition of hematopoiesis.

At the initial stage of leukemia, there are no clinical symptoms. Anemia is rare, but a change in the number of leukocytes in one direction or another and slight thrombocytopenia may be observed.

Based on these signs, it is impossible to unambiguously diagnose developing leukemia, but often, in the absence of other reasons for anemia, a hematologist can refer the patient for a puncture of bone marrow tissue. Analysis of hematopoietic tissue gives an unambiguous result: with a diagnosis of “acute leukemia”, a large number of blast (immature) cells are found in the hematopoietic tissue.

Despite the theoretical possibility of diagnosing more early stage, most often acute leukemia is detected at an advanced (clinical) stage.

In some forms of acute leukemia, symptoms do not appear, but characteristic changes in blood composition are noticeable (decrease in the number of reticulocytes, erythrocytes, platelets, increase in ESR, presence of blasts and disappearance of eosinophils, basophils, mature and transitional forms of leukocytes).

The state of remission characterizes the complete disappearance of clinical symptoms of the disease. With complete remission, the absence of blasts in the peripheral blood is complemented by a low number of blasts in the bone marrow tissue (no more than 5%), and with incomplete remission, the number of immature cells against the background of hematological improvement remains high.

Relapse of acute leukemia is possible not only in the hematopoietic system, but also outside it. Each subsequent clinical manifestation of leukemia is prognostically more dangerous for the patient.

At the terminal stage of the disease, there is a final inhibition of blood cell production, resistance to antitumor therapy and the development of necrotic processes in the body.

Symptoms of acute leukemia

The symptoms of acute leukemia create a characteristic clinical picture, so at an advanced stage of the disease an unambiguous diagnosis is possible. There are several syndromes that can occur with this disease:

• anemic (associated with sharp drop number of red blood cells);
• hemorrhagic (caused by a decrease in the number of platelets by 4-5 times relative to the norm);
• intoxication;
• proliferative or hyperplastic (associated with the spread of clones of immature cells in peripheral blood and internal organs);
• osteoarticular.

Symptoms of acute leukemia

Symptoms in adults and children are not fundamentally different. The manifestation of leukemia is most often similar to the manifestations of viral diseases (fever, chills, sweating). This is due to the fact that the patient’s blood does not contain mature cells of the immune system that can destroy the infection.

Frequent ARVI, exacerbation chronic infections and the appearance of new ones (pneumonia, pyelonephritis, herpes, etc.) against the background of anemia and bleeding of the mucous membrane are an early diagnostic sign of leukemia.

Diagnosis of the disease

Diagnosis of leukemia consists of three stages: monitoring changes in the patient’s blood composition, studying the ratio of hematopoietic cells and blasts in the blood and bone marrow tissue, as well as general research body.

IN general analysis blood in acute leukemia reveals changes such as:

• decrease in hemoglobin, the number of reticulocytes and erythrocytes by 2-3 times compared to the norm (the number of red blood cells can be up to 1.0-1.5 * 10 9 / ml with a norm of 3.6-5.0 * 10 9 / ml);
• thrombocytopenia (the number of platelets can drop by an order of magnitude or more - up to 20 * 10 9 / l when the norm is 180-320 * 10 9 / l);
• change in the total number of leukocytes, fixation of different sizes of white blood cells;
• leukemic failure (a small number of mature and transitional leukocytes - neutrophils, eosinophils, basophils, monocytes, lymphocytes in the presence of blasts);
• increased ESR.

A dynamic study is necessary not only to exclude errors in diagnosis, but also to monitor the rate of displacement of normal hematopoietic cells by blasts.

Despite the fact that leukemia has a number of characteristic clinical signs, the main method of diagnosing the disease is the study of a fragment of bone marrow, which is obtained by puncture of the sternum or trepanobiopsy of the ilium. Cytochemical analysis (staining a smear with reagents) allows you to differentiate cells, and clarifying immunophenotyping allows you to finally establish the type of tumor clone.

In acute leukemia, the proportion of blasts usually exceeds 20%, the red germ of hematopoiesis is suppressed (the exception is cases of erythroblastic leukemia), megakaryocytes are absent or significantly reduced (the exception is megakaryoblastic leukemia). The number of lymphocytes in the hematopoietic tissue in leukemia is usually increased.

With vague symptoms and at the initial stage of the disease, there is a need for differential diagnosis, which is aimed at excluding mononucleosis, thrombocytopenic purpura, HIV infection, leukemoid reactions to severe systemic infections, etc. The results of a myelogram make it possible to unambiguously determine the disease.

General diagnostics with ECG, ultrasound, x-ray of internal organs, as well as spinal tap carried out to determine the degree of damage to the body by blast infiltration.

Treatment of acute leukemia

Treatment of acute leukemia can be done in several ways, depending on the stage of the disease, the degree of damage to internal organs and the patient’s health condition. There are two main methods of treatment for leukemia:

• chemotherapy with several cytostatics;
• bone marrow transplantation (BMT).

Additionally, in the presence of foci of disease outside the bone marrow, irradiation of the affected organ (including the brain in neuroleukemia) and endolumbar administration of cytostatic solutions are performed.

When diagnosed with acute leukemia, treatment is aimed at destroying blasts, i.e. in fact, the patient’s body is left without the ability to protect against infectious agents and with an abnormally low number of red blood cells and platelets. To a large extent, the patient’s survival depends on maintaining sterile conditions and timely administration of antibiotics.

To compensate for anemia and thrombocytopenia, the patient is given a transfusion of blood components. Additional therapy is also aimed at reducing intoxication of the body.

TCM is considered the most effective treatment for acute leukemia. Transplantation of healthy stem cells helps restore normal hematopoiesis to the patient. However, due to difficulties in finding donors and many contraindications to surgery, bone marrow transplantation is possible in a very small proportion of cases.

BMT is performed only upon complete remission (usually the first) and after intensive immunosuppressive therapy. Engraftment of allogeneic bone marrow guarantees a sharp reduction in the chances of relapse.

Acute leukemia is a serious and aggressive disease. However, modern treatment methods can practically guarantee the patient's survival for at least several years after the end of therapy. Timely diagnosis and careful patient care play an important role in the success of treatment.