Acute leukemia is a malignant disease affecting the bone marrow, the hematopoietic organ. The anomaly manifests itself in the mutation of bone marrow stem cells and the appearance of immature lymphoid cells called lymphoblasts. There is a decrease in platelets, leukocytes and erythrocytes in the blood. With the progression of the disease, immature cells enter other organs and tissues. Leukemic infiltration of lymph nodes, mucous membranes, spleen, liver, brain, etc. occurs. Leukemia, in which hyperplastic syndrome most often occurs, mainly affects children from two to five years old. According to statistics, the incidence in boys is higher than in girls. Adults are more affected by the disease after 60 years.
Clinical Syndromes
Various anomalies of the hematopoietic system in the body of an individual are manifested by various symptoms and syndromes. In some cases, it is impossible to separate the main and secondary complaints of the patient, therefore, in hematologicalpatients, it is reasonable to talk about a group of signs of a common origin or syndromes instead of symptoms:
- hyperplastic;
- anemic;
- hemorrhagic;
- infectious-toxic.
Causes of leukemia
One of the priority areas of medical science is the study of problems associated with leukemia. However, despite ongoing research, scientists have not yet identified the exact causes of leukemia. Only the factors contributing to its development have been identified. These include:
- Hereditary predisposition. Statistical data show that close relatives in several generations suffer from leukemia.
- Exposure to carcinogens. Toxic substances: insecticides, fertilizers, petroleum products, as well as some medications (penicillin antibiotics and cephalosporins) negatively affect the body of an individual.
- Infectious and viral diseases sometimes cause he althy cells to mutate, and adult symptoms of acute leukemia can suddenly appear.
- Chromosomal abnormalities.
- Radioactive exposure that causes abnormal degeneration of he althy cells.
- Severe congenital pathologies: Wiskott-Aldrich syndrome, Down syndrome.
- Chemotherapy. Carrying it out to treat other diseases in some cases provokes the development of leukemia.
- Systematic smoking.
These factors only contribute to the onset of the disease, but the disease develops andin their absence.
Clinical signs of leukemia
Common symptoms of acute leukemia in adults:
- Intoxication syndrome. It is characterized by general malaise, weakness, weight loss, fever. The latter may occur with the presence of a viral, bacterial or fungal infection in the body.
- Hemorrhagic syndrome. There are hemorrhages on the dermis and mucous membranes, vomiting with blood and tarry stools.
- Hyperplastic syndrome. All lymph nodes that are accessible to inspection and palpation are enlarged. They become dense, mobile, but painless even at high magnification. The spleen and liver become inflamed and enlarged, and pain in the abdomen occurs. As a result of infiltration of the joint capsule and periosteum, as well as a bone marrow tumor, pain and aching in the bones appear.
- Anemic syndrome. As a result of intoxication, the skin becomes pale, bluish-red plaques appear, with slight damage to the dermis, panaritiums and paronychia occur, ulcerative-necrotic changes appear in the oral cavity, and tachycardia torments.
- Respiratory disorders. Enlargement of mediastinal lymph nodes leads to compression of the bronchi and respiratory failure.
- Changes in the organs of vision. Swelling of the optic nerve occurs, hemorrhage appears in the retina of the eye, leukemic plaques on the fundus are possible.
Diagnosis of leukemia
To make a diagnosis you need:
- take a complete medical history;
- examine the patient, makepalpation of the lymph nodes, liver and spleen;
- general blood test - the number of platelets, erythrocytes and leukocytes is determined, abnormally altered blood cells are detected;
- chest x-ray - determine the increase in peripheral lymph nodes in the chest cavity, changes in the thymus gland and the condition of the lungs;
- aspiration and bone marrow biopsy;
- microscopic examination for the detection of malignant cells;
- spinal puncture - the presence of cancer cells is determined;
- CT - on the computer screen they look at the state of internal organs;
- MRI - allows you to get pictures of organs and tissues;
- Ultrasound - Ultrasound is performed to confirm enlargement of the liver and spleen.
Based on a comprehensive examination, a diagnosis is made and treatment of the patient is prescribed.
Stages of the course of the disease
There are three stages in the course of leukemia:
- Initial - signs of leukemia are mild. They manifest themselves in mild fatigue and drowsiness. The disease is discovered by chance during preventive examinations or the diagnosis of other diseases that begin to worsen during this period. The main blood parameters in the laboratory study may be slightly changed, the size of the liver is normal.
- Expanded - various organs are affected, so the symptoms are pronounced. During this period, there is an alternation of exacerbations and remissions. Leukemia ends with recovery ora significant deterioration in all indicators.
- Terminal - the treatment turned out to be ineffective, the hematopoietic system is strongly depressed, ulcerative and necrotic changes occur. The stage ends with the death of the patient.
Toddler leukemia
Acute leukemia in children occurs and develops very quickly. The number of lymphoblastss is growing rapidly, which affects the well-being of the child. He becomes lethargic, complains of nausea and headaches. In the evening, the temperature rises to 38 degrees and above, although there are no symptoms of a cold. When bathing, parents may notice the appearance of hematomas and bruises on the body. This symptom should alert if the baby did not fall during the game. Symptoms of the disease are expressed by exacerbations of chronic diseases or the long course of diseases such as pneumonia, bronchitis, pharyngitis, tonsillitis. They are difficult to treat, the child is forced to take medication for a long period, undermining the strength of an already weakened body. In addition, hyperplastic syndrome is manifested in acute leukemia, expressed by a rapid increase in lymph nodes.
At the onset of the disease, the cervical are more often inflamed, then the submandibular, supraclavicular and axillary are involved. Lymph nodes increase all the time, but do not have pain, and over time can cause compression of the bronchi, superior vena cava, bile duct. And also there is a rapid increase in the size of organs such as the spleen and liver, which are easily palpated and protrude from under the ribs. Sometimes children experience gastric, rectal and nasal prolonged and voluminous bleeding. Acute leukemia is most common in children, so parents should be very attentive to the child's he alth and pay attention to all his ailments and complaints.
Treatment of disease in children
When leukemia is confirmed, the child is hospitalized in the hematology or oncology department of a specialized clinic. As a result of treatment, you need:
- destroy damaged cells;
- provide supportive care;
- to prevent the occurrence of infectious diseases;
- replenish the lack of platelets and red blood cells.
The duration of hospital treatment for each child is determined individually and consists of:
- chemotherapy - various combinations of cytostatic drugs are used;
- radiotherapy – tailored to a specific patient;
- bone marrow transplantation – possible after high dose drug therapy.
Treatment tactics are determined by:
- number of blast cells;
- possibility of relapse;
- disease stage.
There are international recommendations (protocols) for the treatment of leukemia. For the treatment of a child, a long-term program is drawn up according to the protocol with a clear prognosis of survival, the intensity of the course is directly dependent on the riskdisease recurrence. Without a bone marrow transplant, treatment for leukemia lasts approximately two years. During this period, inpatient treatment is replaced by outpatient treatment several times.
Steps of therapy
According to international recommendations, the treatment of childhood leukemia consists of the following steps:
- Preliminary - during this period, the patient is prepared for the main course. To do this, a short course of chemotherapy is done to reduce the number of leukemic cells and prevent kidney failure.
- Inductive - carried out for the onset of remission. Therapy is used, enhanced with several drugs and lasting from one and a half to two months.
- Time of consolidation with intensive therapy - the achieved remission is consolidated when the normal size of the liver is established and the lymph nodes are reduced. The development of a tumor on the brain and spinal cord is prevented. During this period, if necessary, radiation is applied and cytostatics are injected into the canal of the spinal cord.
- Repeated combination - various combinations of potent drugs are administered, conducting separate courses. The period can last up to several months. The goal is to destroy the blast cells.
- Maintenance care – performed on an outpatient basis. The child can attend kindergarten or school. Drug dosage is kept to a minimum.
The use of protocols improves the effectiveness of treatment, experience is accumulating in preventing complications and identifying side effects of drugs.
Differential diagnosishyperplastic syndrome
Manifestations of this syndrome should be differentiated from:
- Vincent's ulcerative necrotic stomatitis;
- hypertrophic gingivitis of other etiology;
- reactions in severe bacterial infections;
- infectious mononucleosis;
- poisoning the body with heavy metals;
- hypovitaminosis C.
In all these cases, there are no markers of leukemia in the blood test and myelogram. In doubtful situations, a bone marrow study is performed, in some cases a multizonal one, when a substance is taken for analysis from three points.
Treatments for adult leukemia
After the diagnosis, treatment begins immediately, which is carried out in oncological hematology centers according to established drug prescribing regimens. The main task is to restore he althy hematopoiesis, long-term remission, prevention of relapse. To select a treatment regimen, the age of the patient, his individual characteristics and the number of white cells in the blood are taken into account. The main treatments consist of:
- Chemotherapy - combined cytostatic drugs are administered intravenously. Therapy is carried out in courses, taking into account the weight of the patient and the level of blood mutation. A new type of chemotherapy is being used with the drugs Imatinib and Herceptin, which inhibit the growth of unhe althy cells.
- Biological reception - drugs are used to maintain the body's defenses and reduce hyperplasticsyndrome.
- Radiation method - use the effect of radiotherapy on the bone marrow under CT control.
- Surgical way - bone marrow transplantation is prescribed during remission of the disease. Chemotherapy and irradiation of the damaged area are preliminarily performed. This method is considered very effective and is carried out with complete remission of the disease.
Prognosis for leukemia
The following factors influence the forecast:
- a type of leukemia;
- age of patient;
- features of the disease;
- individual response to chemotherapy.
Children with leukemia have a significantly better prognosis than adults. This is due to the fact that the drugs used for treatment cause fewer adverse reactions in children. In addition, older people have many comorbidities that do not allow full chemotherapy. And adults in most cases go to the doctor with an advanced form of the disease, when leukemic hyperplasia is pronounced. According to medical statistics, the five-year survival rate for acute leukemia in children is up to 85%, and in adults - only up to 40%. This is a serious but curable disease. Modern treatment protocols give high efficiency. It should be noted that after a five-year remission, relapses of the disease never occur.
Conclusion
Acute leukemia is a rapidly progressive form of cancer of the hematopoietic tissue of the bone marrow. Stem cells mutate and spread throughout the body, causing symptoms of the disease. He althy cells are being squeezed outchanged, with dire consequences.
At the same time, the production of he althy cells also decreases, since the presence of a tumor promotes the synthesis of substances that inhibit their growth. This pathology proceeds with damage to the bone marrow, spleen, liver, thymus gland and peripheral lymph nodes.
