Chronic lymphocytic leukemia is a disease in which the body produces an excessive amount of white blood cells. A similar disorder develops mainly in people after 60 years. The disease develops very slowly and may show no symptoms for the first few years.
Lymphocytic leukemia is distinguished by the degree of maturity of malignant cells. In the course of such a pathology, the primary is the damage to the bone marrow, and the nutritional basis for this is the leukocytes developing in it.
The cause of the disease is still unknown. Many doctors believe that the disease is genetic in nature. It is important to recognize the course of the disease in a timely manner, to carry out diagnostics and subsequent treatment.
Features of the disease
Lymphocytes are a type of leukocytes that belong to the functional element of immunity. He althy lymphocytes degenerate into a plasma cell and produce immunoglobulins. These antibodies are eliminatedpoisonous, pathogenic microorganisms, alien to the human body.
Chronic lymphocytic leukemia (ICD-10 code - C91.1) is a tumor disease of the circulatory system. During the course of the disease, leukemic lymphocytes continuously multiply and accumulate in the bone marrow, spleen, blood, liver, and lymph nodes. It should be noted that the higher the rate of cell division, the more aggressive the pathology.
Chronic lymphocytic leukemia is a disease that mainly affects the elderly. Often the disease develops very slowly and almost asymptomatically. It is found quite by accident during a study of a general blood test. In appearance, abnormal lymphocytes do not differ from normal ones, however, their functional significance is impaired.
Patient resistance to pathogens decreases. The cause of the disease is not yet fully known, but exposure to viruses and genetic predisposition are considered aggravating factors.
Flow Stages
To select the most optimal methods of treatment, as well as to determine the prognosis of the course of the disease, there are several stages of chronic lymphocytic leukemia. At the very beginning of the development of the disease, only lymphocytosis is determined in the laboratory in the blood. On average, patients with this stage live more than 12 years. The degree of risk is considered minimal.
At stage 1, an increase in lymph nodes joins lymphocytosis, which can be determined palparously or instrumentally. Average durationlife is up to 9 years, and the degree of risk is intermediate.
In the course of stage 2, in addition to lymphocytosis, when examining a patient, splenomegaly and hepatomegaly can be determined. On average, patients live up to 6 years.
At stage 3, hemoglobin drops sharply, and there is also a steady lymphocytosis and an increase in the size of the lymph nodes. The life expectancy of the patient is up to 3 years.
When the 4th degree proceeds, thrombocytopenia joins all these manifestations. The risk in this case is very high, and the average life expectancy of patients is less than a year and a half.
Disease classification
Chronic lymphocytic leukemia (ICD-10 code - C91.1) is divided into several groups, based on what kind of blood cells began to multiply very quickly and almost uncontrollably. It is by this parameter that the disease is divided into:
- megakaryocytic leukemia;
- monocyte;
- myeloid leukemia;
- erythromyelosis;
- macrophage;
- lymphocytic leukemia;
- erythremia;
- mast cell;
- hairy cell.
A benign chronic lesion is characterized by a slow increase in leukocytosis and lymphocytes. The increase in lymph nodes is insignificant and there is no anemia and signs of intoxication. The patient's condition is quite satisfactory. Special treatment is not required, the patient is only recommended to observe a rational regime of rest and work, to consume he althy food rich in vitamins. Recommendedgive up bad habits, avoid hypothermia.
Progressive form of chronic lymphocytic leukemia refers to the classic and is characterized by the fact that the increase in the number of leukocytes occurs regularly, every month. Lymph nodes gradually increase and signs of intoxication are observed, in particular, such as:
- fever;
- weakness;
- weight loss;
- excessive sweating.
With a significant increase in the number of leukocytes, specific chemotherapy is prescribed. With proper treatment, it is possible to achieve a long-term remission. The tumor form is characterized by the fact that leukocytosis in the blood is insignificant. In this case, there is an increase in the spleen, lymph nodes, tonsils. For treatment, combined courses of chemotherapy are prescribed, as well as radiation therapy.
Splenomegalic type of chronic lymphocytic leukemia (according to ICD-10 - C91.1) is characterized by moderate leukocytosis, slightly enlarged lymph nodes, and large spleen. Radiation therapy is prescribed for treatment, and in severe cases, removal of the spleen is indicated.
The bone marrow form of chronic lymphocytic leukemia is expressed in a slight increase in the spleen and lymph nodes. Blood tests reveal lymphocytosis, a rapid decrease in platelets, red blood cells, and he althy white blood cells. In addition, there is increased bleeding and anemia. For treatment, a course of chemotherapy is prescribed.
Prolymphocytic type of chronic lymphocytic leukemia (according to ICD-10 - C91.3) is characterized by the fact that in patientsthere is increased leukocytosis with a significant increase in the spleen. She does not respond well to standard treatment.
The hairy cell type of the disease is a special form in which leukemic pathological lymphocytes have characteristic features. During its course, the lymph nodes do not change, the liver and spleen increase, and patients suffer from various infections, bone damage and bleeding. The only treatment is removal of the spleen and chemotherapy.
Main symptoms
Chronic blood lymphocytic leukemia develops over a long period, and symptoms may not appear for a long time, only blood counts change. Then gradually there is a decrease in the level of iron, resulting in signs of anemia. The initial signs can also become a manifestation of leukemia, but often they go unnoticed. Among the main signs, one can distinguish such as:
- pallor of skin and mucous membranes;
- weakness;
- sweating;
- dyspnea on exertion.
In addition, the temperature may rise and rapid weight loss can begin. A large number of lymphocytes affect the bone marrow and gradually settle in the lymph nodes. It is worth noting that the lymph nodes are significantly enlarged and remain painless. Their consistency is somewhat reminiscent of soft dough, and sizes can reach 10-15 cm. Lymph nodes can squeeze vital organs, provoking cardiovascular and respiratoryfailure.
Together with the lymph nodes, the spleen begins to increase in size, and then the liver. These two organs generally do not grow to a significant size, but there may be exceptions.
Chronic lymphocytic leukemia provokes various kinds of immune disorders. Pathological leukemic lymphocytes cease to fully produce antibodies, which become insufficient for the body to resist pathogens and various infections, the frequency of which increases sharply. The respiratory organs are often affected, resulting in severe bronchitis, pleurisy and pneumonia.
Urinary tract infections or skin lesions are not uncommon. Another consequence of a decrease in immunity is the formation of antibodies to one's own red blood cells, which provokes the development of hemolytic anemia, which manifests itself in the form of jaundice.
Diagnostics
To make a diagnosis of chronic lymphocytic leukorrosis, a blood test is done first. At the initial stage of the pathology, the clinical picture may change somewhat. The severity of leukocytosis largely depends on the stage of the course of the disease.
Also, in the course of chronic lymphocytic leukemia, blood tests reveal a lack of red blood cells and hemoglobin. Such a violation can be triggered by their displacement by tumor cells from the bone marrow. The level of platelets in the initial stages of the course of the disease often remains withinnorms, however, as the pathological process develops, their number decreases.
To confirm the diagnosis, examination methods such as:
- biopsy of the affected lymph node;
- bone marrow puncture;
- determination of the level of immunoglobulins;
- cellular immunophenotyping.
Cellular analysis of blood and bone marrow allows you to determine the immunological markers of the disease in order to exclude the course of other diseases and make a prognosis regarding its course.
Features of treatment
Unlike many other malignant processes, chronic lymphocytic leukemia is not treated at the initial stage. Basically, therapy begins when signs of progression of the disease occur, which include such as:
- rapid increase in the number of abnormal leukocytes in the blood;
- significant growth of lymph nodes;
- progression of anemia, thrombocytopenia;
- enlargement of the spleen in size;
- appearance of signs of intoxication.
The method of therapy is selected purely individually, based on accurate diagnostic data and patient characteristics. Basically, therapy is aimed at eliminating complications. By itself, this disease is still incurable.
Chemodrugs are used in minimal dosages of toxic substances and are often prescribed to prolong the patient's life and get rid of unpleasant symptoms. Patientsshould always be under the strict supervision of a hematologist-oncologist. A blood test should be performed 1-3 times over 6 months. If necessary, special supportive cytostatic therapy is prescribed.
Conservative Therapy
Treatment of chronic lymphocytic leukemia is carried out after identifying all possible complications, establishing the form, stage and diagnosis. Diet compliance and drug therapy are shown. If the disease is severe, a bone marrow transplant is required, as this is the only possible way to achieve a complete cure.
At the very beginning of the course of the disease, dispensary observation is indicated, and if necessary, the doctor prescribes antibacterial drugs. When an infection is attached, antiviral and antifungal agents are required. In the following months, a course of chemotherapy is indicated, aimed at the rapid removal of cancer cells from the body. Radiation therapy is used when you need to quickly reduce the size of the tumor and there is no way to treat it with chemotherapy drugs.
Medication use
Reviews of chronic lymphocytic leukemia in fifty percent of cases are positive, because due to proper treatment, the patient's well-being can be normalized. Many patients say that with chemotherapy in the initial stages, life can be significantly extended and its quality improved.
In the absence of concomitant diseases, if the patient's age is under 70 years, mainly applya combination of drugs such as Cyclophosphamide, Fludarabine, Rituximab. In case of poor tolerance, other drug combinations may be used.
For the elderly or in the presence of concomitant diseases, more sparing combinations of drugs are prescribed, in particular, Obinutuzumab with Chlorambucil, Rituximab and Chlorambucil or Cyclophosphamide with Prednisolone. With a steady course of disorders or relapse, patients can change the regimen of therapy. In particular, it can be a combination of Idelalisib and Rituximab.
Very debilitated patients with severe comorbidities are prescribed mainly monotherapy, in particular drugs that are relatively well tolerated. For example, such as Rituximab, Prednisolone, Chlorambucil.
Features of food
All patients with chronic lymphocytic leukemia need a rational distribution of rest and work, as well as proper nutrition. The usual diet should be dominated by animal products, and fat intake should also be limited. Be sure to consume fresh fruits, herbs, vegetables.
With anemia, foods high in iron will be useful to normalize hematopoietic factors. Liver should be regularly added to the diet, as well as vitamin teas.
Prognosis for the patient
For most patients suffering from this disorder, the prognosis aftertherapy is good enough. At the initial stage of the course of chronic lymphocytic leukemia, life expectancy is more than 10 years. Many can do without special treatment. Despite the fact that the disease is incurable, the initial stage can continue for a long time. Treatment often leads to sustained remission. Only the attending doctor can give a more accurate forecast.
There are many modern techniques for treatment. Newer, more advanced drugs and therapies are emerging all the time. New drugs that have been introduced in the past few years are helping to significantly improve treatment outcomes.
There is no specific prevention of lymphocytic leukemia. Self-medication can only significantly aggravate the situation and can be deadly for the patient.
