Acute monoblastic leukemia. Acute monocytic leukemia. Treatment of chronic lymphocytic leukemia

Acute leukemia is a cancer of the blood, in which the formed elements of the blood are gradually replaced by immature blast cells.

This is the most common form of hemoblastoses. It occurs in 3 people per hundred thousand of the population, and, according to statistics, adults get sick three times more often than children.

Types of acute leukemia

The international FAB classification differentiates acute leukemias according to the type of tumor cells into two large groups- lymphoblastic and non-lymphoblastic. In turn, they can be divided into several subspecies:

1. Acute lymphoblastic leukemia:

Pre-Form

Pre-T-shape

Other or neither T nor B-shape

2. Acute non-lymphoblastic or, as they are also called, myeloid leukemias:

Acute myeloid disease, which is characterized by the appearance of a large number of precursors of granulocytes

Acute monoblast and acute myelomonoblastic, which are based on the active reproduction of monoblasts

Acute megakaryoblastic - develops as a result of active reproduction of platelet precursors, the so-called megakaryocytes

Acute erythroblast, characterized by an increase in the level of erythroblasts

3. separate group is acute undifferentiated leukemia

Symptoms of acute leukemia

Acute myeloid leukemia

Acute myeloid leukemia is characterized by a slight enlargement of the spleen, heat body and damage to internal organs.

So, for example, with leukemic pneumonitis, the focus of infiltration and inflammation is located in the lungs, causing characteristic symptoms- cough and fever.

Every fourth patient with myeloid leukemia has leukemic meningitis with severe headaches, fever, chills, and neurological symptoms.

At a severe stage of the course of the process, leukemic infiltration of the kidneys can develop, leading to serious kidney failure up to complete urinary retention.

Specific leukemids appear on the skin - pink or light brown formations, the liver enlarges and becomes dense.

When the intestines are affected, there is bloating, liquefaction of the stool, severe, unbearable pain appears. AT severe cases ulcers are formed, cases of perforation are possible.

Acute lymphoblastic leukemia

This variant of the disease is characterized by an enlarged spleen and lymph nodes. Usually, pathological process fixed in the supraclavicular region, first on one side, and then on both. Lymph nodes are dense, painless, with compression of neighboring organs, characteristic symptoms may occur.

For example, with an increase in lymph nodes in the mediastinum, a cough may appear, as well as respiratory failure in the form of shortness of breath. Damage to the mesenteric nodes abdominal cavity leads to abdominal pain. Men may experience hardening and pain in the ovaries, most often on one side.

Acute erythromyeloblastic leukemia

In acute erythromyeloblastic leukemia, anemic syndrome- a pronounced decrease in the level of erythrocytes and hemoglobin in the blood, manifested by weakness, pallor and increased fatigue.

Stages of acute leukemia

Oncologists distinguish five stages of the disease, occurring with characteristic symptoms:

initial stage acute leukemia

This period often proceeds hidden, without pronounced clinical manifestations. It lasts from several months to several years - at this time the pathological process is just beginning, the level of leukocytes changes slightly (and their number can either increase or decrease), appear immature forms and anemia develops.

A blood test at this stage is not as informative as a study bone marrow, which makes it possible to identify a large number of blast cells.

Advanced stage of acute leukemia

At this stage, there true symptoms diseases caused by inhibition of hematopoietic processes and the appearance of a large number of immature cells in the peripheral blood.

In the advanced stage of acute leukemia, two variants of the course of the disease can be distinguished:

The patient feels satisfactory, there are no complaints, but at the same time, characteristic signs of leukemia are found in the blood test.

The patient has a significant deterioration in well-being, but without pronounced changes from peripheral blood

Remission

Remission, that is, a period of subsiding exacerbation, can be complete and incomplete.

Complete remission is characterized by the absence of symptoms of the disease, as well as blast cells in the blood. In the bone marrow, the level of immature cells should not exceed 5%.

With incomplete remission, the patient may feel relieved and feel better, but the level of blast cells in the bone marrow remains elevated.

relapse

Relapses of acute leukemia can occur directly in the bone marrow, as well as outside it.

terminal stage

This stage characterized large quantity immature leukocytes in the peripheral blood and is accompanied by inhibition of the function of all vital important organs. Most often ends in death.

Diagnosis of acute leukemia

The doctor may suspect the diagnosis of "acute leukemia" by changes in the blood test, but the key criterion is an increase in blast cells in the bone marrow.

Changes in peripheral blood count

In most cases with acute leukemia, patients develop anemia with a sharp decrease in the level of red blood cells and hemoglobin. There is also a drop in the level of platelets (it is restored in the remission stage and falls again with an exacerbation of the pathological process).

As for leukocytes, a twofold picture can be observed - both leukopenia, that is, a decrease in the level of leukocytes, and leukocytosis, that is, an increase in the level of these cells. As a rule, pathological blast cells are also present in the blood, but in some cases they may be absent, which does not exclude leukemia.

Leukemia, in which a large number of blast cells are fixed in the blood, is called "leukemic", and leukemia with the absence of blast cells is called "alukemia".

Changes in the red bone marrow

The study of red bone marrow is the most important criterion for the diagnosis of acute leukemia.

The disease is characterized by a specific picture - an increase in the level of blast cells and inhibition of the formation of red blood cells.

Another important diagnostic technique is a trephine biopsy. Bone sections are sent for biopsy, which in turn allows the detection of blastic hyperplasia of the red bone marrow to confirm the disease.

Criteria for the diagnosis of acute leukemia:

30% or more of all cellular elements red bone marrow accounts for blasts

The level of erythrokaryocytes is more than 50%, blasts - not less than 30%

In acute promyelocytic leukemia, specific hypergranular atypical promyelocytes appear in the bone marrow.

Treatment of acute leukemia

The treatment regimen for acute leukemia depends on the age and condition of the patient, the type and stage of development of the disease, and is always calculated individually in each case.

There are two main types of therapy for acute leukemia - chemotherapy and surgical treatment- bone marrow transplantation.

Chemotherapy consists of two consecutive stages:

The task of the first stage is the induction of remission. With the help of chemotherapy, oncologists achieve a decrease in the level of blast cells

The consolidation phase required to destroy the remaining cancer cells

Reinduction, as a rule, completely repeats the scheme (drugs, dosages, frequency of administration) of the first stage

In addition to chemotherapy drugs, general scheme Treatments include cytostatics.

Statistically, total duration chemotherapy treatment for acute leukemia is about 2 years.

Chemotherapy in combination with cytostatics is an aggressive method of exposure, causing a number of side effects(nausea, vomiting, deterioration of health, hair loss, etc.). In order to alleviate the patient's condition, concomitant therapy is prescribed. In addition, depending on the condition, antibiotics, detoxification agents, platelet and erythrocyte mass, and blood transfusion may be recommended.

Bone marrow transplant

Bone marrow transplantation provides the patient with healthy stem cells, which later become the progenitors of normal shaped elements blood.

The most important condition for transplantation - complete remission of the disease. It is important that the bone marrow cleaned of blast cells is refilled with healthy cells.

In order to prepare the patient for surgery, special immunosuppressive therapy is carried out. This is necessary for the destruction of leukemia cells and suppression defensive forces organism to reduce the risk of transplant rejection.

Contraindications for bone marrow transplantation:

Violations of the functioning of internal organs

Acute infectious diseases

Relapse of acute leukemia that does not go into remission

Elderly age

Disease prognosis

According to statistics, the prognosis in children with acute leukemia is better than in adults. So, children's survival for 5 years is 65 - 85%, adult - from 20 to 40%.

Acute myeloid leukemia is potentially more dangerous, in his case five-year survival in patients under 55 years of age is 40-60%, and in the elderly only 20%.

• Acute leukemia- these are rapidly progressive diseases that develop as a result of a violation of the maturation of blood cells (white bodies, leukocytes) in the bone marrow, cloning of their precursors (immature (blast) cells), the formation of a tumor from them and its growth in the bone marrow, with possible further metastasis ( spread with the blood or lymph flow of tumor cells in healthy organs).
• Chronic leukemia differ from acute ones in that the disease proceeds for a long time, pathological production of precursor cells and mature leukocytes occurs, disrupting the formation of other cell lines (erythrocyte line and platelet line). A tumor is formed from mature and young blood cells.

Anatomy and physiology of the bone marrow

red blood cells- These are red blood cells, contain hemoglobin, oxygen is fixed on it, with the help of which the cells of the body feed. With a lack of red blood cells, insufficient saturation of the cells and tissues of the body with oxygen occurs, as a result of which it manifests itself in various clinical symptoms.

Leukocytes these include: lymphocytes, monocytes, neutrophils, eosinophils, basophils. They are white blood cells, they play a role in protecting the body and developing immunity. Their deficiency causes a decrease in immunity and the development of various infectious diseases.
Platelets are platelets that are involved in the formation of a blood clot. A lack of platelets leads to various bleeding.
Read more about the types of blood cells in a separate article by clicking on the link.

Causes of leukemia, risk factors

• Ionizing radiation: doctors exposed to radiologists, after the atomic bombing, radiation therapy, ultraviolet radiation;
• Chemical carcinogens: toluene, is a part of paints, varnishes; pesticides are used in agriculture; arsenic is found in metallurgy; some medications, for example: Chloramphenicol and others;
• Some types of viruses: HTLV (T - human lymphotropic virus);
• Household factors: car exhausts, additives in various food products, smoking;
• Hereditary predisposition to cancer;
• Mechanical damage fabrics.

Symptoms of various types of leukemia

1. For acute leukemia 4 clinical syndromes are noted:

• anemic syndrome: develops due to a lack of red blood cell production, many or some of the symptoms may be present. It manifests itself in the form of fatigue, pallor of the skin and sclera, dizziness, nausea, fast heartbeat, brittle nails, hair loss, pathological perception of smell;
• Hemorrhagic syndrome: develops as a result of a lack of platelets. Manifested the following symptoms: initially bleeding from the gums, bruising, hemorrhages in the mucous membranes (tongue and others) or in the skin, in the form small dots or spots. In the future, with the progression of leukemia, massive bleeding also develops, as a result DIC syndrome(disseminated intravascular coagulation);
• Syndrome of infectious complications with symptoms of intoxication: develops as a result of a lack of leukocytes and with a subsequent decrease in immunity, an increase in body temperature up to 39 0 C, nausea, vomiting, loss of appetite, a sharp decline weight, headache, general weakness. The patient joins various infections: flu, pneumonia, pyelonephritis, abscesses, and others;
• Metastases - Through the flow of blood or lymph, tumor cells enter healthy organs, disrupting their structure, functions and increasing their size. First of all, metastases enter the lymph nodes, spleen, liver, and then to other organs.

Diagnosis of leukemia

• Decreased hemoglobin level (normal 120g/l);
• Decrease in the level of erythrocytes (norm 3.5-5.5 * 10 12 / l);
• Low platelets(norm 150-400 * 10 9 / l);
• Reticulocytes (young red blood cells) level decreases or absent (normal 02-1%);
• Blast (young) cells> 20% in acute leukemia, and in chronic it may be less (normal up to 5%);
• Changes in the number of leukocytes: in 15% of patients with acute leukemia increases >100*10 9 /l, the rest of the patients may have a moderate increase or even decrease. The rate of leukocytes - (4-9 * 10 9 / l);
• Reduction in the number of neutrophils (normal 45-70%);
• Absence of stab leukocytes, eosinophils and basophils;
• Increased ESR (normal 2-12mm / h).

1. Blood chemistry: non-specific method, indicates a change in indicators as a result of damage to the liver, kidneys:

• An increase in the level of lactate dehydrogenase (normal 250 U / l);
• High ASAT (norm up to 39 U / l);
• High urea (norm 7.5 mmol / l);
• Raise uric acid(norm up to 400 µmol/l);
• Increase in bilirubin ˃20 µmol/l;
• Decreased fibrinogen
• Decreased total protein
• Decrease in glucose ˂ 3.5 mmol/l.

1. Myelogram (analysis of bone marrow punctate): is the method of choice for confirming acute leukemia

• Blasts (young cells) >30%;
• Low level erythrocytes, leukocytes, platelets.

1. Trepanobiopsy ( histological examination iliac bone biopsy): does not allow for an accurate diagnosis, but only determines the growth of tumor cells, with the displacement of normal cells.
2. Cytochemical study of bone marrow punctate: reveals specific enzymes of blasts (reaction to peroxidase, lipids, glycogen, nonspecific esterase), determines the variant of acute leukemia.
3. Immunological research method: detects specific surface antigens on cells, determines the variant of acute leukemia.
4. Ultrasound of the internal organs: non-specific method, reveals enlarged liver, spleen and other internal organs with metastases of tumor cells.
5. x-ray chest: is a non-specific method, detects the presence of inflammation in the lungs when an infection is attached and enlarged lymph nodes.

Leukemia treatment

Medical treatment

1. polychemotherapy, used for the purpose of antitumor action:

1. Transfusion therapy: erythrocyte mass, platelet mass, isotonic solutions, in order to correct severe anemic syndrome, hemorrhagic syndrome and detoxification;
2. Restorative therapy:

• used to strengthen the immune system. Duovit 1 tablet 1 time per day.
• Iron supplements to correct iron deficiency. Sorbifer 1 tablet 2 times a day.
• Immunomodulators increase the reactivity of the body. Timalin, intramuscularly 10-20 mg 1 time per day, 5 days, T-activin, intramuscularly 100 mcg 1 time per day, 5 days;

1. Hormone therapy: Prednisolone at a dose of 50 g per day.
2. Antibiotics a wide range actions are prescribed for the treatment of adjoining infections. Imipenem 1-2 g per day.
3. Radiotherapy used to treat chronic leukemia. Irradiation of the enlarged spleen, lymph nodes.

Surgery

Folk methods of treatment

An infusion of crushed pine needles, dry onion skin, rose hips, mix all the ingredients, add water, and bring to a boil. Infuse for a day, strain and drink instead of water.

Drink juices from red beets, pomegranate, carrots. Eat pumpkin.

Infusion of chestnut flowers: take 1 tablespoon of chestnut flowers, pour 200 g of water into them, boil and leave to infuse for several hours. Drink one sip at a time, you need to drink 1 liter per day.
Well helps in strengthening the body, a decoction of the leaves and fruits of blueberries. About 1 liter of boiling water, pour 5 tablespoons of blueberry leaves and fruits, leave for several hours, drink everything in one day, take about 3 months.

Monocytic leukemia (monocytic leukemia) is a tumor process with a significant increase in the content of monocytic cells with normal or low leukocytosis.

Most often, they fall ill with the elderly, as a rule, older than 50 years, cases of illness in children of the first years of life are extremely rare.

In many patients, for a long time there is no suppression of the erythrocyte and platelet germ of hematopoiesis, but sometimes anemia manifests itself early and does not respond to any therapy, which can remain the only manifestation of the disease for many years. Since a significant increase in monocytes in the blood can accompany many other diseases (for example, tuberculosis, Waldenström's macroglobulinemia, some types of cancer), more or less long-term monitoring of the blood picture is required to diagnose chronic monocytic leukemia to exclude other somatic diseases.

The clinical picture in chronic monocytic leukemia does not have pronounced features for a long time. Usually, the health of patients worsened only 3-4 years after detection in the blood. high percentage monocytes. Among hematologists, it is believed that this variant occurs much more often than it is diagnosed precisely because of its asymptomatic nature.

The hematological picture is as poor as the clinical one: bone marrow hematopoiesis is practically not disturbed for a long time, deviations in the blood count are not detected, but in most patients there is a significant acceleration of ESR, which is often the only symptom.

In the bone marrow trepanate, monocytic hyperplasia is found, and in the urine there is a greatly elevated level of lysozyme. Based on these features, monocytic leukemias can be distinguished from other leukemias and from leukemoid reactions.

Chronic monocytic leukemia in the benign stage does not require any special treatment. Patients with anemia need repeated red blood cell transfusions. With an increase in cytopenias or the appearance of a hemorrhagic syndrome, small doses of glucocorticoids are usually prescribed. AT terminal stage shows the whole complex of cytostatic therapy used in the treatment of acute leukemia.

The average life expectancy of patients with chronic monocytic leukemia is 5-10 years or more.

Malignant cancer diseases in our minds are closely related to tumors. However, there are dangerous states, which are on early stages may not show up at all. These include myeloid leukemia.

What is acute myeloid leukemia?

The disease is localized in the peripheral blood, as well as in the bone marrow.

With the development of the disease malignant cells inhibit the growth of healthy ones, thereby infecting all organs of the human body.

Reasons for development

The exact reasons for the formation of ML are unknown. Scientists have identified the factors that lead to active development diseases. These can be called:

• Pre-leukemic pathologies of the hematopoietic system such as myelodysplastic or myeloproliferative syndromes. The risk may increase or decrease depending on the form of the syndrome.
• Chemotherapy in the patient's history. The risk increases if chemotherapy was given less than 5 years ago.
• Ionizing radiation.
• Genetic mutations of the fetus, for example, Down syndrome and the like.
• The impact of biological mutagens on the mother's body during pregnancy.

Also great importance has a predisposition to myeloid leukemia. If a family history of any of the relatives observed the disease, it big share probability will appear in the next generations.

Symptoms of the disease

Myeloid leukemia is not characteristic only for this disease signs, may manifest different symptoms depending on the age and form of the disease. For most patients, an increase in body temperature and a feeling of pain in the bones are characteristic.

In more than 80% of cases, patients develop anemic syndrome. The patient feels tired skin acquire a pale bluish tint, appetite decreases, severe shortness of breath appears.

Since at myeloid leukemia the level of platelets decreases, patients have severe and prolonged bleeding after injuries, unreasonable nosebleeds and the appearance of bruises “out of the blue”.

As the number of normal white blood cells decreases, the patient's immunity decreases, which leads to the emergence of infectious diseases and resistance to treatment in chronic ones. With the development of the disease, the mucous membranes of the mouth and gastrointestinal tract may be affected, and swelling on the gums may appear.

Rarely, pathological leukemic cells can form malignant tumor myelosarcoma, localized outside the bone marrow.

Diagnostics

It is impossible to diagnose ML by symptoms alone, because any characteristic features no.

The disease is detected by analysis and research:

• General and biochemical analysis blood. They reveal an increase / decrease in leukocytes, a decrease in platelets and erythrocytes.
• Microscopy and flow cytometry. To differentiate ML from other blood diseases, clarify the type.
• Ultrasound to assess the state of organs.
• X-ray.

Before starting chemotherapy, the patient is prescribed additional tests eg urinalysis, echo and echocardiography.

Treatment

Basic consist of chemotherapy. Chemotherapy can be combined with basic therapeutic methods including diet, physiotherapy exercises and hardware blood purification.

Chemotherapy is divided into 2 stages: induction and consolidation. The first stage is designed to obtain a stable remission, and the second is carried out in order to destroy residual pathological cells.

Induction therapy includes cytarabine and an anthracycline antibiotic such as daunrubicin. Statistics show that this method can cure a little less than 70% of patients.

Also, induction therapy may include regimens such as:

1. FLAG;
2. monotherapy large dosage cytarabine;
3. new drugs being researched;

Upon reaching a stable remission after induction therapy, doctors proceed to consolidating.

The second stage is mandatory in most cases, since without it the likelihood of a recurrence of the disease is high.

Consolidation therapy may include 2-5 courses of additional chemotherapy, allogeneic stem cell transplantation, and others.

Patient life prognosis

Acute myeloid leukemia responds well to treatment. The prognosis depends on the individual characteristics of the patient, the type of disease, its degree and similar factors.

On average, with a favorable prognosis and the absence of complications, survival for 5 years is more than 70%, while the recurrence rate is less than 35%. If the patient's condition is complicated, then the survival rate is 15%, while the condition can recur in 78% of cases.

Video about what leukemia and chemotherapy are:

Hematologist

Higher education:

Hematologist

Samara State medical University(SamGMU, KMI)

Level of education - Specialist
1993-1999

Additional education:

"Hematology"

Russian Medical Academy Postgraduate Education

Monocytic leukemia is a type of leukemia. Pathology is characterized by a change in the composition of the blood. Moreover, the number of monocytes increases with a constant level of leukocytes. Chronic form The disease is more commonly diagnosed in older patients. If the content of myelocytes is also increased in the blood and bone marrow, we are talking about myelomonocytic leukemia - a variant of monocytic. Symptoms of diseases are similar.

The essence and classification of pathology

The basis of the development of leukemia is the exit into the bloodstream a large number immature cells that are unable to perform their functions. As a result, the body's defenses fail, the immune system is weakening. The increasing concentration of altered cells inhibits the production of platelets and red blood cells, the number of which critically decreases over time. With absence adequate therapy the process is exacerbated, provoking the development of anemia, infectious lesions and hemorrhages.

Myelomonocytic leukemia, like monocytic, develops in stages:

• on the initial phase inhibition of hematopoietic processes is manifested. This is the so-called first attack, which is characterized by some severity of symptoms;
• at the stage of remission, the indicators of bone marrow puncture are close to normal;
• phase of incomplete remission intensive care reflects the onset of a certain improvement;
• the terminal stage is a sign of futility conservative therapy. Tumor formations grow, signs of anemia, thrombocytopenia are observed.

In accordance with ICD-10, monocytic leukemia is divided into several types:

1. Spicy;
2. Chronic:

• less than 5% of blasts in the blood, less than 10% in the bone marrow;
• 5-20% of blasts in the blood, 10-20% in the bone marrow;
• with eosinophilia (exceeding the norm of eosinophils in the blood);

1. Juvenile;
2. Another;
3. Unspecified.

Chronic monocytic leukemia for a long time is asymptomatic, while the blood cells mature partially. Very immature blasts rapidly increasing in number are a sign of acute leukemia. The juvenile form of the pathology is observed quite rarely - in children under four years old. Sometimes diagnosed with acute myelomonocytic leukemia with eosinophilia.

Chronic monocytic leukemia is much more common than it is diagnosed.

Reasons for the development of the disease

Pathologically altered blood composition does not allow organs to receive enough necessary nutrients and oxygen, it causes systemic disorders organism. Initially, the development of monocytic leukemia is provoked by:

• genetic predisposition;
• radioactive exposure;
• low immunity;
• viral agents (Epstein-Barr, HIV);
• chromosomal abnormalities (Down syndrome, Bloom-Torre-Mahacek syndrome, Fanconi anemia);
• intoxication with carcinogens;
• consequences of chemotherapy;
• harmful working conditions;
• unfavorable ecology;
• smoking.

Chronic myelomonocytic leukemia (CMML) is more commonly diagnosed in men over 60 years of age. There is a high probability of developing a juvenile form of the disease in children with type 1 neurofibromatosis. The reasons for the progression of the pathology include an altered structure of the TET2 gene (produces a protein that controls the amount of monocytes produced by stem cells).

Benign chronic monocytic leukemia does not need special therapy for a long time.

Diagnostic measures

After analyzing the history and physical examination ( oral cavity, eyes, spleen, liver) conduct laboratory research blood:

• clinical and biochemical analyzes;
• cytochemistry (assessment of the chemical nature of cells);
• flow cytometry (analysis of dispersed media);
• immunohistochemistry (tissue microscopy);
• cytogenetic test (microscopy of chromosomes);
• fluorescent hybridization (study of genetic material);
• PCR diagnostics (molecular genetic analysis);
• visual methods (ultrasound, radiography, MRI, PET).

Diagnosis is confirmed by biopsy and bone marrow aspiration. Newly discovered chronic monocytic leukemia must be differentiated from infectious mononucleosis.

Symptoms and therapy

The development of monocytic leukemia is accompanied by symptoms characteristic of other pathologies:

• weakness;
• pallor;
• dizziness;
• poor appetite;
• weight loss;
• gag reflexes;
• an increase in the volume of the liver and spleen;
• hemorrhages (including internal);
• susceptibility to infectious diseases;
• fever;
• fragility of the bones.

In the later stages of the development of pathology, anemia, tachycardia, visual impairment, brain damage, sexual dysfunction. Manifestations depend on the type of monocytic leukemia.

Peculiarities different types diseases

Chronic monocytic leukemia, like acute, requires maintenance therapy during and after the main treatment.

In many patients, after the use of conservative therapy, there is a positive trend. Five years after treatment, about a third of patients disappear all Clinical signs diseases. When transplanting stem cells, the effectiveness of treatment doubles.