Chronic lymphoid leukosis

Description:

The chronic lymphoid leukosis is an oncological disease of lymphatic fabric at which tumoral lymphocytes collect in peripheral blood, marrow and lymph nodes. Unlike acute leukoses, the tumor grows rather slowly owing to what disturbances of a hemopoiesis develop only in late stages of development of a disease.

Symptoms of a chronic lymphoid leukosis:

Weakness
Hyperadenosis
Weight in a stomach (in left hypochondrium)
Tendency to infections
Perspiration
Decrease in body weight

Most often the first symptom of a chronic lymphoid leukosis is the angiomegaly. Owing to increase in a spleen, emergence of heavy feeling in a stomach is possible. Quite often patients test considerable general weakness, lose weight, they increased the frequency of development of infectious diseases. Symptoms develop gradually, for a long time. Approximately in 25% of cases the disease is found accidentally at the blood test appointed in other occasion (medical examination, inspection concerning not hematologic disease).

Stages of a chronic lymphoid leukosis:

There are several approaches to definition of stages of a chronic lymphoid leukosis - the system Rai, Binet and the International working group on a chronic lymphoid leukosis. All of them consider that the fact that life expectancy of patients with a chronic lymphoid leukosis depends on degree of prevalence of a tumor (number of the affected groups of lymph nodes) and extent of disturbance of a hemopoiesis in marrow. The disturbance of a marrowy hemopoiesis caused by tumoral growth in marrow leads to development of anemia (to decrease in number of erythrocytes in blood) and thrombocytopenia (decrease in number of thrombocytes). Definition of a stage of a chronic lymphoid leukosis allows to make the decision on need to begin treatment and to choose the therapy mode, most acceptable for this patient.

According to the modern system of a stadirovaniye of a chronic lymphoid leukosis offered by the International working group on a chronic lymphoid leukosis allocate three stages:
Stage And - a lymphocytosis at defeat no more than 2 groups of lymph nodes (or for lack of their defeat); thrombocytopenia and anemia are absent.
Stage In - 3 and more groups of lymph nodes are affected; thrombocytopenia and anemia are absent.
Stage With - existence of thrombocytopenia or anemia irrespective of number of the affected groups of lymph nodes.

Depending on existence of these or those symptoms, the Roman figures can be added to alphabetic reference of a stage of a chronic lymphoid leukosis:
I - in the presence of a lymphadenopathy
II - at increase in a spleen (splenomegaly)
III - in the presence of anemia
IV - in the presence of thrombocytopenia

Diagnosis:

To make the diagnosis of a chronic lymphoid leukosis, it is necessary to conduct the next researches:
Medical examination
Clinical blood test with calculation of a leukocytic formula
The research of marrow allows to reveal a defeat picture, characteristic of this disease.
Immunophenotyping of cells of marrow and peripheral blood reveals the specific immunological markers characteristic of tumor cells at a chronic lymphoid leukosis.
Biopsy of the affected lymph node with its morphological and immunological research.
Determination of level β 2 microglobulins helps to predict the course of a disease.
The cytogenetic analysis allows to obtain data on the characteristic of tumor cells which in some cases have predictive value.
Determination of level of immunoglobulins allows to define, the risk of development of infectious complications in this patient is how high.

Treatment of a chronic lymphoid leukosis:

Unlike many other tumors, consider that at a chronic lymphoid leukosis performing therapy in early stages of a disease is not reasonable. It is caused by the fact that at most of patients in initial stages of a chronic lymphoid leukosis the disease has the "smoldering" character, and patients can do long time without treatment, normally feeling and keeping a usual way of life. Treatment needs to be begun only at emergence of signs of progressing of a disease to which carry:
Bystry increase of number of lymphocytes in blood
The progressing hyperadenosis
Significant increase in a spleen
Increase of anemia and thrombocytopenia
Emergence of symptoms of tumoral intoxication - fever, night sweats, the loss of weight expressed to weakness

There are several approaches to treatment of a chronic lymphoid leukosis:
The chemotherapy drug Chlorbutinum was a standard method of treatment of a chronic lymphoid leukosis until recently. Now it is proved more effective use of new group of drugs, so-called purine analogs which representative is Fludara.
Carry a bioimmunotherapy using monoclones to effective methods of treatment of a chronic lymphoid leukosis. Administration of these drugs allows to destroy selectively tumor cells, without damaging healthy body tissues.
At unsatisfactory efficiency of other methods of treatment, the high-dose chemotherapy with transplantation of the hemopoietic stem cells can be carried out.
Radiation therapy is applied as an auxiliary method of treatment in the presence of big tumoral weight.
Removal of a spleen (splenectomy) it is sometimes shown at significant increase in this body.

The choice of a method of treatment is very important decision which has to be based on the exact data concerning the diagnosis taking into account specific features of the patient. Discussion of questions of treatment with the patient and, at his desire, with his relatives is the integral element of the approval of the general program of treatment.