In chronic lymphocytic leukemia various stages more often functionally defective B-cell population of lymphocytes that do not differentiate to form plasma cells.These functionally inert lymphocytes, with a very long life cycle (months and years), accumulate in parenchymal organs of blood formation in chronic lymphocytic leukemia.Developing in chronic lymphocytic leukemia immunological homeostasis violations give rise to these patients with autoimmune hemolytic anemia, thrombocytopenia, malignant neoplasms, and various infectious complications, and others. Chronic lymphocytic leukemia is most common in the elderly, which is probably due to the age-related changes in their immune system.Treatment of chronic lymphocytic leukemia depends on the stage of the disease.
Treatment of chronic lymphocytic leukemia
What is needed for the treatment of chronic lymphocytic leukemia?
X-ray examination in the treatment of chronic lymphocytic leukemia can be detected by the expansion of mediastinal lymph nodes.Hist
Indications for cytostatic agents for the treatment of chronic lymphocytic leukemia are the evolution of the illness of subleukemic in leukemic stage, the tendency to anemizatsii and thrombocytopenia, severe or rapidly progressive hyperplasia of the lymph nodes in chronic lymphocytic leukemia, especially in the mediastinum and abdomen, growing enlargement of the liver and spleen, even when subleukemicblood picture.Usually spend monochemotherapy chlorambucil (4 - 15 grams per day) or cyclophosphamide (200 - 400 mg every other day or every day).
When compression of the lymph nodes or splenomegaly bodies indicated for the treatment of radiation therapy (external gamma-therapy).When expressed hypersplenism or autoimmune conflicts in chronic lymphocytic leukemia is performed splenectomy.In the case of infectious complications antibacterial treatment is carried out in the usual way.
The clinical course of chronic lymphocytic leukemia are distinguished by initial, detailed and terminal stage.
stages of chronic lymphocytic leukemia
Treatment of early stage chronic lymphocytic leukemia
In the initial stages of chronic lymphocytic leukemia health of patients is satisfactory, marked a long period of slight increase in the cervical and axillary lymph nodes, moderate leukocytosis (up to 10 - 15x10 ^ / l) th lymphocytosis in the blood(50 - 70%).This is due to the fact that many years of chronic lymphocytic leukemia has no tumor progression, so patients with early stage feels well and continue to work.Leukemic process in this step affects only the lymphoid tissue of the bone marrow, lymph nodes and spleen, not suppressing the other shoots hematopoiesis.
Treatment of advanced stage CLL
In the advanced stage of chronic lymphocytic leukemia is increasing general weakness, sweating, subfebrillitet, heaviness in the hypochondria, decreased appetite, becomes unstable chair.An objective study of chronic lymphocytic leukemia is detected generalized increase in peripheral, hilar and retroperitoneal lymph nodes.Peripheral lymph nodes (cervical, axillary, inguinal) increased up to 2 - 3 cm, myagkovataya consistency, painless on palpation, is not welded to each other and surrounding tissues can be non-specific and specific skin lesions in chronic lymphocytic leukemia at this stage.Specific leukemia skin lesions at this stage include skin lymphoma and erythroderma.
palpable at this stage chronic lymphocytic leukemia enlarged liver and spleen.If the spleen is developing ischemic infarct or hemorrhage, it is manifested by sharp pains in the left upper quadrant and fever.3 - 6 m, the treatment of chronic lymphocytic leukemia as a result of bone marrow infiltration occur anemia (including autoimmune), thrombocytopenia, hemorrhagic syndrome.Increasing leukemic intoxication causes weight loss patients.Maybe cholestatic jaundice with persistent pruritus due to compression of enlarged lymph nodes of the common bile duct.
treatment of end-stage chronic lymphocytic leukemia
In end-stage treatment of the above symptoms are dramatically enhanced.Patients become kaheksichnymi, there are signs of severe intoxication and even septic conditions.In the internal organs develop marked degenerative changes with disabilities (cardiac, renal and other disease).Often this step in the treatment of chronic lymphocytic leukemia observed immune severe hemorrhagic syndrome (for example, various bleeding).Sometimes imperious crisis (1 - 4%), against which develops necrosis of various localizations.
lethal outcome in chronic lymphocytic leukemia occurs most often due to infection, autoimmune conflict, exhaustion and severe degeneration of organs, as well as transformation in lymphosarcoma.In the peripheral blood of patients with chronic lymphocytic leukemia this stage, there is an absolute lymphocytosis (60 - 80%) with a significant leukocytosis, identified cellular shade leykoliza (Botkin calf - basket cells) that are not in other diseases.
absolute number of granulocytes, hemoglobin levels of red blood cells and platelets in the early stages of chronic lymphocytic leukemia is usually within the normal range.Over time, developing anemia (often autoimmune form of hemolytic anemia), and thrombocytopenia.The myelogram is dominated by lymphocytes, granulocytes and eritronormoblastov content drastically reduced.In the later stages of the disease found total lymphoid metaplasia of the bone marrow (95 - 98%).