Acute leukemia: symptoms, treatment and prognosis
These signs are very similar to an acute viral infection, so it is not uncommon for patients to be treated for it, and a number of changes that are characteristic of acute leukemia are found during the examination( including a general blood test).
In general, the picture of the disease in acute leukemia is determined by the dominant syndrome, they are distinguished by several:
- Anemic( weakness, dyspnea, pallor).
- Intoxicating( worsening of appetite, fever, weight loss, sweating, drowsiness).
- Hemorrhagic( hematomas, petechial rash on the skin, bleeding, bleeding gums).
- Bone-joint( infiltration of periosteum and joint capsule, osteoporosis, aseptic necrosis).
- Proliferative( enlargement of lymph nodes, spleen, liver).
In addition, very often acute leukemia develops infectious complications caused by immunodeficiency( in the blood of insufficiently mature lymphocytes and leukocytes), less often - neiroleukemia( metastasis of leukemia cells in the brain, which proceeds according to the type of meningitis or encephalitis).
The symptoms described above can not be ignored, as the timely detection of acute leukemia significantly increases the effectiveness of antitumor treatment and gives the patient a chance for a full recovery.
Diagnosis of acute leukemia
Diagnosis of acute leukemia consists of several stages:
- At the first stage, a general blood test( in dynamics) is performed.Repeated studies are necessary to eliminate the error.In the analysis of patients with acute leukemia, a change in the ratio of cellular elements to the appearance of blasts is found.
- The next stage of diagnostics, which is carried out in a specialized oncohematological unit, consists in the examination of the bone marrow with the obligatory cytochemical analysis( staining blood and bone marrow smears with special dyes that allow differentiating cells and establishing the type of leukemia).Further, to clarify the diagnosis, immunophenotyping of blasts is performed, as well as cytogenetic analysis to detect chromosomal abnormalities.According to WHO recommendations, the diagnosis of acute leukemia is made when more than 20% of blast cells are found in the bone marrow.
- The third stage of diagnosis is the determination of the degree of involvement of the internal organs in the pathological process.To do this, chest X-ray, ultrasound of internal organs, diagnostic lumbar puncture and other studies are performed in the presence of indications.
Acute leukemia treatment
There are two methods for treating acute leukemia: multicomponent chemotherapy and bone marrow transplantation. Treatment protocols( prescribing regimens) for ALL and AML are used differently.
The first stage of chemotherapy is the induction of remission, the main goal of which is to reduce the number of blast cells to levels that are not detectable by available methods.The second stage is consolidation, aimed at eliminating the remaining leukemia cells.This stage is followed by re-induction - a repetition of the induction stage.In addition, a mandatory element of treatment is maintenance therapy with oral cytotoxic drugs.
The choice of the protocol in each specific clinical case depends on the risk group the patient belongs to( the role of the person's age, the genetic features of the disease, the number of leukocytes in the blood, the response to previous treatment, etc.). The total duration of chemotherapy for acute leukemia is about 2 years.
Criteria for complete remission of acute leukemia( all of which should be present simultaneously):
- no clinical symptoms of the disease;
- detection in the bone marrow of not more than 5% of blast cells and normal ratio of cells of other germs of hematopoiesis;
- absence of blasts in peripheral blood;
- absence of extramedullary( ie located outside the bone marrow) lesions.
Chemotherapy, although aimed at curing a patient, has a very negative effect on the body, since it is toxic.Therefore, against its background, the hair begins to drop out in patients, nausea, vomiting, impaired functioning of the heart, kidneys, and liver.To timely identify side effects of treatment and monitor the effectiveness of therapy, all patients need to regularly take blood tests, undergo bone marrow tests, biochemical blood test, ECG, echocardiography, etc.After completion of treatment, patients should also remain under medical supervision( outpatient).
An important treatment in acute leukemia is concomitant therapy, which is prescribed depending on the patient's symptoms.Patients may require transfusion of blood products, the appointment of antibiotics, detoxification treatment to reduce intoxication due to the disease and used chemotherapy drugs.In addition, in the presence of indications, preventive irradiation of the brain and endolyumbal administration of cytostatics are carried out to prevent neurological complications.
Proper care for patients is also very important.They must be protected from infections, creating living conditions that are closest to sterile, excluding contacts with potentially infectious people, etc.
Bone marrow transplantation
Bone marrow transplant patients with acute leukemia, because only it has stem cells that can become the ancestors of blood cells.Transplantation performed by such patients should be allogenic, that is, from a related or unrelated compatible donor. This treatment procedure is indicated for both ALL and AML, and it is desirable to perform a transplant during the first remission, especially if there is a high risk of recurrence-the return of the disease.
In the first relapse of AML, transplantation is generally the only rescue, since the choice of conservative treatment in such cases is very limited and often comes down to palliative therapy( aimed at improving the quality of life and alleviating the condition of a dying person).
The main condition for the transplantation is complete remission( so that the "empty" bone marrow can fill with normal cells). To prepare a patient for the transplant procedure, conditioning is also mandatory - immunosuppressive therapy designed to destroy the remaining leukemia cells and create a deep depression of immunity, which is necessary to prevent rejection of the graft.
Contraindications to bone marrow transplantation:
- Serious disorders of the function of internal organs.
- Acute infectious diseases.Relapse of leukemia that is not treatable.
- The elderly.
Prognosis for leukemia
The following factors affect the prognosis:
- age of the patient;
- type and subspecies of leukemia;
- cytogenetic features of the disease( eg, the presence of the Philadelphia chromosome);
- reaction of the body to chemotherapy.
Prognosis in children with acute leukemia is much better than in adults.This is due, first, to the higher reactogenicity of the child's body for treatment, and secondly, to the presence in the elderly of a mass of concomitant diseases that do not allow for complete chemotherapy.In addition, adult patients often turn to doctors when the disease is already neglected, to the health of the same children, parents are usually more responsible.
If to operate with figures, the five-year survival rate at ALL in children, according to different data, makes from 65 to 85%, at adults - from 20 to 40%.With AML, the prognosis is somewhat different: a five-year survival rate is observed in 40-60% of patients younger than 55 years, and only in 20% of older patients.
In summary, it should be noted that acute leukemia is a serious illness, but treatable.The effectiveness of modern protocols for its treatment is quite high, and relapse after five years of remission almost never occurs.
Zubkova Olga Sergeevna, medical reviewer, epidemiologist