Treatment of acute lymphoblastic leukemia in Israel: highly professional and timely assistance

Acute lymphoblastic leukemia is a malignant pathology of the bone marrow and blood, which consists of the production of blast (immature) leukocytes by the hematopoietic organ. These cells are unable to perform their function and gradually displace normal cells, which leads to a catastrophic decline in immunity, anemia, infectious inflammatory processes, bleeding and other disturbances in the normal functioning of the body. The disease develops very quickly and, in the absence of qualified medical care, leads to death within several months.

Kinds

The generally accepted classification of acute lymphoblastic leukemia (ALL) divides them into two groups, depending on the type of leukocytes affected.

• B-cell (up to 85% of all cases) is most typical for childhood, with the peak incidence occurring in the 3rd year of life. Adults rarely get sick. The second risk group is people over 60 years of age, but among older people the incidence is 5-6 times lower than in children
• T-cell (15-20% of cases) is characterized by a more severe course and high aggressiveness. The largest number of cases occurs among 15-year-olds.

Pathological mutation of B-leukocytes and T-leukocytes can occur at different stages of maturation. If immature cells appear in the blood, mutated in the initial stages, then the prefix “pre” is added to the name of the form of leukemia. This distinguishes lymphocytic oncopathologies from acute non-lymphoblastic leukemia, in which there is no such division.

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The essence of the disease

Leukemia, or leukemia, is a disease of the hematopoietic system, sometimes colloquially called “blood cancer.” In leukemia, the bone marrow produces an excess amount of abnormal, immature blood cells, usually the precursors of white blood cells. These blast cells, multiplying and accumulating in the bone marrow, interfere with the production and functioning of normal blood cells, which causes the main symptoms of the disease. In addition, these tumor cells can accumulate in the lymph nodes, liver, spleen, central nervous system and other organs, also causing specific symptoms.

As you know, different blood cells develop differently and have different precursors - that is, they belong to different lines of hematopoiesis (see diagram in the article “Hematopoiesis”). The line of hematopoiesis leading to the appearance of lymphocytes is called lymphoid; the remaining leukocytes belong to the myeloid lineage. Accordingly, leukemias are distinguished from the precursor cells of lymphocytes (such leukemias are called lymphoblastic, lymphocytic, or simply lymphocytic leukemias) and from the precursors of other leukocytes (myeloblastic, myeloid, myeloid leukemias).

Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in children, but the disease also occurs in adults. The term "acute" refers to the rapid progression of the disease, as opposed to chronic leukemia. The term “lymphoblastic” means that the immature cells that form the basis of the disease are lymphoblasts, that is, the precursors of lymphocytes.

Incidence and risk factors

ALL accounts for 75-80% of all tumor diseases of the hematopoietic system in children and approximately 25% of all childhood cancers in general (approximately 4 cases per 100 thousand children per year). ALL is the most common cancer in children. Most often, ALL occurs before the age of 14 years; Peak incidence in children occurs between 2 and 5 years of age. This disease occurs slightly more often in boys than in girls.

The likelihood of developing ALL is slightly increased in people who have previously been treated for another disease (usually cancer) using radiation or certain types of cytotoxic chemotherapy. The risk of ALL is also increased in children with certain genetic disorders, such as Down syndrome, neurofibromatosis type I, or a number of primary immunodeficiency conditions.

A child has a higher than average risk of getting the disease if his or her twin brother or sister has already been diagnosed with leukemia. Other cases where ALL occurs in more than one child in the same family do occur, but are extremely rare.

However, in most cases of ALL, no known risk factor can be found, and the causes of the disease remain unknown.

Signs and symptoms

ALL is characterized by many different symptoms and can manifest itself in completely different ways in different patients. Most of the observed symptoms, however, are due to severe hematopoietic disorders: an excess of abnormal blast cells in ALL is combined with an insufficient number of normal functional blood cells.

Weakness, pallor, loss of appetite, weight loss, rapid heartbeat (tachycardia) are usually observed - manifestations of anemia and tumor intoxication. Lack of platelets is manifested by small hemorrhages on the skin and mucous membranes, bleeding from the gums, nosebleeds and intestinal bleeding, bruises. Due to the accumulation of blast cells, lymph nodes often become enlarged - in particular, cervical, axillary, and inguinal. The liver and spleen are also often enlarged - as they say, hepatosplenomegaly occurs.

Pain in bones and joints is often observed, and sometimes pathological (that is, caused by disease) bone fractures occur. Due to insufficient numbers of normal mature white blood cells, frequent infections are possible. An increase in temperature can be observed both due to an infection arising from leukemia, and due to tumor intoxication. Sometimes one of the manifestations of acute leukemia is a prolonged sore throat, which is difficult to treat with antibiotics.

In some cases, ALL causes changes in other organs: eyes, kidneys, testicles in boys and ovaries in girls, and in boys, damage to the genital organs is more common. Damage to the central nervous system - neuroleukemia - may occur.

Since all the observed symptoms may be associated with other diseases and are not specific to ALL, before starting treatment, laboratory diagnosis is necessary, which is urgently carried out in a hospital setting.

Diagnostics

In ALL, changes occur in the usual clinical blood test: as a rule, the levels of red blood cells and platelets are reduced, and blast cells appear. Very high leukocytosis (hyperleukocytosis) is possible, but, contrary to popular belief, it is not always observed. In general, a reliable diagnosis can only be made by examining a bone marrow sample; For this purpose, a bone marrow puncture is necessary.

During a morphological study, the diagnosis of “acute lymphoblastic leukemia” is made when more than 25% of blast cells are detected in the bone marrow (otherwise it may be a lymphoblastic lymphoma). But more subtle studies are necessarily carried out: cytochemical (staining of cells, which makes it possible to more accurately determine their nature), cytogenetic (study of the structure of chromosomes in leukemic cells), immunophenotyping (study of protein marker molecules located on the surface of cells). The fact is that during diagnosis it is very important not only to reliably distinguish ALL from acute myeloid leukemia, but also to determine the specific variant of ALL, since it greatly influences the therapy and prognosis of the disease.

Thus, ALL can be B-cell (about 80% of cases) or T-cell, depending on whether the leukemic cells belong to the B- or T-lymphocyte lineage. Depending on the “degree of maturity” of blast cells, several variants are distinguished among both B- and T-cell leukemias; their identification by immunophenotyping is important for determining treatment strategies. The cytogenetic characteristics of tumor cells are essential for prescribing therapy (see below).

During the diagnosis of ALL, it is also necessary to examine the state of the central nervous system. Analysis of cerebrospinal fluid (CSF) allows you to determine whether the patient has damage to the central nervous system - neuroleukemia. A sample of cerebrospinal fluid for analysis is obtained by puncture of the spinal canal.

Additional diagnostic procedures are also possible to examine the affected lymph nodes and internal organs - computed tomography (CT), ultrasound (US), and so on.

Diagnostic studies make it possible for each individual patient to determine one or another risk group, on which the prognosis of the disease and planned treatment depend. So, they talk about standard, intermediate, high risk, etc. Assignment to one or another group within a specific treatment protocol depends on many factors. Let's list some of them.

• Age of the patient: age under 1 year or older than 10 years is considered less favorable.
• White blood cell count: The risk increases if the leukocytosis is very high at the time of diagnosis.
• Spread of ALL to organs other than the bone marrow (eg, the onset of neuroleukemia) determines a higher risk.
• With early or repeated relapse, the risk increases.

In addition, the choice of treatment strategy depends on the type of leukemia (B- or T-cell ALL), as well as cytogenetic abnormalities in leukemic cells associated with chromosome number and translocations. Some of them reliably influence the course of the disease and the course of therapy, others are only being studied. Thus, the Philadelphia chromosome - translocation t(9;22) - requires the addition of additional targeted drugs to therapy. The t(4;11) translocation often requires bone marrow transplantation. At the same time, for example, the t(12;21) translocation is usually associated with a relatively good prognosis.

Treatment

As mentioned in the previous section, modern treatment of ALL is based on dividing patients into risk groups based on how likely they are to achieve and maintain remission with the same therapy. Accordingly, patients at higher risk (i.e., those with a worse initial prognosis) receive more intensive therapy, while those at lower risk can use less intensive therapy and thereby avoid unnecessary toxicity and severe complications.

Therapy for ALL usually consists of three stages:

1. Remission induction (that is, therapy aimed at achieving remission) is carried out during the first few weeks of treatment. Remission here means the content of less than 5% of blast cells in the bone marrow and their absence in normal (peripheral) blood, combined with signs of restoration of normal hematopoiesis. During induction, intensive multicomponent chemotherapy is carried out with cytostatic drugs that cause the destruction of leukemic cells. At this stage, depending on the protocol, medications such as glucocorticosteroid hormones, asparaginase and pegaspargase, vincristine, daunorubicin, and other drugs may be used. Induction allows achieving remission in more than 95% of children and 75-90% of adults with ALL. It is fundamentally important to evaluate the response to induction therapy through laboratory tests: in case of a poor response (the desired results were not achieved by the control date), the patient is transferred to a higher risk group.
2. Consolidation (consolidation) of remission is aimed at destroying residual abnormal blast cells to avoid relapse of the disease. The total duration of this stage is measured in months and is highly dependent on the specific treatment protocol. During courses of therapy at the consolidation stage, methotrexate, asparaginase, 6-mercaptopurine, vincristine, glucocorticosteroids, daunorubicin and a number of other drugs can be used, again depending on the specific protocol, depending on the protocol and therapeutic group. At the induction and consolidation stages, chemotherapy drugs are administered mainly intravenously, in a hospital or one-day hospital setting.
3. Maintenance therapy is carried out to maintain remission, that is, to further reduce the risk of relapse after the induction and consolidation stages. The duration of maintenance therapy is one and a half to two years. At this stage, the main drugs are 6-mercaptopurine and methotrexate. Maintenance therapy is the least intensive phase of treatment. The child lives at home; permanent stays or daily visits to the hospital are not required.

There is also the concept of reinduction: these are cycles of intensive polychemotherapy periodically repeated after achieving remission. Reinduction allows you to further reduce the number of leukemic cells and thereby increase the “reliability” of remission.

If treatment or prevention of neuroleukemia is required at the listed stages, chemotherapy drugs are administered intrathecally, that is, into the spinal canal through lumbar punctures. Sometimes medications are injected into the ventricles (special cavities) of the brain through a special Ommaya reservoir, which is installed under the scalp. For intrathecal administration in ALL, methotrexate, cytarabine and glucocorticosteroid hormones are used. In some patients, irradiation of the head is also used - cranial irradiation.

Unfortunately, despite all the above measures, sometimes a relapse of ALL occurs - bone marrow, extramedullary (that is, outside the bone marrow - for example, with damage to the central nervous system or testes) or combined. In this case, anti-relapse therapy is carried out. The choice of treatment for relapse depends on the timing of its occurrence (early or late) and whether the relapse is bone marrow or extramedullary. With early relapse, the chances of success with drug therapy alone are significantly reduced and transplantation is almost always planned.

Bone marrow transplantation from a related or unrelated donor may be used in the treatment of ALL. If the treatment plan includes a transplant, it is performed after remission is achieved. In general, transplantation is only indicated in high-risk settings (eg, after early relapse or poor response to induction therapy) because it is a very difficult treatment and good results with standard therapy for ALL are on average likely, especially in children.

Chemotherapy for ALL is highly effective, but is often difficult to tolerate and can be associated with serious side effects. Thus, during the treatment, hematopoiesis is suppressed and transfusions of donor blood components - platelets - are necessary to avoid bleeding when the level of the patient’s own platelets is very low, and red blood cells to combat anemia. Transfusions of donor granulocytes are used only in rare cases with severe infectious complications.

Common side effects of chemotherapy include nausea, vomiting, and baldness. A serious problem is associated with the possibility of allergic reactions to chemotherapy drugs, including anaphylactic shock - a life-threatening condition characterized by swelling, difficulty breathing, severe itching, etc. Thus, allergies to asparaginase are relatively common, and it may be necessary to use analogues of this drug (Oncaspar, Erwinase).

Since both leukemia itself and the chemotherapy used in its treatment sharply reduce the body’s resistance to various infections, patients during treatment need effective antibacterial and antifungal drugs for the prevention and treatment of infectious complications. Both common and opportunistic infections are dangerous.

Intensive treatment of ALL imposes serious restrictions on the patient's lifestyle. It is necessary to follow a certain diet and strict hygiene requirements. To avoid infections, contacts with the outside world are limited. If the level of platelets is very low, you should not only avoid injury, but even, for example, brush your teeth with a toothbrush, so as not to provoke bleeding from the gums. Once remission is achieved, the severity of these restrictions is gradually reduced. Doctors and nurses tell each patient what he can and cannot do at the current stage of treatment.

In recent years, several new treatment options have emerged for even the most challenging cases of ALL. Of particular note are the immunotherapy drugs Blincyto (blinatumomab) and Bisponsa (inotuzumab ozogamicin), as well as CAR T-cell therapy used for B-cell ALL. There are also special drugs for T-cell ALL, such as Atriance (nelarabine). Evoltra (clofarabine) is also sometimes used. Some patients benefit from the inclusion of Velcade or Bartizar (bortezomib) in therapy. There are other options.

Forecast

Without treatment, ALL leads to the death of the patient within several months. However, the use of modern treatment protocols gives very good results for ALL: 85-90% of sick children can be cured. In adults, especially the elderly, the results are worse, but, nevertheless, in approximately 40% of adult patients it is possible to achieve long-term remission - that is, the absence of relapses of the disease for many years.

Symptoms

The first manifestations of acute lymphoid leukemia are nonspecific and are characteristic of many diseases:

• pale skin due to developing anemia;
• lethargy, loss of strength, drowsiness;
• frequent infectious diseases due to decreased immunity;
• elevated body temperature.

With the development of the disease, an increase in the number of blast lymphocytes in the blood and a lack of healthy cells, more pronounced symptoms appear:

• bleeding of mucous membranes;
• bruises, pinpoint skin hemorrhages;
• long-term healing of even small scratches and wounds, accompanied by infection, inflammation, suppuration;
• pain in the limbs caused by the growth of a bone marrow tumor;
• an increase in the size of the liver, spleen, lymph nodes, leading to abdominal pain;
• difficulty breathing, shortness of breath;
• paralysis of the facial nerve, blurred vision, vomiting due to damage to the meninges.

In each individual case, an individual symptom complex is formed, which may include the listed signs partially or completely.

Nonlymphoblastic acute leukemias

Non-lymphoblastic acute leukemia - these types of leukemia arise as a result of a mutation in one of the myeloid progenitor cells. They predominate among adult leukemias. In the group of acute myeloid leukemia, the following forms of the disease are distinguished: MO-acute myeloid leukemia, in which blast cells have minimal signs of differentiation; M1-2—acute myeloblastic leukemia with the presence of cells of varying degrees of maturity; MZ—acute promyelocytic leukemia; M4 - acute myelomonoblastic leukemia; M5—acute monoblastic leukemia; M6—acute erythroleukemia; M7 - acute megakaryoblastic leukemia.

Acute myeloblastic (AML) and myelomonoblastic leukemia (AMML) are the most common : among non-lymphoblastic acute leukemias of adults, these forms account for approx. 80%. Age-related peaks of acute myeloblastic and myelomonoblastic leukemia are observed at the age of up to 1-2 years, then at 38 years (AML) and at 50 years (AML). Clinic : characterized by an acute onset of the disease with high fever, necrosis in the throat (with deep primary granulocytopenia); often there are bone pains, anemia, and hemorrhagic phenomena, which are caused not only by thrombocytopenia, but also by disseminated intravascular coagulation syndrome. Bleeding of the mucous membranes (gingival, nasal, uterine, intestinal bleeding), petechial rash on the skin, primarily the legs, is observed; hematuria is observed less often, and even less often, hemorrhage in the brain. Hemorrhagic syndrome is often the earliest manifestation of acute nonlymphoblastic leukemia. The enlargement of the spleen in acute myeloblastic and myelomonoblastic leukemia is moderate. Ulcerative-necrotic lesions of the mucous membranes of the oral cavity (stomatitis, hyperplastic gingivitis with bleeding), pharynx (angina) and intestines are very characteristic - necrotic enteropathy, paraproctitis, etc., which is explained by a decrease in the level of blood granulocytes. Initial symptoms of necrotic enteropathy: splashing and rumbling upon palpation of the ileocecal area, pasty stools, slight bloating, high fever. Prognosis: the average frequency of first remissions in acute myeloblastic and myelomonoblastic leukemia with modern therapy reaches 60%. The duration of the first remission exceeds 2 years. Oncological recovery is observed in 10% of patients of all ages.

Causes and risk factors

The direct cause of the disease is always a malignant mutation of cells of the hematopoietic system, due to which they become capable of rapid uncontrolled reproduction. There is an assumption that changes in the genome occur during intrauterine development, but until a certain point the process remains incomplete. External circumstances often become the “trigger”:

• radioactive radiation of any nature, including during treatment of other forms of cancer;
• some chemical compounds - benzene, certain chemotherapy drugs;
• viral infections (Epstein-Barr, HTLV);
• inherited predisposition.

Acute lymphocytic leukemia often develops in children, less often in people over 60 years of age, and very rarely in adults. Representatives of the white race get sick more often than blacks, men – somewhat more often than women.

Pathophysiology

Under the influence of the above etiological factors, somatic mutations of the precursor cells of hematopoietic and lymphoid tissues occur in the human body.

https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1526-0968.2002.00402.x

The first stage of leukemia formation begins with a mutation in the parent cell, which acquires the ability to rapidly proliferate. As a result of this process, cells are formed that are their clone.

At the stage of formation of the first copy, the tumor retains the ability to further differentiate (benign tumor growth). Over time, numerous mutations and changes in structure occur in the primary leukemia clone. As a result, they not only actively proliferate, but also lose the ability to differentiate (malignant tumor growth).

In both children and adults, acute leukemia can present with extremely high blast counts; a phenomenon known as hyperleukocytosis. Respiratory failure, intracranial hemorrhage and severe metabolic abnormalities frequently occur in acute hyperleukocytic leukemia (AHL) and are the main determinants of the observed high early mortality (20% to 40%).

The process leading to these complications has long been known as leukostasis, but the biological mechanisms underlying its development and progression remain unclear. Traditionally, leukostasis is associated with the accumulation of leukemic blasts in the microcirculation, and its treatment is aimed at quickly reducing leukocytosis. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1526-0968.2002.00402.x

Stages

Since in blood cancers the tumor as such does not develop, general staging criteria are not suitable for assessing their course. The initial stage of acute lymphoblastic leukemia is considered to be the period from the appearance of a malignant clone to the appearance of pronounced symptoms. Next, the following stages are distinguished.

1. The first attack, or debut. At this time, the disease develops rapidly, the patient consults a doctor, is placed in a hematology hospital and undergoes induction therapy.
2. Remission. It can be complete, with a decrease in the level of blast leukocytes of less than 5% and the presence of all healthy hematopoietic germs in the myelogram, and partial, in which the improvement in blood counts is temporary and stops after a certain period.
3. Relapse. The condition occurs after remission and is characterized by the return of signs of the disease with an increase in the level of blastosis above 5%. There are early (with remission for less than a year) and late (with remission for more than a year) relapse of acute lymphoblastic leukemia.

Sometimes, after several remissions and relapses, the patient enters the terminal stage, in which the therapy does not produce any results. After this, death inevitably occurs. In most patients, treatment results are more favorable, and after remission, as a rule, recovery occurs.

Consequences (remission and relapse)

Just a few decades ago, acute leukemia led to the death of the patient within 2-3 months after diagnosis. Today, the situation has changed dramatically thanks to the emergence of new drugs for treatment.

At the moment, the clinic of acute leukemia distinguishes the following stages:

1. The first attack - during this period, tumor cells actively multiply in the bone marrow and enter the blood. It is at this stage that the diagnosis is made. Symptoms of the disease will be determined by which hematopoietic germ is affected. As a rule, these are persistent infections, anemia, general weakness, enlarged lymph nodes, etc.
2. Remission period. If acute leukemia has responded to chemotherapy, the tumor cells are destroyed and hematopoiesis is restored. The number of blasts in the bone marrow returns to normal and does not exceed 5% of the total number of cells. There are several types of remission, depending on how completely the tumor clone is suppressed. Currently, the goal of treatment is to achieve complete remission within 5 years. After this period, the patient is considered completely healthy.
3. Relapse. Some patients experience a relapse, in which the number of blasts increases again. They again enter the bloodstream and can form extramarrow foci of infiltration. There may be several relapses, and each time it becomes more and more difficult to put them into remission. However, many patients achieve a complete five-year remission, even after several relapses.
4. Terminal stage. They talk about it when all the used methods for treating acute leukemia lose their effectiveness and it is no longer possible to restrain tumor growth. The body's hematopoietic system is completely suppressed.

Diagnostics

To diagnose acute lymphocytic leukemia, a number of laboratory tests and instrumental studies are required.

• A general blood test must be carried out with a leukocyte count to identify the primary signs of the disease.
• A biochemical blood test is carried out to clarify the condition of internal organs, in particular the liver and kidneys.
• Bone marrow biopsy from the ilium provides material for basic research.
• A myelogram is necessary to determine the extent of bone marrow damage.
• Immunophenotypic analysis of bone marrow allows you to accurately determine the type of leukocyte damage.
• Cytogenetic and molecular genetic analysis allows you to select the optimal treatment strategy in accordance with the identified features.
• A lumbar puncture is necessary to obtain a sample of cerebrospinal fluid to determine whether the disease has spread to the central nervous system.
• A chest x-ray is necessary to identify enlarged lymph nodes, as well as to determine the inflammatory process in the lungs.

During treatment, there may be a need for further diagnostic and monitoring studies.

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Diagnosis of lymphocytic leukemia

To diagnose lymphocytic leukemia, a clinical blood test is performed (code 2 and code 5). It allows the specialist to obtain information about the ratio of blood elements, their quality and quantity.

Leukocytes in acute lymphocytic leukemia can be elevated, decreased, or normal. To determine the leukocyte formula (the ratio of certain types of leukocytes), a blood smear is used, which is applied to a glass slide, stained with special dyes and examined under a microscope. This is how the doctor determines the ratio of leukocytes and identifies immature, pathological cells that differ from normal ones in appearance.

Treatment

The treatment strategy for acute lymphoblastic leukemia is developed and approved by a council, which includes doctors of several specializations: general oncologist, chemotherapist, radiologist, hematologist, and other specialists. As a rule, the patient is prescribed a set of measures, including the most effective techniques.

• Chemotherapy is a key method for cancer of the blood and bone marrow. Modern drugs effectively destroy malignant cells or inhibit their growth and division. Depending on the indications, each patient is given an individual course with several different chemotherapy drugs. If they do not have the desired effect, the prescriptions are adjusted taking into account new data.
• Radiation therapy is used as an adjuvant method in the treatment of some subtypes of the disease. Most often, it precedes a bone marrow transplant surgery, when total destruction of tumor cells is required.
• Bone marrow transplantation is necessary after some high-dose treatments that completely destroy the patient's own bone marrow. The transplant allows you to resume the production of blood cells immediately after the deactivation of the tumor pathology.

Treatment consists of several stages:

• preparatory, necessary to reduce the number of leukemia cells in the blood;
• induction of remission - an intensive course, the goal of which is the maximum possible destruction of the tumor;
• consolidation aimed at consolidating the result and destroying residual lesions;
• reinduction, or repetition of induction to completely eliminate the possibility of relapse;
• maintenance therapy, which, with successful treatment, lasts about two years and consists of small doses of cytostatics.

Between stages, breaks are taken to restore the body after exposure to heavy drugs.

Palliative care

There are a large number of treatment methods available for the treatment of acute leukemia. This could be chemotherapy, targeted therapy, immunotherapy. All these methods can lead to remission even after multiple relapses. Therefore, as such, palliative therapy is rarely prescribed and, as a rule, in older patients who cannot tolerate severe treatment.

In this case, chemotherapy, drug therapy and radiation therapy are used.

Chemotherapy

Chemotherapy in palliative treatment is not carried out with the goal of achieving remission, but to keep the tumor clone from rapidly multiplying. At this stage, standard cytostatic drugs in lower dosages, immunotherapy, targeted therapy and other methods of antitumor treatment can be used.

Radiation therapy

Radiation therapy can be used to relieve pain in severe bone damage, as well as in the presence of extramedullary lesions.

Forecasts

In acute lymphoblastic leukemia, the prognosis depends primarily on the age of the patient. In children, recovery occurs in 80-90% of cases. For adults, the rate is currently 40-45%, with younger patients having significantly higher odds than people over 60 years of age. We should not forget that in recent years, oncologists have made significant progress in the treatment of blood diseases. Every year new, increasingly effective and safe targeted chemotherapy drugs appear.

Diagnosis and treatment of acute lymphoblastic leukemia in Moscow

If you or a member of your family have signs of acute lymphoblastic leukemia, contact the Medicine Clinic. We offer our patients:

• treatment by oncologists, chemotherapists, and highly qualified hematologists;
• diagnostics using the latest medical equipment;
• stay in a comfortable hospital room under round-the-clock supervision;
• medical service in accordance with the strict standards of world medicine.

Call us to find out the details you are interested in and schedule a consultation.

Advantages of treatment at Top Ikhilov

• Experience and high professionalism of medical staff
• Selection of the most effective types of therapy
• Use of new generation drugs, high-tech procedures and innovative techniques
• Moderate prices
• Comfortable conditions for staying in the clinic.

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Questions and answers

How long do people live with acute lymphoblastic leukemia?

The disease has a rapid course, so without medical care, death occurs within a few months. With timely treatment, 80-90% of children and about 40% of adults have a chance to live more than 7 years.

How long does treatment for acute lymphoblastic leukemia last?

• The preparatory stage of treatment lasts 1-2 weeks.
• Induction – up to 8 weeks.
• Consolidation – up to 4 months.
• Reinduction – several months.
• Maintenance therapy – up to one and a half years.

The total duration of treatment is approximately two or two and a half years.
How do you know if you have acute lymphoblastic leukemia?

If you have:

• symptoms of general malaise – lethargy, weakness, fever;
• bleeding from the nose, gums, and other mucous membranes;
• poorly healing wounds on the skin;
• severe sweating at night -

It is necessary to contact an oncologist or hematologist as soon as possible and have tests done. The listed symptoms do not always indicate the onset of acute lymphoblastic leukemia, but this disease develops rapidly and aggressively. For the success of treating roads literally every day.

Attention! You can cure this disease for free and receive medical care at JSC "Medicine" (clinic of Academician Roitberg) under the State Guarantees program of Compulsory Medical Insurance (Compulsory Medical Insurance) and High-Tech Medical Care. To find out more, please call +7(495) 775-73-60, or on the VMP page for compulsory medical insurance

Diagnosis of acute myeloid leukemia

A thorough diagnosis is extremely important, since during its course the doctor can not only establish the very fact of the presence of the disease, but also understand which treatment is suitable for a particular patient.

Diagnosis begins with a routine physical examination and search for bruises, bruises or possible signs of infection, after which a number of procedures are prescribed:

• Blood tests
  : allow you to see its composition, detect changed cells, and also evaluate the functioning of internal organs such as the liver or kidneys.
• Collecting bone marrow samples
  : this procedure is mandatory because this is where the disease begins to develop. Typically, samples are taken from the back of the pelvis or chest bones in two painful, simultaneous procedures. During aspiration, the patient lies on his side or stomach, the doctor cleans the skin of the thigh, numbs the tissue and inserts a thin needle into it, after which a small amount of liquid bone marrow is sucked out with a syringe. During a biopsy, the specialist also removes small pieces of bone using a thicker needle.
• Cerebrospinal fluid test
  - lumbar or spinal tap: ordered if a person has symptoms that may be caused by the spread of abnormal cells into the brain or spinal cord. To collect samples, the doctor numbs an area of ​​skin in the lower back above the spine and inserts a small needle into the area between the vertebrae.
• Molecular and genetic tests: needed to detect mutations, or changes, in genes. Doctors need such data to select the optimal treatment.
• Imaging tests - ultrasound, X-ray, MRI or PET scan: create images of the internal tissues of the body. They are not prescribed to detect leukemia per se, but to detect infections, other health problems, or determine how advanced the disease is if experts believe it has spread beyond the bone marrow.

Department of Oncohematology, Cancer Center Lapino-2.

List of sources

• Savchenko V.G., Parovichnikova E.N. Acute leukemia//Clinical oncohematology: a guide for doctors. Ed. Volkova M.A.. 2nd ed., revised. and additional 2007
• Blindar, Valentina Nikolaevna Algorithm for laboratory diagnosis of acute leukemia. Guide for doctors / Blindar Valentina Nikolaevna. — M.: Medical Information Agency (MIA), 2013
• Gavrilov, O.K. Bone marrow and peripheral blood cells / O.K. Gavrilov, G.I. Kozinets, N.B. Chernyak. — M.: Medicine, 2014
• Davidenkova, E.F. Clinic and genetics of leukemia / E.F. Davidenkova, S.I. Sherman, N.N. Kolosova. — M.: Medicine, 2010

Clinical symptoms

Acute leukemia can be asymptomatic or have a fairly acute onset. It all starts with intoxication syndrome due to increased breakdown of leukemia cells. Manifested by weight loss, loss of strength, general weakness, drowsiness, decreased appetite, nausea, vomiting, headache, high temperature (neoplastic fever), sweating (especially at night). In general, the picture of the disease has certain syndromes, including:

Immunodeficiency (caused by a sharp violation of cellular and humoral immunity due to the functional inferiority of leukocytes). It can manifest itself as sore throat, pneumonia and the presence of other infections (bacterial, viral, fungal).

Hyperplastic is caused by leukemic tissue infiltration and is represented by enlarged lymph nodes, tonsils, liver and spleen (hepatolienal syndrome).

Hemorrhagic (as a result of a decrease in the number of platelets, increased vascular permeability and impaired coagulation). It can manifest itself as subcutaneous hemorrhages and nasal, gastric, intestinal, renal, and pulmonary bleeding.

Anemic syndrome (caused by a decrease in the number of red hematopoietic cells). Presented with weakness, dizziness, tinnitus, darkening of the eyes, pale skin, tachycardia.

There are also secondary symptoms and syndromes that are not observed in all groups of patients, including:

- Osteoarticular - pain in bones and joints.

- Ulcerative-necrotic - stomatitis, gingivitis, tonsillitis.

- Damage to the genitourinary system - enlargement and hardening of the testicles or ovaries, urination disorders, possible hematuria, uterine bleeding.

- Damage to the digestive organs - dysphagia and obstruction of the esophagus, signs of gastric ulcer, necrotizing enterocolitis.

- Kidney damage - proteinuria, microhematuria, leukocyturia, signs of acute renal failure.

- Lung damage - cough, hemoptysis, shortness of breath, fine wheezing, signs of respiratory failure.

- Heart damage - signs of myocarditis, exudative pericarditis, arrhythmia.

- Skin damage - the appearance of leukemia - dense infiltrates (nodes) of different colors, which are often accompanied by itching.

https://repo.knmu.edu.ua/handle/123456789/3190