What is Chronic lymphocytic leukemia :
The white blood cells are the cells involved in the body’s defense. Within find different types of leukocytes such as polymorphonuclear leukocytes, lymphocytes or monocytes, each with a specific function within the immune system.
Leukocytes originate in the bone marrow cells from immature blasts that are known to create differentiating different types of leukocytes. When this occurs, for different reasons, a loss of control mechanisms of proliferation of these white blood cells of leukemia speech, ie cancer blasts leukocytes and their precursors.
Depending on the type of blasts in leukemia involving lymphatic leukemias are distinguished, if involved lymphoblasts, precursors of lymphocytes, or myeloid leukemias, whether they are the precursors of red blood cells, platelets and leukocytes from other cells that cause cancer.
Also, depending on your establishment and the proportion of mature and immature cells involved in leukemia, it may be acute, with a predominance of immature forms and rapid evolution, or chronic, with a greater number of mature cells and slower progression.
Therefore, when a patient suffers from a hematologic cancer cells where there is a predominance of mature lymphocytes, said pathology is classified as chronic lymphocytic leukemia.
How does it occur ?
Most of these chronic lymphatic leukemia are of unknown origin, although it is true that there is a familial incidence. It is the most common leukemia in the West and has a clear predominance of older persons, over 60 years in general and men. It is a quarter of all leukemias are diagnosed.
Cancer usually a type B lymphocyte immune defects, both in regard to the immunoglobulins that are on the surface and enable them to recognize antigens on their ability to produce antibodies and appropriately respond to factors that stimulate reproduction before immune system activation. For this reason, although there is a large number of lymphocytes in the blood, the body’s immune capacity is diminished.
There is a special form of chronic lymphocytic leukemia lymphocytes which are affected by cancer presents projections of cytoplasm elongated and narrow, like hair, which is why this type is known hematological cancer hairy cell leukemia or hairy (Greek trika hair).
Chronic lymphatic leukemia T cells are much less frequent. Highlights include forms of leukemia and adult T-cell lymphocytosis T large granular.
Chronic lymphocytic leukemia Symptoms
In the early stages of the disease by more than 70% of patients do not have any symptoms. As the disease progresses there is a picture of fatigue, weakness, weight loss and lack of appetite. Fatigue can be exacerbated by a state of anemia. As there is a great proliferation of lymphocytes altered autoimmune situations can arise, namely that these cancer cells produce antibodies against the body itself, usually against erythrocytes and platelets, so that phenomena can occur haemolytic anemia or autoimmune thrombocytopenia. In advanced stages, because of this lack of platelets can be bleeding and bruising, and recurrent infections due to immune system malfunction.
The altered cells invade other organs, especially lymph nodes causing lymphadenopathy, and liver or spleen, resulting in liver and spleen.
Not always, but sometimes chronic lymphocytic leukemia can be transformed into another entity, such as large cell lymphoma, a highly aggressive lymphoma, this transformation is called Richter syndrome and occurs in 3-4% of cases. The most frequent transformation prolymphocytic leukemia, which occurs in 10-20% of cases in which there transformation. However, these changes are rare, because most patients eventually die from the tumor or the immunosuppression involves the immune system malfunction.
The hairy one is characterized by pancytopenia, ie a decrease of all hematologic cell lines (erythrocytes, leukocytes and platelets) and massive splenomegaly. Often associated with autoimmune vasculitis, especially polyarteritis nodosa.
Chronic lymphocytic leukemia Diagnosis
The diagnosis of CLL is based on the analytical and bone marrow biopsy. In a number of cases the diagnosis be made through an incidental finding of elevated levels of lymphocytes to perform a blood test. The same can be detected down analytic both platelets and red cells in advanced stages.
Chronic lymphocytic leukemia should be suspected in elderly patients who present a picture of tiredness, weakness and loss of weight and appetite without other apparent cause. It should also be noted as diagnosis in patients or relate to explore one enlarged liver, spleen, or both.
There will be a blood smear to study cells and see their changes. It is quite common to find that the extension perform for microscopic observation blood lymphocytes breakage, leading to some known forms of Gumprecht spots or shadows.
When performing a bone marrow puncture generally level sternum or iliac crest, be appreciated that more than 40% of the cells are lymphocytes that occupy type B. Similarly, how are you cells will invade the interstitial space, respecting or not the fat that divides the spaces where blood cells are made. Genetic and cytological evidence that characterize cell proliferation characteristic of chronic lymphocytic leukemia.
Applies with regard to the diagnosis of hairy cell leukemia is based on the display characteristics of hairy cells in blood and bone marrow aspirates, usually dry, i.e. obtaining of material with low hematological large because of the fibrosis that occurs, a fact that will make it necessary the bone marrow biopsy.
Imaging tests such as computed tomography (CT) and ultrasound allow assessing the presence or absence of lymph node, liver or spleen.
There are two classifications of the evolution of chronic lymphocytic leukemia, stadiums that are relevant because they involve differences in median survival of patients. The international system is based on the number of lymphatic areas affected, and in the presence or absence of anemia, thrombocytopenia, hepatomegaly and splenomegaly. The classification of Rai, meanwhile, classifies the disease:
Stage 0, only the presence of more than 15,000 cells/mm3.
Stage I, lymphadenopathy added.
Stage II, with hepatomegaly, splenomegaly or both.
Stage III, with a hemoglobin less than 11 mg / dl in men and 10 mg / dl in women.
Stage IV, with platelet counts below the 100000/mm3.
Stage 0 is a survival of about 14 years, stages I and II of about 7.5 years and stages III and IV d approximately 2.5 years.
Chronic lymphocytic leukemia Treatment
If there are no symptoms is preferred therapeutic abstention. At the onset of symptoms, there will be chemotherapy, sometimes associated with radiotherapy, splenectomy or immunoglobulin treatments. If possible, you can raise bone marrow transplantation.
In the case of hairy cell leukemia is often choose splenectomy since most of the tumor mass usually found in this organ. Also available with chemotherapy and interferon treatment.
Precautions
Given the unknown in most cases of this condition, there are no preventive measures against it.