Acute and chronic: fundamental difference
These are not stages of one disease, but different diseases, and the word “acute” here does not mean the severity of the condition at the time of treatment, but the speed of development and the type of cells.
- Acute leukemia develops over weeks: the bone marrow is filled with immature cells, and hematopoiesis is quickly depleted. Treatment begins immediately, usually in a hospital
- Chronic leukemia develops over years and is often discovered by chance, in a blood test in a person without complaints
- Based on cell type, leukemias are divided into lymphoid and myeloid - both treatment and prognosis depend on this
- Acute lymphoblastic leukemia is the most common form in children, and with modern treatment, most of them recover
- Acute myeloid leukemia is more common in adults and requires more intensive treatment
- Chronic leukemia can move into a more aggressive phase over time, so observation is not stopped even if the condition is stable
- Chronic lymphocytic leukemia is more often detected after 60 years of age; with an asymptomatic course, treatment may not be required for years, and this is a deliberate tactic of observation, and not refusal of help
Surveillance tactics for chronic lymphocytic leukemia raise the most questions among patients: the diagnosis is made, but treatment is not prescribed. The logic here is that early initiation of therapy in asymptomatic patients does not increase life expectancy, but adds side effects. Therefore, the disease is monitored by tests and examinations, and treatment begins when indications appear - rapid growth of lymph nodes, decrease in hemoglobin and platelets, general symptoms.
Symptoms and why they are like this
Almost all manifestations are explained by one mechanism: altered cells displace normal hematopoiesis from the bone marrow, and the body consistently lacks all three types of blood cells.
- Lack of red blood cells: weakness, pallor, shortness of breath on exertion, dizziness, palpitations
- Lack of full-fledged leukocytes: repeated infections, prolonged sore throats, prolonged fever, stomatitis, poorly healing wounds
- Lack of platelets: bruises, pinpoint rashes, bleeding gums, nosebleeds, heavy periods
- Accumulation of cells in organs: enlargement of lymph nodes, liver and spleen, heaviness and distension in the abdomen
- Quick satiety and feeling of fullness after a small portion of food due to an enlarged spleen
- Shortness of breath and pallor that worsens over a matter of weeks and is not explained by exercise or a cold
- Pain in bones and joints, especially noticeable in children
- Common signs: weight loss, night sweats, lack of appetite
- Overgrowth and bleeding of the gums is a characteristic symptom of certain forms of acute leukemia.
- Headache, nausea, blurred vision due to damage to the membranes of the brain
- Skin rashes and indurations that do not respond to conventional treatment
The rate of occurrence of complaints is the most important guideline. In acute forms, a person can usually name almost the exact date when everything changed: a month ago he worked as usual, but now he cannot go up to the floor. In chronic forms, the picture is blurred, there may be no complaints at all, and the disease is detected during medical examination or preparation for surgery. Therefore, the doctor is interested not only in what is bothering him, but also from when.
Elevated white blood cells – is this leukemia?
This is the most common reason for panic after receiving a test in hand, and almost always in vain.
- Leukocytosis is a normal reaction to infection: with sore throat, pneumonia, appendicitis, leukocytes naturally increase
- The level increases under stress, after physical activity, during pregnancy, against the background of hormonal drugs, in smokers
- Not only the number matters, but also the leukocyte formula: which cells have grown and whether there are any immature forms among them
- The blast cells in the analysis are really alarming, very high numbers without signs of infection and a simultaneous decrease in red blood cells and platelets
- Persistent lymphocytosis in a person over 60 years of age, persisting for months without infection, is also alarming.
- Moderate leukocytosis, which lasts a week after a sore throat and then goes away, is a normal course and not a sign of illness
- Leukemia can occur with normal or even low leukocytes - the number itself does not solve anything
The procedure for dealing with an incomprehensible test is simple: do not look for an explanation on the Internet, but show the result to the doctor and, if necessary, retake it 1–2 weeks after recovery from the infection. Dynamics say much more than a one-time result.
How to make a diagnosis
Diagnostics is progressing: from simple and accessible to complex and clarifying. Each next step is taken only when the previous one has given grounds, so the examination is rarely redundant.
- Общий анализ крови с лейкоцитарной формулой и обязательным просмотром мазка врачом.
- Пункция костного мозга и трепанобиопсия — main метод: без них диагноз лейкоза не ставится.
- Иммунофенотипирование методом проточной цитометрии — определяет, of каких именно клеток исходит опухоль.
- Цитогенетическое и молекулярно-генетическое исследование: выявляет конкретные поломки, от которых зависят выбор препарата и прогноз.
- Биохимия крови, показатели работы почек и печени, ЛДГ, коагулограмма.
- УЗИ органов брюшной полости, КТ, при необходимости — исследование спинномозговой жидкости.
- Типирование пациента и близких родственников, если рассматривается трансплантация костного мозга.
- ЭКГ и оценка работы сердца до начала химиотерапии — часть препаратов требует такого контроля.
Today, genetic research of tumor cells is not a formality, but a part that determines treatment. The same disease in terms of external signs, with different breakdowns, is treated with different drugs and has a different prognosis. That is why several days pass between the first alarming analysis and the prescription of therapy: doctors are waiting for the results, without which the choice of treatment would be approximate.
Treatment today
Over the past twenty years, the treatment of leukemia has changed more than most other areas of medicine. The only approach - intensive chemotherapy for everyone - has been replaced by regimens selected for a specific genetic variant of the disease, and some patients today receive drugs in the form of tablets on an outpatient basis.
- Chemotherapy is the basis of treatment of acute leukemia, carried out in stages: achieving remission, consolidating the result, maintenance therapy
- Targeted drugs - specifically block a specific genetic defect in a tumor cell
- Immunotherapy and monoclonal antibodies
- Bone marrow transplantation at high risk of relapse and in certain forms
- Accompanying therapy: prevention and treatment of infections, transfusion of blood components, support for kidney function - it is no less important than the main treatment
- Prevention of damage to the membranes of the brain in forms prone to such spread
- Regular monitoring of residual traces of the disease after achieving remission - it is used to decide whether to change tactics
Results vary greatly across forms. Childhood acute lymphoblastic leukemia and acute promyelocytic leukemia are among those diseases where recovery has become a common outcome. In other forms, the goal may be different - long-term control of the disease with preserved quality of life, and this is also a full-fledged result of treatment, and not a half-measure.
What is known about the reasons
The question “why did this happen” is asked by everyone, and the honest answer most often sounds the same: it is impossible to establish a specific reason. This is difficult to accept, but important - because the search for someone to blame usually ends with a feeling of guilt on the part of the patient himself or his parents, and there is no reason for this.
- In most cases, it is impossible to determine the specific cause: the breakdown occurs in one cell by chance
- Known factors: ionizing radiation, previous chemotherapy and radiation therapy
- Prolonged contact with benzene and a number of industrial chemicals
- Smoking is a proven factor for some myeloid leukemias
- Some congenital genetic syndromes
- Age: the risk of most forms increases after age 60
- Pre-existing bone marrow diseases, particularly myelodysplastic syndrome
- Long-term use of immunosuppressive drugs after organ transplantation
- Certain chromosomal features detected at birth increase the risk in children
Separately, it is worth saying that this is not the reason. Neither household appliances, nor mobile phones, nor a microwave oven, nor vaccinations, nor stress or fear lead to leukemia - these are persistent fears that have no confirmation. Prevention in the usual sense does not exist for most forms, and the only thing that is really in a person’s hands is not to ignore changes in health and take a general blood test at least once a year.