Introduction to chronic leukemia

Introduction Chronic leukemia is divided into chronic myeloid leukemia and chronic lymphocytic leukemia. The main manifestations are lymphadenopathy, often accompanied by hepatosplenomegaly, anemia and bleeding, and a small number of patients are also associated with skin damage. There are many elderly people in this disease, occasionally young people, more men than women. According to the characteristics of clinical lymphadenopathy, hepatosplenomegaly and fatigue of chronic leukemia, it belongs to the category of "symptoms", "accumulation", "sputum" and "labor" of traditional Chinese medicine. Pathological Overview Chronic myeloid leukemia, referred to as chronic myelognous leukemia (CML), is a clinically invasive and relatively slow-developing leukemia. He is a malignant proliferative disease originating from bone marrow pluripotent hematopoietic stem cells, which is characterized by expansion of the myeloid progenitor cell pool and excessive growth of the myeloid cell line and its progenitor cells. More than 90% of cases have CML marker chromosomes - the molecular biology of the ph1 chromosome is the ber/abl gene rearrangement. Clinically, CML is characterized by fatigue, weight loss, fever, splenomegaly and abnormal increase of white blood cells. The incidence of CML worldwide is not consistent. The incidence of CML incidence in China is 036/100,000 per year. In China, CML accounts for about 20% of all types of leukemia and 95% of chronic leukemia. The age of onset is widely distributed, but the incidence rate gradually increases with age. The incidence of men is higher than that of women. Chronic lymphocytic leukemia, referred to as chronic lymphoblastic leukemia (CLL), is a disease in which the lymphocytes of the body are abnormally proliferated and accumulating with low immune function. The incidence of CLL in China is low, generally accounting for less than 10% of the total number of leukemias, ranking fourth in the leukemia type. Because of the extremely long lifespan of lymphocytes in patients with CLL, and often accompanied by defects in immune response, it is also called "immune incompetent lymphocyte accumulation disease." Pathological etiology 1, Chinese medicine 1 seven emotions internal injuries, emotional dissonance, poor air-conditioning, liver qi stagnation, qi stagnation for a long time, then qi stagnation and blood stasis, collaterals converge, blood stasis, long accumulation of blocks. 2 eating disorders, over-eating fat and wine, hurt the spleen and stomach, spleen and dysfunction, lose the fluid without weight, wet turbidity endogenous, condensed into a product, sputum gas, blood flow is not smooth, sputum endogenous. 3 is impermanent, the cold temperature is not adjusted, and the external evil is felt. 2, Western medicine (a) the pathogenesis of chronic myeloid leukemia (1) cytogenetics (2) G-6-PD isoenzymes (3) cell dynamics (4) spleen factors spleen in the pathogenesis of CML Role, many experimental and clinical observations indicate that the spleen is conducive to leukemia cell migration, proliferation and rapid changes. The granulosa cell proliferation state is different. The spleen not only "captures" leukemia cells, but also is a "warehouse" and a "concealed place" of leukemia cells, and provides a favorable environment for its proliferation and metastasis, and makes leukemia cells in the bone marrow. The round-trip circulation between the blood and the spleen increases, and the normal release regulation process of the cells is destroyed. (B) the pathogenesis of chronic lymphocytic leukemia (1) chromosomal abnormalities (2) cloning of leukemia (3) abnormal cell dynamics pathological classification: chronic leukemia, divided into chronic myeloid leukemia and chronic lymphocytic leukemia. 1. Fever: It is a common symptom of this disease. Low fever is more common in the disease, and high fever is often caused by infection. The site of infection usually occurs in the mouth, respiratory tract, urinary tract, perianal and skin. 2. Bleeding: It can occur in any part of the skin and mucous membranes in the whole body. In severe cases, there may be visceral hemorrhage and even fatal intracranial blood. 3. Anemia: Most patients have varying degrees of anemia. It is pale, dizzy, weak, and short of heart. Clinical manifestations 1. Clinical manifestations Patients are mostly elderly, with very slow onset, often without self-conscious symptoms, and occasionally confirmed by laboratory examination. (1) Symptoms: early fatigue, fatigue, dizziness, palpitations, shortness of breath, weight loss, low fever, night sweats, skin purpura, itchy skin, bone pain, often susceptible to infection, about 10% of patients can be complicated by autoimmune hemolytic anemia. (2) Signs: 1 lymph node enlargement, the most common lymph node enlargement in the neck, followed by axillary, groin and trochlear lymph nodes, generally moderate hardness, smooth surface, no tenderness, no redness and no adhesion of the epidermis. If the mediastinal lymph nodes are swollen, compression of the bronchi causes coughing, hoarseness or difficulty breathing. CT scan revealed a retroperitoneal, mesenteric lymph node enlargement. 2 hepatosplenomegaly: mild hepatic swelling, splenomegaly accounted for about 72%, usually 3 to 4crn under the ribs, individual patients can flatten the umbilicus, swelling is less than chronic myeloid leukemia. 3 skin damage: skin thickening, nodules, so that systemic erythroderma can occur. 2, laboratory examination (1) blood: the total number of white blood cells is often > 15 × 109 / L, generally in the range of 30 × 109 / L ~ 200 × 109 / L, about 80% ~ 90% of the classification of mature small lymphocytes, a small amount Heterotypic lymphocytes and young lymphocytes, broken cells are easy to see on blood, and hemoglobin and platelet counts may decrease as the disease progresses. Anemia is positive cells, positive pigmented anemia, and reticulocytes are elevated when hemolyzed. (2) Bone marrow: It shows that hyperplasia is active, lymphatic system predominates, mature small lymphocytes account for 50% to 90%, occasionally primitive and immature lymphocytes, and red, granulocyte and giant three-cell cells are significantly reduced in the late stage. When there is hemolysis, erythroid cells can show compensatory hyperplasia. (3) Immunological examination: the cell surface marker has monoclonality, and the cells have immunological characteristics of chronic lymphocytic leukemia (Sig, CD5, C3d, CD19, CD20, CD4, rat red blood cell rose petal receptor is positive), individual patients Monoclonal immunoglobulins are visible in the blood. The anti-human globulin test was positive at the time of hemolysis. (4) Cytogenetics: About half of chronic lymphocytic leukemias have chromosomal abnormalities. The most common number abnormality is the addition of a chromosome 12 (+12), followed by the supernumerous number 3, 16, or 18. Common structural abnormalities are the translocation of the long arm of chromosomes 12 and 11, the deletion of the short arm or long arm of chromosome 6, the deletion of the long arm of chromosome 11, and the increase of chromosomes such as the increase of the long arm of chromosome 14. It has been reported that patients with chronic lymphocytic leukemia with "+12" have a significantly shorter period of time from the diagnosis to the clinical signs of treatment indications than the control group without "+12", so it is considered that "+12" seems to be short and the course of disease is poor. The prognosis is related. (5) Biochemistry and histochemistry: The lymphocyte PAS reaction was strongly positive, and about one-third of patients had positive Coomb's test. Some patients have hypogammaglobulinemia, and the conversion rate of phytohemagglutinin (PHA) is significantly reduced. 3. Chronic lymphocytosis: Chronic lymphocyte acute changes are rare, and the time to rapid changes can vary from 1 to 20 years. Acute lymphoblastic leukemia, acute myeloid leukemia, acute monocytic leukemia, stem cell leukemia, acute plasma cell leukemia and erythroleukemia can occur. Once a sudden change occurs, it often dies quickly. Diagnostic criteria (1) Clinical manifestations: 1 may have fatigue, decreased physical strength, weight loss, hypothermia, anemia or bleeding. 2 may have lymph nodes (including head and neck, armpits, groin), liver, splenomegaly. (2) Laboratory examination: 1 peripheral blood WBC>10×109/L, lymphocyte ratio ≥50%, absolute value≥5×109/L, the morphology is mainly mature lymphocytes, visible immature lymphocytes or atypical lymphoid cell. 2 bone marrow: bone marrow hyperplasia is active or significantly active, lymphocytes ≥ 40%, mainly mature lymphocytes. (3) Immunophenotyping: 1B-CLL: mouse rosette test positive: SIg weakly positive, showing K or λ monoclonal light chain; CD5, CD19, CD20 positive; CD10, CD22 negative. 2T-CLL: Sheep rosette test positive: CD2, CD3, CD8 (or CD4) positive, CD5 negative. (4) Morphological classification: B-CLL is divided into three subtypes: 1 typical CLL: more than 90% are similar mature small lymphocytes. 2CLL is associated with juvenile lymphocytosis (CLL/PL): immature lymphocytes >10%, but <50%. Lymphocyte Read more...