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Chronic Monocytic Leukemia

What is Chronic Monocytic Leukemia?

Chronic monocytic leukemia is a tumor process with a significant increase in the content of monocytic cells with normal or low leukocytosis.

Most often, elderly people, usually older than 50 years old, get sick with them; cases of illness in children of the first years of life are extremely rare.

Pathogenesis during Chronic Monocytic Leukemia

Many patients have long had no suppression of the erythrocyte and platelet germ of hematopoiesis, but sometimes anemia, which may remain the only manifestation of the disease, manifests itself early and does not respond to therapy. Since a significant increase in blood monocytes can accompany many other diseases (for example, tuberculosis, Waldenstrom macroglobulinemia, some types of cancer), the diagnosis of chronic monocytic leukemia requires more or less prolonged monitoring of the blood picture to exclude other somatic diseases.

Symptoms of Chronic Monocytic Leukemia

Chronic monocytic leukemia is characterized by slow progression for many months and even years. Its features are peripheral blood monocytosis, an increase in the content of monocytes in the bone marrow, and the absence of damage to other blood-forming sprouts.

Positive reactions to nonspecific esterase and naphthylaminase, a weakly positive reaction with Sudan Black, and an increase (tenfold compared with the norm) in the amount of lysozyme in blood serum and in urine are characteristic. In the late stages of the disease, anemia and thrombocytopenia join, in the hemogram single erythro- and normoblasts, promonocytes and monoblasts can be detected. Normo- or hyperchromic anemia is sometimes a long time – the only sign of the disease. In the bone marrow, suppression of erythro- and megakaryocytopoiesis is noted along with monocytosis, an increase in the number of promonocytes and monoblasts. Most patients have significantly increased ESR. An increase in the number of plasma cells and immunoglobulins can be observed, cases with monoclonal hypergammaglobulinemia are described. There is hyperplasia of the spleen, hepatomegaly, an increase in peripheral lymph nodes is less characteristic. In the terminal stage of the disease, young forms are sometimes found – promonocytes and monoblasts; against the background of deep thrombocytopenia, hemorrhagic syndrome often develops. Rarely fever, a tendency to infections.

Diagnosis of Chronic Monocytic Leukemia

Diagnosis of chronic monocytic leukemia is based on the detection of monocytosis in the blood and bone marrow (it may be less pronounced in the myelogram than in the hemogram); in bone marrow biopsy – polymorphic cell hyperplasia with diffuse proliferation of monocytopoiesis cells; high levels of lysozyme in blood serum and urine are characteristic. As already mentioned, in chronic myelomonocytic leukemia, the content of monocytes and myelocytes in the blood and bone marrow increases. Clinical symptoms are not much different from those observed in chronic monocytic leukemia.

Treatment of Chronic Monocytic Leukemia

The benign stage of chronic monocytic leukemia does not require any special treatment. Patients with anemia need repeated transfusions of red blood cells. With an increase in cytopenia or the appearance of hemorrhagic syndrome, small doses of glucocorticoids are usually prescribed. Those. treatment is symptomatic rather than etiotropic (aimed at the cause of the disease). T

The treatment of chronic monocytic leukemia in the expanded stage does not require special treatment, only with deep anemia, a periodic transfusion of the red blood cell is necessary. With an increase in thrombocytopenia and the appearance of hemorrhagic syndrome, it is advisable to prescribe small doses of corticosteroid hormones.

The terminal stage in chronic monocytic and chronic myelogenous leukemia requires the use of a combination of cytostatic drugs, usually used in the treatment of acute leukemia: vincristine and prednisolone, VAMP, cytosar and rubomycin.

The average life expectancy of patients with chronic monocytic leukemia is 5-10 years or more.