The rapid growth of lymph nodes and their acquisition of stony density, compression and infiltration of neighboring organs and tissues with edema and pain syndrome are characteristic of the malignant transformation of Richter syndrome CLL (transformation into large cell lymphosarcoma). The development of large-cell lymphosarcoma in patients with mature cell lymphoproliferative diseases is a poor, prognostic sign and, as a rule, is accompanied by worsening of the condition, the appearance of common symptoms and generalization of the extramedullary tumor process. Life expectancy after the discovery of a large-cell lymphosarcoma usually does not exceed six months, despite the use of methods of combined chemotherapy adequate for high-grade lymphomas. At the same time, according to the data, the development of large cell lymphosarcoma in CLL patients does not always mean the later stage of the tumor progression, the terminal state and poor prognosis.

According to the author, the life expectancy of CLL patients after verification of Richter syndrome ranged from 3.5 months to 9 years. At this stage of the disease, compression with enlarged lymph nodes of the bronchi and lung tissue is most likely, accompanied by impaired ventilation of the lungs and the drainage function of the bronchi. A number of authors point to the possibility of significant compression by the transformed lymph nodes of the trachea and bronchi, causing dyspnea and asthma attacks, described a case of an isolated lesion of a bronchial tree with endobronchial tumor growth in Richter syndrome. The possibility of compression and rupture of the thoracic lymphatic duct in patients with CLL is noted. But this complication in CLL is rare, much more often it is characteristic of non-Hodgkin’s lymphomas and lymphogranulomatosis.

Emphasizes the need for strict implementation of recommendations for examination of the organs of the thoracic cavity in patients with systemic lymphoproliferative diseases. Sometimes it is necessary to apply such diagnostic methods as radiography of the chest, image diagnostics, helium-67 scanning, positron emission tomography, lymph node biopsy.

Chronic lymphocytic leukemia (CLL) is one of the most common forms of hemoblastosis. According to a number of specialists, the proportion of CLL in the structure of this pathology is 30–40%. CLL is a benign tumor, the substrate of which is predominantly morphologically mature lymphocytes. The disease is manifested by lymphatic leukocytosis, diffuse lymphocytic proliferation in the bone marrow, enlarged lymph nodes, liver and spleen.

The main manifestations of CLL are caused by the proliferation of mature lymphocytes belonging to a small subpopulation of CD 5+ B lymphocytes. Along with an increase in the number of lymphocytes in the blood, an increase in lymph nodes, liver, spleen, the presence of a large number of autoimmune complications (autoimmune hemolytic anemia and autoimmune thrombocytopenia) is a specific feature of the pathogenesis of this disease. In the overwhelming majority of cases, the B-cell variant of CLL occurs; the T-cell variant of CLL occurs very rarely, in 2–5% of cases. B-cell CLL is traditionally considered a disease of the elderly. Often the disease is benign; over the course of many years, the progression of the tumor process has not been observed even in the absence of primary restraint therapy. But there may be a rapidly progressive course of the disease when death occurs within 1 to 2 years.

CLL is a heterogeneous disease that has many forms with different clinical manifestations, the duration of the disease and the response to therapy. There are several clinical classifications of CLL. Abroad mainly use classifications. These classifications are designed for staging CLL, taking into account tumor progression. In Russia, in the majority of cases, the classification allows for differentiated therapy of hemoblastosis to be distinguished from a benign, progressive (classical), tumor, spleen-night, abdominal, bone marrow, pro-lymphocytic forms. Some authors suggest to distinguish different types of disease in the CLL classification . Therapy for CLL is constantly being improved.

In addition to tumor progression, a significant factor affecting the life expectancy of CLL patients is the development of secondary immunodeficiency, manifested by infectious complications of various localization. The problem of infectious complications in none of the hemoblastoses has such independent and decisive significance as in chronic lymphocytic leukemia. Modern cytostatic therapy allows to significantly control tumor growth in CLL.

At the same time, success in treating patients with this disease is often determined by the possibilities of timely prevention of infectious complications, by the adequacy and timeliness of therapy. Infectious complications in this disease occur in 52 – 86% of patients. In 69.8 – 85% of cases, they are the direct cause of death. The increased susceptibility of such patients to infections is defined by the term “infectivity”. The susceptibility of CLL patients to various infections manifests itself already in the initial stage of the disease. Infectious complications occur even in patients with a benign variant of CLL. As the tumor progression syndrome develops in CLL, the frequency of infectious complications increases.

In the early stages of tumor progression, increased infectivity is associated with defects in the immune response, impaired interaction of T and B lymphocytes, and the development of hypogammaglobulinemia. Immune insufficiency in CLL patients is characterized by a defect in the humoral linkage with symptoms of panhypo immunoglobulinemia, an imbalance of T lymphocytes, characterized by an increase in the number of T suppressors (CD8 + cells) and a decrease in the number of T helper cells (CD4 + cells), impaired phagocytic complementary link; the degree of these changes increases with the development of the disease.

With the progression of CLL, repeated and protracted infectious processes can contribute to their short treatment due to inadequate antibiotic therapy. Cytostatic therapy has a inhibitory effect on the number of T-lymphocytes and neutrophil phagocytic activity. The use of traditional cytostatic treatments (cyclophosphamide, chlorbutin, prednisone) leads to a decrease in the total number of T- and B-lymphocytes.

Among all infectious complications of CLL, the most common inflammatory nonspecific pulmonary-pleural diseases (from 50 to 80% of all infectious complications of CLL) are pneumonia, tracheitis, bronchitis, bronchiolitis, pleurisy.

A high incidence of AML is observed in persons living in areas of high latitudes. In the Amur region, NZL are characterized by a more severe and protracted course. In the structure of morbidity in the Amur region, among respiratory diseases, pneumonia occupies a special place, a high level of the disease was noted in most regions of the region. Severe AML in the high latitudes contributes to the formation of pulmonary and cardiac insufficiency in these patients. This is due to many factors, primarily, the climatic and geographical conditions of the Amur region and the influence of low temperatures on the human immunological reactivity. Low temperature and high relative humidity of the air contributes to the formation of airway hyperresponsiveness in the population living in these climatic conditions. Because of this, a large role is played by methods of detecting premorbid conditions of chronic nonspecific lung diseases.

The occurrence and protracted course of infectious diseases of the respiratory tract is also promoted by the increase in paratracheal and bronchopulmonary lymph nodes in most CLL patients, which disturb the drainage function of the bronchi, ventilation and blood circulation in the lungs. For the most part, peripheral lymph nodes are larger than the intrathoracic, but reverse relationships can also occur. The severity of mediastinal lymphadenopathy depends on the stage of development of the tumor process.

Lymphadenopathy in patients with CLL is mainly peripheral. In this case, for the first time, patients come to a doctor for the first time. Only a few of them at this time radiographically determine the increase in mediastinal lymph nodes. Later, in the advanced stage of the disease, mediastinal lymphadenopathy is detected in more than half of the patients, sometimes reaching considerable sizes. Hyperplasia of the intrathoracic lymph nodes is observed in 63.9% of cases, at autopsy – in 73% of cases. However, even with a significant increase in lymphoid organs, the development of a compression syndrome is not characteristic of the classical course of CLL.