Terminal Stage

The terminal stage of CLL was more often manifested by cachexia, transformation into lymphosarcoma, “prolymphocytic crisis” was observed only in two patients, “blast crisis” CLL was not registered. In the vast majority of cases, the bronchopulmonary complications of hemoblastosis were the direct cause of death – 59.9%. In 23.8% of cases, death was due to concomitant cardiovascular pathology (ischemic heart disease, myocardial infarction, hypertensive disease).

The classification of J. Binet (1981) is taken as a basis when dividing patients with CLL into three groups, since it allows staging of hemoblastosis taking into account the stages of tumor progression.

Group I (48 people) – CLL patients in stage A according to J. Binet classification. In 39 patients with CLL, blood samples showed moderate leukocytosis and absolute lymphocytosis, the lymph nodes of all groups were of normal size. In 9 patients, except for leukocytosis and lymphocytosis, an increase in peripheral lymph nodes (1-2 groups) up to 2 cm in diameter, soft-elastic consistency; but for many years they have not experienced progression of the disease. No patient in group I had splenomegaly, anemia and thrombocytopenia. Thus, group I consisted of patients with a benign form of the disease. Course cytostatic therapy was not prescribed to these patients. They were monitored dynamically, sometimes given primary restraint therapy with chlorambucil. The average age of patients of group I is 58.7 ± 2.0 years,longevity is the same as in the population.

Group II – 112 people. This group includes patients with stage B according to the classification of J. Binet. The majority of patients belonged to the progressive and splenic (partially tumor) forms according to A.I. Vorobyov et al. (1985 – 2005). These patients were characterized by high leukocytosis, increasing lymphadenopathy (an increase in more than three groups of lymph nodes), splenosis and hepatomegaly. In blood tests, Hb values> 100 g / l and platelets> 100 × 10 9 / l. Lymph nodes were of a soft-elastic consistency, painless, not welded between themselves and the surrounding tissues. With the progression of CLL, infectious complications developed. In 80 patients of group II, according to ERTGS and CT, an increase in mediastinal lymph nodes was diagnosed. The average age of patients in group II was 58.5 ± 3.2 years. The median survival is 97 months.

Group III included 68 patients. This group consisted of patients in stage C according to the classification of J. Binet. The majority of patients belonged to the A.I. Vorobyov et al. (1985 – 2000). This group included 6 patients with the spleen form of CLL, all patients with abdominal, bone marrow and pro-lymphocytic forms of hemoblastosis, as well as patients who at the time of the survey were diagnosed with Richter syndrome. In all patients, anemia was diagnosed in blood tests (HB <100 g / l), in 33 patients thrombocytopenia (Tr <100 × 10 9 / l) Patients of group III are characterized by increasing lymphadenopathy (the lymph nodes reached considerable size, had a dense elastic consistency, were soldered to conglomerates), hepato-and splenomegaly, the appearance of pronounced symptoms of tumor intoxication, frequent infectious complications, the development of auto-immune complications, often there was a transformation into large – cellular lymphoma. In a number of patients of the third group, high leukocytosis with atypical lymphocyte morphology was noted. In all patients of group III, CT and ERTG of the mediastinum were shown to show an enlarged lymph nodes. The average age of patients in group III was 61.2 ± 5.5 years. Median survival – 43 months.

Leave a Reply

Your email address will not be published. Required fields are marked *