Therapy
Unfortunately, a cure for this disease is currently not possible. The therapeutic strategies aim at improving the quality of life (palliative therapy). Chemotherapy is also used here. In rare cases, irradiation of certain areas is also considered.
Forecast
According to current knowledge, chronic lymphatic leukaemia cannot be cured by medication. Only bone marrow transplantation represents a possible, but risky, curative, i.e. curable, therapeutic approach. Nevertheless, there have been many advances in the treatment of CLL in recent years.
In many cases, a combination of chemotherapy and so-called antibodies can slow down the progression of the disease considerably, so that patients can remain free of symptoms for a long time. However, as with any disease, it is very difficult to make generally valid statements regarding life expectancy or prognosis. However, various properties or characteristics of chronic lymphatic leukaemia allow conclusions to be drawn about the course of the disease.
These so-called “risk factors” can, for example, be determined as markers in the blood or as a feature on the leukaemia cells themselves. For example, an elevated ß2-microglobulin concentration in the blood is a rather unfavourable factor and indicates a rapid progression of CLL. The loss or replacement of individual gene segments of the leukaemia cells represents a special situation.
The so-called “17p deletion” and the “p53 mutation” are particularly relevant. Behind these rather bulky terms are genetic changes in the chromosomes of the leukaemia cells. These lead to a partly rapid, uncontrolled growth of the cancer cells.
If one of these mutations is detected in a CLL patient, more aggressive drugs are therefore used at an early stage. In addition to the characteristics of chronic lymphatic leukaemia per se, the general condition, age and previous illnesses of the affected person naturally also play an important role. Therefore, all possible concomitant diseases, such as high blood pressure or diabetes, are excluded before treatment.
In addition, an analysis of numerous laboratory values is carried out to detect, for example, possible reduced kidney or liver function. Not to be neglected are e.g. the age, but also the physical fitness of the patient. After all, the “fitter” the patients are at the initial diagnosis, the more likely they are to tolerate the chemo- and antibody therapy, which is rich in side effects. The Binet stage classification also serves as a rough guide to the prognosis. In principle, however, only the attending physician can make individual statements about the prognosis and life expectancy of the patients.
Staging
In order to ensure a uniform and generally valid classification of chronic lymphatic leukaemia, physicians in Europe have agreed on the so-called “Binet Classification”. For this purpose CLL is divided into 3 stages (A-C). To determine the stage, only a blood and lymph node examination is required.
Basically, the stages play an important role, especially for the beginning of the therapy. Thus, patients in stage A are only treated in exceptional cases. Patients in stage B receive therapy as soon as they feel symptoms.
Stage C is already referred to as advanced chronic lymphatic leukemia. As a rule, these patients are always treated. It is also true that life expectancy decreases as the stage increases.
Less common, but certainly applied, is the stage classification according to Rai. In contrast to the stages according to Binet, any enlargement of the liver or spleen is also included here. Stage 0: Exclusively elevated lymphocytes (subtype of white blood cells) Stage 1: + enlarged lymph nodes Stage 2: + enlargement of the liver and/or spleen Stage 3: + deficiency of red blood cells ( anaemia) Stage 4: + deficiency of platelets
- Binet A: Less than 3 enlarged lymph node regions, increased lymphocytes (subtype of white blood cells), no deficiency of red blood cells and platelets.
- Binet B: More than 3 enlarged lymph node regions, elevated lymphocytes (subtype of white blood cells), no lack of red blood cells and platelets. – Binet C: Red blood cell deficiency ( anaemia), platelet deficiency (thrombocytopenia), regardless of the number of enlarged lymph node regions.
