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Chronic lymphocytic leukaemia (CLL) is one of the most common oncohaematological diseases. It originates in the bone marrow. The illness causes abnormal production of immature blood cells (atypical B-lymphocytes). It mostly affects mature and elderly people. Men are twice as likely to be diagnosed as women. CLL is a slowly progressive form of blood cancer with a fluctuating course. Patients have well-defined periods of increasing and decreasing symptoms. Tactics and treatments for this pathology are considered on a patient-by-patient basis. Read our article about the most effective treatments for this type of leukaemia, where they are available abroad and how much they cost.

 

 

What are the symptoms of lymphocytic leukaemia?

лимфолейкоз

Lymphocytic leukaemia is the most common type of leukaemia in adults. The disease produces immature lymphocytes that accumulate in the bone marrow. Once in the bloodstream, they disturb various organs (spleen, liver, lymph nodes, etc.). The number of abnormal cells increases slowly, allowing the disease to be asymptomatic for a long time.

 

As leukaemia progresses, patients develop lymphostasis – the accumulation and retention of lymphatic fluid in the tissues. This is manifested by persistent swelling of the limbs and ulceration of the skin.

 

Patients also show increased susceptibility to infections, profuse sweating, palpitations, constant fatigue and irritability. The lymph nodes, spleen and liver may enlarge greatly, leading to signs such as:

 

    иконка галочки pain and heaviness in the left or right subcostal area,  

    иконка галочки nausea and vomiting,  

    иконка галочки elevated body temperature,  

    иконка галочки stool changes,  

    иконка галочки itching and jaundice of the skin,  

    иконка галочки severe weight loss.

 

In the advanced stages of CLL, people become severely anaemic and their platelet counts drop significantly. This causes patients to feel tired and dizzy all the time, and have spontaneous haemorrhages of the internal organs, muscles, joints, skin and mucous membranes.

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Stages of chronic lymphocytic leukaemia

Two staging systems, Binet and RAI, are commonly considered for CLL. The first classification divides the disease into 3 groups: A, B and C. These are distinguished by the number of enlarged lymph nodes and the presence of anaemia or thrombocytopenia.

 

Stages A and B occur without a decrease in haemoglobin and/or erythrocyte counts per unit of blood volume and a decrease in platelet counts. The main difference is the extent of damage to the lymphatic system. Stage A is characterised by an increase in 1-3 groups of lymph nodes, while in stage B more than three areas are involved.

    In stage C, the number of enlarged lymph nodes is irrelevant. These patients have signs of anaemia and thrombocytopenia. There is an enlargement of the spleen and/or liver.

 

The RAI system involves dividing chronic lymphocytic leukaemia into five stages (0 to 4). In the initial stages of the disease, there are no symptoms. Patients have a 40% increase in the number of lymphocytes in the blood and bone marrow. There is slight damage to the lymph nodes. From stage 2 onwards, the spleen and liver enlarge, and in stages 3 and 4, anaemia and thrombocytopenia develop.

How is chronic leukaemia diagnosed?

диагностика лимфолейкоза

First of all, chronic lymphocytic leukaemia can be identified by a peripheral blood count (haemogram) and bone marrow count (myelogram). The results of the examination show absolute lymphocytosis. 

 

An example of a blood test for chronic lymphocytic leukaemia: The number of B-lymphocytes is increased to or greater than 5×109/l. 

 

Immunophenotyping is performed to confirm the diagnosis. This is a procedure that uses monoclonal antibodies to identify blood cells based on the types of antigens or markers on their surface. This method makes it possible to identify and/or count groups of white blood cells. It allows doctors to accurately determine the type of leukaemia, assess the patient’s health status and predict the progression of the disease.

 

In addition, patients undergo chest X-rays, abdominal ultrasounds and CT scans. These tests can detect complications caused by lymphatic leukaemia, such as the enlarged spleen, liver and lymph nodes. They can also rule out other possible causes of the symptoms.

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What is the most effective treatment for chronic lymphocytic leukaemia?

 

Lymphatic leukaemia usually develops slowly. It can remain stable for years, even throughout the patient’s whole life. Therefore, once the diagnosis is made, treatment may not be carried out immediately. Initially, the patient’s condition may remain monitored. 

 

Active progression of the condition, with frequent periods of exacerbation and deterioration in the person’s well-being, is an indication for a change from observation to conservative treatment.

 

Chemotherapy and bone marrow transplants are considered to be among the most effective options to fight the disease. The anti-tumour treatment of lymphatic leukaemia is carried out in full compliance with the international protocols established by the NCCN, ENA, ESMO, etc. 

лечение лимфолейкоза

 

The most effective chemotherapy regimen is FCR. It involves a combination of three drugs. They are administered over a 28-day treatment cycle. This oncotherapy can achieve remission in 85% of patients. 

 

Bone marrow transplantation (BMT) is used when a patient wants to get rid of CLL completely or to gain a longer control over the disease than chemotherapy can offer. Donors can be first-line relatives or unrelated individuals who match the genotype.

 

Before BMT, the patient usually undergoes high-dose chemotherapy. This is an intensive treatment that is not always possible for older patients in a weaker general condition. Therefore, BMT is not often performed, although transplantation is considered to be the only potential cure for lymphatic leukaemia.

    In 2014, the US Food and Drug Administration (FDA) approved the use of a tyrosine kinase inhibitor (the targeted drug Ibrutinib) in patients with chronic lymphocytic leukaemia who have failed at least one course of anti-tumour treatment. The drug is less toxic than chemotherapy. It can alleviate symptoms and prolong the life of patients, even those with an unfavourable prognosis.

 

Radiotherapy to shrink the lymph nodes and spleen is given as palliative treatment. Blood transfusions may also be given to improve the blood count. In some cases, antibacterial, antifungal and antiviral drugs are indicated. These help to reduce the risk of infection. Sometimes patients may have their spleen removed.

The prognosis for chronic lymphocytic leukaemia

прогнозы при лимфолейкозе

Chronic lymphatic leukaemia is an incurable disease. It can last for years without progression, or it can affect the body rapidly.

 

In 10% of cases, it has a slow course and may allow the patient to live more than 20 years from the time of diagnosis without causing serious problems. These patients often die not from lymphatic leukaemia, but other diseases related to old age or other causes.

 

In 15%, CLL develops rapidly. Life expectancy, in this case, is approximately 2-3 years. In 75% of patients, lymphatic leukaemia progresses for 5-10 years. After this, they will enter the terminal stage of the disease, which can last for several more years.

How much does it cost to treat chronic lymphocytic leukaemia abroad?

The price of treatment for lymphocytic leukaemia varies according to many criteria, the main ones being: the severity of the pathology, how the disease is treated, the level of the clinic, the doctor’s fees, etc. The approximate cost of medical services for this cancer abroad is as follows:

Turkey

ProcedureCost
Chemotherapyfrom $1,900
BMT from a related donorfrom $65,000
BMT from an unrelated donorfrom $95,000

Israel

ProcedureCost
Chemotherapyfrom $2,900
BMT from a related donorfrom $150,000
BMT from an unrelated donorfrom $190,000

Spain

ProcedureCost
Chemotherapyfrom €2,500
BMT from a related donorfrom €152,500
BMT from an unrelated donorfrom €175,000

South Korea

ProcedureCost
Chemotherapyfrom $2,100
BMT from a related donorfrom $160,000

Where is chronic lymphatic leukaemia treated abroad?

The No. 1 choice among patients with lymphocytic leukaemia is Turkey. The clinics in this country have everything you need, from the new generation of antitumor drugs to onco-haematologists with more than 20 and 30 years of experience. Professor Yener Koc is considered to be one of such specialists. He practises at the Medikana International Hospital Istanbul. He is the founder of the Bone Marrow Transplant Centre and one of the leading experts in the field. Around 2,000 transplants have been performed under his leadership. 

 

Also, top Turkish clinics for the treatment of chronic lymphocytic leukaemia include:

 

 

 

 

In Spain Professor José Rifón Roca, a renowned onco-haematologist, treats patients with CLL. He is head of the haematopoietic transplant unit at the University Hospital of Navarra. The doctor specialises in bone marrow transplants. He has been practising for over 28 years.

 

The Teknon Clinic and the University Hospital of Chiron Madrid also perform well in the treatment of lymphocytic leukaemia. Here, the cost of a bone marrow transplant from a first-line relative starts at €190,000 and from an unrelated donor at €220,000. 

 

 

In Israel and South Korea, treatment for chronic lymphocytic leukaemia of any stage is available at leading general medical centres, in particular:

 

 

 

    Resume

    иконка галочки Lymphocytic leukaemia is a chronic oncohaematological disease that predominantly affects people over the age of 40. Men are twice as likely to become ill as women. It is characterised by an increased number of immature B-lymphocytes in the bone marrow and blood. 

    иконка галочки A blood test can detect lymphocytic leukaemia. It shows a 40% rise in the lymphocyte count. The disease is treated with chemotherapy and bone marrow transplantation. Some patients may be treated with targeted drugs, blood transfusions and pharmacotherapy. 

    иконка галочки More than half of patients with CLL live approximately 8-10 years after diagnosis. Approximately 10% of patients survive past the 20-year mark, and 15% of those with an aggressive form of lymphatic leukaemia live for around 2-3 years. 

    иконка галочки For treatment of lymphocytic leukaemia patients are referred to medical centres in Turkey, Israel, Spain and South Korea. Among the clinics in these countries, the most popular are Medicana, Koç, Memorial, Ichilov, Medistate, SoonChunHyang, Medipol, Sheba, Hadassah, Teknon, Quiron Madrid and Uniclinica Navarra. 

To travel to a leading clinic abroad for treatment of chronic lymphocytic leukaemia, please contact the medical coordinators of the international medical platform MediGlobus.

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