Akutna limfoblastna leukemija

Branka Toljić; Snežana Stojanović-Ristić

doi:10.5937/opmed29-43121

Branka Toljić Zavod za zdravstvenu zaštitu studenata, Beograd
Snežana Stojanović-Ristić Zavod za zdravstvenu zaštitu studenata, Beograd

DOI: https://doi.org/10.5937/opmed29-43121

Ključne reči: leukemija, mlada osoba, rana dijagnostika

Sažetak

Uvod. Akutna limfoblastna leukemija (ALL) je heterogena bolest koju karakteriše klonalno bujanje i nagomilavanje nezrelih limfoidnih ćelija u koštanoj srži i limfoidnim organima. Etiologija nastanka nije poznata, ali se u vezu dovode izloženost radijaciji, određenim hemikalijama i genetika. Bolest karakteriše nagli početak. U kliničkoj slici prevladava prisustvo opštih simptoma: umor, malaksalost, noćno znojenje, gubitak telesne mase, febrilnost. Dijagnoza se postavlja na osnovu anamneze, fizikalnog nalaza, analize krvi, biopsije koštane srži, citogenetskih i imunohistohemijskih testiranja. Osnovu lečenja čini polihemioterapija, radioterapija, transplantacija matičnih ćelija hematopoeze.

Prikaz bolesnika. U radu je prikazan pacijent starosti 20 godina. Prvi put se javio lekaru zbog bola u vratu. Lečen je od strane fizijatra. Nakon završene fizikalne terapije, u krvnoj slici je viđena pancitopenija. Izabrani lekar ga upućuje hematologu gde bivaju nastavljena ispitivanja i postavljena dijagnoza ALL. Lečenje je započeto hemioterapijom po predviđenom protokolu. Potom je urađena srodna alogena transplantacija matičnih ćelija hematopoeze. U daljem kliničkom toku rađene su redovne hematološke procene i procena MRD nalaza. Sve vreme se održavala morfološka kompletna remisija, ali uz pozitivan MRD nalaz. Primenjena je terapija monoklonskim antiCD22 antitelom na koju je dobro odgovorio. Osam meseci kasnije se utvrđuje relaps B-ALL. Dolazi do pogoršanja opšteg stanja bolesnika i uprkos primenjenoj intenzivnoj terapiji dolazi do nastupanja letalnog ishoda.

Zaključak. Akutna limfoblastna leukemija je bolest čiji ishod zavisi od mnogobrojnih faktora. Zbog atipične simptomatologije treba razmišljati o ovoj bolesti kako bi se skratilo vreme do postavljanja dijagnoze, omogućilo pravovremeno lečenje, a samim tim uticalo i na ishod bolesti.

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