Malignant Neoplasms of the Hematopoietic and Lymphatic Systems

Malignant neoplasms of the hematopoietic and lymphatic systems, or hemoblastoses, are a group of diseases that affect the bone marrow, blood cells, and hematopoietic system. As a result, the functioning of the hematopoietic system is disrupted, and the body stops producing leukocytes, platelets, and erythrocytes in the required amounts. Instead, abnormal white blood cells are formed. If medical help is not sought in time, tumor cells can spread to the kidneys, liver, lungs, spleen, and other organs. In this article, we will take a closer look at the methods of diagnosing and treating malignant neoplasms of the hematopoietic and lymphatic systems.

Classification of Hemoblastoses

Depending on the localization of the mutated cells, hemoblastoses are divided into two major groups:

• Leukemias — cancer cells form in the bone marrow.
• Lymphomas — malignant lymphocytic cells are localized in the lymph nodes, but other organs may also become involved in the process.

Based on the rate of progression, lymphomas are classified into three forms:

• Indolent. These are incurable, characterized by a slow progression, and may transform into aggressive forms. Without treatment, a patient may live for 7 to 10 years.
• Aggressive. These are characterized by rapid progression; lymphomas quickly become evident (e.g., swollen lymph nodes). Without treatment, the patient’s life expectancy is about 1–2 years.
• Highly aggressive. These require high‑dose chemotherapy combined with hematopoietic stem cell transplantation. Without treatment, life expectancy is no more than 2 years.

Lymphomas develop from different types of cells, so they respond to treatment differently. With proper therapy, there is a high chance of complete recovery.

Causes of Malignant Neoplasms of the Hematopoietic and Lymphatic Systems

Hemoblastoses arise due to mutations that cause the patient’s immune system cells — lymphocytes — to grow and multiply actively. Additional risk factors influencing the development of the disease include:

• Congenital immunodeficiency states — Louis‑Bar syndrome, Wiskott‑Aldrich syndrome, etc.
• Acquired immunodeficiencies — use of cytostatics and glucocorticosteroids in high doses, AIDS.
• Viral infections — Epstein‑Barr virus, hepatitis C virus, HIV, T‑cell lymphotropic virus.
• Prolonged exposure to household and industrial carcinogens, herbicides, and other harmful substances.
• Autoimmune diseases — systemic lupus erythematosus, rheumatoid arthritis, etc.
• Smoking and excessive alcohol consumption.
• Pregnancy at an age older than 35 years.

The disease may also develop due to strong exposure to ionizing radiation. A risk factor is also receiving radiation therapy for the treatment of other malignant tumors.

Symptoms and Signs

Signs of malignant neoplasms of the hematopoietic and lymphatic systems depend on the stage of the disease. There are five stages in total:

• Initial. Cancer cells have just formed; they are dividing and accumulating, but there are no external manifestations or symptoms.
• Fully developed. Typical symptoms of the specific disease type appear, and characteristic changes occur in the blood.
• Terminal. Medications stop being effective; normal hematopoiesis is suppressed, and only malignant cells are produced.
• Remission. This is characterized by complete or partial restoration of normal parameters in the bone marrow and peripheral blood.
• Relapse. Symptoms return after a period of remission.

Typical symptoms of leukemias include:

• dizziness;
• general weakness;
• anemia;
• gum bleeding;
• high fever;
• itching of the skin.

One of the common diseases of the lymphatic system is lymph node cancer. For a long time, the disease may be asymptomatic or present with only minor symptoms. Early signs include:

• significant enlargement of lymph nodes in the neck and above the collarbone;
• pain in the lumbar region, often occurring at night;
• specific cough, shortness of breath;
• swelling of veins in the neck area.

In acute forms, the patient may experience a sudden rise in body temperature and increased sweating. As the pathology progresses, more characteristic symptoms of lymph node cancer appear:

• skin itching;
• general malaise;
• rapid weight loss;
• fever;
• diarrhea;
• belching;
• headache and dizziness;
• vision problems;
• pain around the navel area.

These symptoms indicate possible involvement of bones, meninges, and spleen. It is important to detect lymph node cancer at an early stage to improve the prognosis for recovery.

Diagnosis of Malignant Neoplasms of the Hematopoietic and Lymphatic Systems

For leukemia, the basis of diagnosis is a complete blood count and examination of bone marrow cells obtained via a puncture needle. Additional tests may include ultrasound of the abdominal cavity and computed tomography.

When hemoblastoses are suspected, the doctor performs a physical examination to identify characteristic symptoms. During the examination, the doctor listens to the patient’s complaints and asks about previous illnesses. Based on all the information obtained, the doctor determines an effective treatment plan.

The next diagnostic step is palpation of the lymph nodes to detect pain and enlargement. To determine the stage of the disease, the following methods are used:

• ultrasound examination of the affected areas;
• computed tomography;
• PET/CT;
• magnetic resonance imaging;
• scintigraphy;
• lymphography;
• chest and bone radiography.

The doctor makes a final diagnosis after performing a biopsy of the tissue from the affected lymph node. This test is carried out if the node is larger than 1 cm, there is suspicion of a malignant tumor, and the patient reports pain. The obtained sample is sent to a laboratory, where a specialist identifies mutated cells under a microscope.

Treatment of Malignant Neoplasms of the Hematopoietic and Lymphatic Systems

Treatment depends on the histological type of the neoplasm, the patient’s age, general condition, and disease stage. In general, the following methods are used to manage the disease:

• chemotherapy;
• targeted therapy;
• surgery;
• radiation therapy;
• bone marrow transplantation.

Let us consider in more detail when each of these methods is prescribed.

Chemotherapy

Chemotherapy is a universal method for treating malignant neoplasms of the hematopoietic and lymphatic systems and can be used either alone or in combination with other approaches. The essence of chemotherapy is the use of antitumor drugs to destroy cancer cells. Medications are administered intravenously or orally. In some cases, local administration is required — for example, into the spinal canal — if there is a high risk of spinal cord or brain involvement.

A disadvantage of this method is that the drugs also damage healthy tissues, leading to side effects. However, when metastases are present, chemotherapy is often the only effective treatment option.

Targeted Therapy

Targeted therapy is a progressive approach that involves the use of genetically modified immune cells. Innovative targeted drugs act on specific molecules located directly in the cancer cell. They cut off the oxygen supply needed for tumor cells to survive and multiply.

Unlike chemotherapy, targeted drugs have less impact on healthy cells. They are often prescribed to elderly patients and those in poor condition when other treatments are contraindicated. Targeted therapy can also be used to prevent cancer recurrence and to control the growth of metastases.

Surgical Intervention

Surgical treatment of hemoblastoses is performed to address life‑threatening conditions. During surgery, the doctor resects regional lymph nodes, which helps minimize the risk of disease recurrence. Removal of inguinal, cervical, submandibular, and axillary lymph nodes requires local anesthesia. For deeper lymph nodes, general anesthesia is necessary. The excised tissue can be used for histological examination to confirm the diagnosis.

Radiation Therapy

In most cases, radiation therapy is prescribed together with surgical treatment. It helps completely destroy any cancer cells that may remain after surgery. This method also reduces disease symptoms — for example, relieves pain and reduces tumor mass when it exerts strong pressure on internal organs. In such cases, radiation therapy is used as a preoperative preparation.

Bone Marrow Transplantation

Bone marrow transplantation is a modern technique that offers a favorable prognosis, especially at early stages of the disease. During the procedure, the surgeon introduces healthy cells into the patient’s body to replace damaged ones. A donor with a compatible genotype is selected for bone marrow transplantation. If no related donor is available, a search is conducted in international and national registries.

Conclusion

According to statistics, treatment for malignant blood diseases is successful in 70–83 % of cases, with a 5‑year survival rate observed. The recurrence rate ranges from 30 to 35 %. Recurrence is more common among men, which is associated with harmful habits and more difficult working conditions. Overall, the success of treatment and the prognosis depend on the stage at which the disease was diagnosed and treatment initiated. The patient’s age also plays an important role.