Ukubukezwa kokufakelwa kwe-Stem Cell Transplantation ye-Primary Myelofibrosis
Ukukhetha ukwelashwa okusemqoka kwe-myelofibrosis eyinhloko kungaba yinselele. Ngokuvamile akukho okukhethayo okucacile. Kunezinhlobo eziningana zokwelashwa kwe-myelofibrosis eyinhloko, kodwa kuphela i-hematopoietic stem cell transplantation (ebizwa nangokuthi ukuguqulwa komnkantsha we-bone) yikwelapha.
Kungani Wonke Umuntu Engakutholi Ukufakelwa?
Umuthi uzwakala kahle, ngakho-ke ungase uzibuze ukuthi kungani wonke umuntu onomtholampilo oyinhloko engatholi ukufakelwa.
Konke mayelana nokulingana kwengozi nokuzuza.
Ukwelapha emtholampilo eyinhloko kuqhutshwa isigaba sengozini esekelwe izimpawu nezimpawu ozizwayo. Uma ungenayo izimpawu noma unayo izimpawu ezinezifo ezisezingeni eliphansi, ukusinda okushoyo ngemuva kokuxilongwa kuyinto engu-15.4. Kule nkinga, izinkinga ezingase zibe khona (isifo esiyingozi noma esingapheliyo nesifo esingenasifo esihambisana nesifo kanye nokufa) okuhlobene nokufakelwa kabusha kunaphezulu kokuzuzwa komuthi. Ucwaningo luye lwabonisa ukuthi ukusinda kweminyaka emihlanu kubantu abanezifo ezincane noma eziphakathi nendawo-1 eziyingozi kwakuphansi uma bebenokufakelwa kwesitembu se-hematopoietic stem cell. Kodwa-ke, ezifweni eziphakathi-2 nezingozi eziphakeme, ukusinda kweminyaka emihlanu kwathuthukiswa kubantu abathola ukufakelwa kokuqhathaniswa nalabo abangekho.
Uma une-myelofibrosis eyisisekelo esiphakathi-2 noma engozini enkulu, ukufakelwa kwe-hematopoietic stem cell (HSCT) kuyindlela yokwelashwa ekhethwayo. Ngenxa yokuthi ukuguga kwandisa ingozi yokuxilongwa okuhlobene nokufakelwa (ikakhulukazi yesibili kuya kwesifo se-graft vs.us host ), i-HSCT imlando igcinelwe abantu abane-myelofibrosis eyinhloko engaphansi kweminyaka engu-60.
Njengoba iminyaka yobudala yabantu abane-myelofibrosis eyinhloko ekuxilongweni ingama-67, lokhu kubaluleka kakhulu inani labantu abane-myelofibrosis eyinhloko abangakwazi ukhetho ngalolu cwaningo. Ukwengeza, umnikeli okhethwayo we-HSCT ungumlingani ohambisana naye. Umntanakho ophelele (umama ofanayo kanye nobaba njengomamukeli) unelinye ithuba lokuba ngumdlalo, okunye kunciphisa inani labantu abangakwazi ukubhekana nalolu cwaningo.
Ukuguqulwa kokuthutha kokuthutha
Njengamanje, amaphesenti angu-40 kuya kwangu-60 abantu abane-myelofibrosis eyinhloko abafaka ukufakelwa ukuhlala bahlala okungenani iminyaka emithathu kuya kweyine. Kunobunye ubufakazi obusikisela ukuthi ukutholakala kwe-splenectomy (ukukhishwa kokuhlinzwa kwe-spleen) ngaphambi kokufakelwa kwesitshalo kuhlotshaniswa namazinga okusinda okuthuthukile ikakhulukazi kumadoda, kodwa isizathu salokhu asizwisisi ngokugcwele. Ukwengeza, abantu abathuthukisa i-myelofibrosis ngemuva kwe- polycythemia vera noma i- thrombocythemia ebalulekile ibonakala sengathi inesilinganiso esingcono sokusinda emva kokufakelwa kokudlula abantu abane-myelofibrosis eyinhloko.
Ubani Ongagunyaziwe?
Abanye abantu abanezifo ezinobungozi abangekho abathintekayo ku-HSCT. Lokhu ngokuyinhloko kunqunywa amathuba okuphila emva kweHSCT.
Izinto ezifana ne-spleen enkulu (ngaphezu kwamasentimitha ayisishiyagalombili ngaphansi komgqa wezintambo) kanye nokumpontshelwa igazi okungaphezu kuka-20 ngaphambi kokufakelwa (ikakhulu uma ngabe bobabili) behlotshaniswa nokuphila okuphansi kweminyaka emihlanu emva kokufakelwa kwesitshalo.
Kuthiwani Uma Ungagunyaziwe?
Ngakho-ke yini enconywayo uma une-myelofibrosis eyinhloko engozini enkulu kodwa awuvumelekile ku-HSCT noma awunayo umnikezeli? Uma unezimpawu ezinjengokukhulisa ubuhlungu besipen, ukukhathala, ubuhlungu besifuba, ukujula ebusuku, njll, i-ruxolitinib ingase ibe yindlela yokwelapha efanele.
I-Ruxolitinib iboniswe ukunciphisa izimpawu, ukunciphisa usayizi we-spleen, nokuthuthukisa i-anemia kubantu abane-myelofibrosis eyinhloko. Enye indlela eya ku-HSCT ingase ibhalise esilingo somtholampilo. Lokhu kuzokunika ukufinyelela kwemithi efundwa njengokwelashwa okungase kube yinto yokuthola imithifibosis yokuqala ekuqaleni.
Akulula ukufunda ukuthi awufanelekile ukwelashwa, kodwa khumbula ukuhlola zonke izinketho zakho.
Ikusasa Lokuguquka Njengokwelapha
Ngokuthuthukiswa kokwelashwa okuzungeze ukuguqulwa, njenge-regimen esetshenziselwa ukuguqula umnkantsha wegazi ngaphambi kokufakelwa isitshalo kanye nemithi evimbela ukuvimbela isifo se-graft versusus host, ukushintshaniswa okuningi kwenziwa kubantu abangaphezu kweminyaka engama-60 kanye nabanikeli abahlukile (izihlobo hhayi ngokulingana okufanisiwe noma okufanelana nabaxhasi abangahlangani).
Ezinye izikhungo zizofakelwa abantu abane-myelofibrosis kuze kube ngu-75 ubudala.
Ngethemba ukuthi, ngokuthuthukiswa okuqhubekayo, i-HSCT izotholakala kubantu abaningi abane-myelofibrosis. Ngenxa yokuthi i-myelofibrosis eyinhloko yisimo esingavamile, kuzothatha iminyaka ngaphambi kokuba siqonde ngokucacile indima yabanikeli abahlukile ku-HSCT yalesi sifo.
Imithombo:
I-Ballen K. Indlela yokuphatha umbuzo wokufakelwa ku-myelofibrosis. I-Blood Cancer Journal. 2012; 2: e59.
I-Tefferi A. Ukuphathwa kwe-myelofibrosis eyinhloko. Ku: Phezulu, I-post TW (Ed), UpToDate, Waltham, MA. (Kufinyelelwe ngoJuni 29, 2016.)