Ukulinda, i-Chemotherapy, i-Monoclonal Antibodies, noma ama-Cell Stp Transplant for CLL
Yiziphi zokwelapha ezingcono kakhulu ze-chronic lymphocytic leukemia (CLL)?
Ukubuyekezwa kwe-Chronic Lymphocytic Leukemia (CLL)
Uma ujwayele izimpawu nezinkinga ze-CLL , futhi usuqedile ukuxilongwa kanye nesiteji se-CLL cishe usulungele ukuthatha isinyathelo esilandelayo. Phela, uzwile okuningi mayelana nezinhlobo ezihlukahlukene zokwelapha ezitholakalayo ngomdlavuza.
Ngokudabukisayo, ngalesi sikhathi asikho ukwelashwa okubhekwa njengophilisi we-chronic lymphocytic leukemia (CLL). Kodwa ngisho nangaphandle kokwelapha, abanye abantu bangaphila iminyaka noma amashumi eminyaka benesifo. Ngesikhathi samanje, ukwelashwa kuqondiswa ekuhlinzekeni iziguli ngokukhululeka ezinkalweni zabo, nethemba lokuqinisekisa izinga elihle lokuphila kanye nokukhululwa isikhathi eside.
Buka futhi ulinde
Iziguli ezingenayo izimpawu ze-CLL, njengezikhukhula ebusuku, imfiva, ukulahlekelwa isisindo, i-anemia (isibalo esiphansi se-cell cell), i- thrombocytopenia (ukubalwa okuphansi kweplatelet) noma ukutheleleka okuvamile akunakwenzeka ukuzuza ekwelapheni. Ukwelashwa okwamanje kulesi sifo ngeke kukhulise impilo yakho, futhi ngeke kunciphise ukuqhuma kwe-leukemia yakho. Ngakho-ke, indlela yokulinda "ilindile" ivame ukuthathwa. Esikhathini sokulinda nokulinda, uzolandelwa isifo semfuyo noma i-oncologist futhi kuzodingeka ube nomsebenzi wegazi futhi ubonwe nguchwepheshe wakho njalo ezinyangeni eziyisithupha kuya kwezingu-12.
Phakathi kokuvakashelwa, kuzodingeka uqaphele izimpawu ukuthi umdlavuza wakho ungaqhubeka. Ungabona:
- Ukuvuvukala ema- lymph nodes akho
- Ukukhathazeka kwesisu noma ubuhlungu
- Izimpawu ze- anemia ezinjengesikhumba esilahlekile nokuzwa ukhathele kakhulu
- Ukutheleleka okuvamile noma ukutheleleka okungeke kwenzeke
- Izinkinga zokuphuza noma ukulimala kalula
Iziguli eziningi zingahlala zibukele futhi zilinde iminyaka ngaphambi kokudinga ukwelashwa kwe-CLL yazo . Kungaba nzima kakhulu ukuthi ufunde ukuthi unomdlavuza, bese "ulinde ukuthi uhambe kakhulu" ngaphambi kokuba uphathe. Ungase uzizwe sengathi ufuna nje ukulwa nalo mhlukumezi bese uphelela!
Nakuba kungase kube nzima ukuba nesineke, kubalulekile ukuthi uqonde ukuthi ulindi futhi ulinde yimihla uma i-CLL ingabonakali izimpawu. Ukucwaninga kwaleli phuzu akubonanga nanoma iyiphi inzuzo yokuqala ukwelashwa ekuqaleni.
I-Chemotherapy
Iminyaka eminingi, i- chemotherapy yomlomo neLeukeran (i-chlorambucil) yayiyindlela ejwayelekile yokwelashwa kwe-CLL uma umdlavuza waqala ukuqhubeka. Ngenkathi iziguli eziningi zenza kahle ngalolu cwaningo, aluzange lunikeze impendulo ephelele (CR) kaningi. Lezi zinsuku, i-chlorambucil isetshenziselwa kuphela iziguli ezinezinye izinto ezibangela impilo ukuthi zivimbele ekutholeni ukwelashwa okunamandla, okunobuthi kakhulu.
Muva nje, i-Fludara (fludarabine) i-chemotherapy ikhonjiswe ukuthi iphumelela ekwelapheni i-CLL engaphenduliwe kanye nokubuyiselwa. Kuye kwathuthukiswa i-CR nokukhula okungaqhubeki okuqhubekayo (PFS) uma kuqhathaniswa ne-chlorambucil, kodwa okwamanje ayizange ibonise inzuzo ekusindeni jikelele (OS) lapho isetshenziswe yedwa.
Esinye isidakamizwa esivela emndenini owodwa, i-Nipent (i-pentostatin,) isetshenzisiwe futhi njengengxenye ye-CLL therapy.
Ukuthuthukiswa kwangempela ekwelashweni kwe-CLL kwenzeka lapho i- Cytoxan (cyclophosphamide) yengezwa ngokuhambisana nokwelashwa kwe-fludarabine. Ukusebenzisa lo mgomo ("FC" noma "Flu / Cy"), impendulo yokwelashwa yanda njengoba kuboniswa yi-CR, PFS, ne-OS. Nakuba ukuhlanganisa lezi zidakamizwa ezimbili kubangele ukwanda kwe-toxicity, akubonakali kubangele izinga eliphezulu lokutheleleka okukhulu.
Ama-Antibodies aMonoclonal
Imiphumela emitholampilo ye-CLL iye yathuthukiswa ngokwengeziwe ngokufaka ukwelashwa kwe-antioclonal antibody.
Ama-antibodies angama-monoclonal empeleni angama-antibodies asebenzayo ahlasela umdlavuza. Nakuba ngabe amasosha omzimba aqaphela amaprotheni angavamile ebusweni noma igciwane, lezi zidakamizwa "ziyaqaphela" izimpawu ezingavamile ebusweni bamangqamuzana omdlavuza. Ukwengezwa kwe-monoclonal antibody Rituxan (rituximab) ohlelweni ("FCR" protocol) lunikeze abantu nge-CLL izinga lokuphendula lika 90% no-96% ne-CR ye-50% isikhangiso se-70%.
Enye i-anti-monoglonal antibody, i-Campath (alemtuzumab) ivunyiwe yi-US Food and Drug Administration (FDA) ukuze isetshenziswe ekwelapheni i-CLL. Kuhloswe ku-"different mark" ye-cell anti antigen ehlukile kune-rituximab, futhi ingasetshenziswa yodwa noma ihlanganiswe ne-chemotherapy.
Ukufakelwa kweStem Cell
Endabeni yezinye izinhlobo ze-khansa yegazi, kwenziwa ucwaningo oluningi ukuqhathanisa imiphumela yokuphila yeziguli ezithola imithi yokwelapha, ngokumelene nokufakelwa kwe-stem cell . Njengoba isilinganiso sobudala besiguli se-CLL esanda kutholakala sisephakathi kweminyaka engu-65 no-70 ubudala, ngokuvamile esidala ukuthi singabhekwa njengomuntu obhalisiwe, lezi zinhlobo zezifundo azenzanga kule namba.
Uma esho lokho, iziguli ezingama-40% ze-CLL zingaphansi kweminyaka engama-60 kanti abangu-12% bangaphansi kweminyaka engama-50. Ukufakelwa kwesitembu se-stem kunganikeza ithuba lokuthola iziguli ezincane ze-CLL ezinezifo ezimbi.
Ukufakelwa kwe-Allogeneic stem cell (ukufakelwa ngokusebenzisa amangqamuzana e-donor stem) isebenzisa ukulinganisa okuphezulu ngokweqile kwe-chemotherapy ukuphatha ukwelashwa kwama-leukemia kanye nama-stem cells anikezwa ukubuyisela isimiso somzimba somzimba wesiguli. Inzuzo ku-allogeneic stem cell transplant yukuthi ngenkathi kungenzeka ibe yingozi kakhulu, ingabangela umphumela "we-graft-versus-leukemia". Okusho ukuthi ama-stem cells azinikeziwe ayaqaphela ukuthi amangqamuzana e-leukemia ajwayelekile futhi awahlasela.
Ngisho noma lezi zindlela zithuthuka ngendlela ephawulekayo, kusekhona ezinye izinkinga ezinkulu ezigulini eziyi-15 kuya ku-25, kanti enye isifo esithinta isifo lapho izicubu zinikela khona ukuthi iziguli zinamaseli angaphandle futhi ziqala ukuhlaselwa.
Ngenxa yemiphumela emibi ye-allogeneic stem cell transplant, ayiboniswa ukuthuthukisa imiphumela kwiziguli ezindala.
Njengamanje, ukucwaninga ukucacisa indima ye- non-diyeloablative , noma " ukuhamba " kwe-CLL kuqhubeka. Ukuguqulwa okungezona okwenziwe nge-myeloablative kuncike ekutheni uketshezi lwe-chemotherapy kanye nokunye okuthinta umthelela we-"graft-versus-leukemia" ukuphatha umdlavuza. Lolu hlobo lwezokwelapha lunganikeza ukhetho lwezokwelapha kubantu abadala abangeke bakwazi ukubekezelela ukufakelwa okujwayelekile kwe-allogeneic.
I-Autologous stem cell transplants ekwelapheni kwe-CLL ibonise imiphumela embi futhi izinga eliphezulu lezifo libuyela emuva, ngezinye izikhathi ngisho neminyaka emva kokufakelwa. Nakuba kungenzeka ukuthi wehlise utshwala, ukufakelwa kwe-autologous akuphumelelanga nakakhulu ekwelapheni i-CLL kunezokwelapha okungezona okwenziwe nge-myeloablative . Ngenxa yalokho, ukufakelwa kwe-autologous akuvunyelwanga ngeziguli ze-CLL.
I-Radiation Therapy
Ezigulini ezine-CLL, ukusetshenziswa kwe- radiation therapy kunomkhawulo ekuhlinzekeni ukukhululeka kwesibonakaliso. Ingasetshenziselwa ukwelapha izindawo ze-lymph nodes ezivuvukayo ezingabangela ukuphazamiseka noma ukuphazamisa ukunyakaza noma ukusebenza kwezitho eziseduze.
Splenectomy
Kulezi ziguli ezithola ipeni elikhulisiwe ngenxa yokuqoqwa kwamangqamuzana e-CLL, i- splenectomy , noma ukususwa kokuhlinzwa kwesipere, kungase kuqala kusize ekuthuthukiseni ukubala kwegazi futhi kunciphise ukungahambi kahle. Njengomuthi wokwelashwa, i-splenectomy isetshenziselwa ukulawula izimpawu zesifo futhi ayinikezi ukwelashwa kwe-leukemia.
Iyifinyelela phezulu
Ngalesi sikhathi, ngenkathi ukwelashwa kwe-CLL kungakwazi ukuhlinzeka iziguli ezinokuphumula kwesifo nokulawula i-leukemia, akukwazi ukuhlinzeka ukwelashwa, kanti inkinga yesifo ihluke kakhulu phakathi kwabantu abahlukene. Nokho, ukuqonda kwethu lolu hlobo oluhlukile lwe-leukemia lukhula njalo. Ukusetshenziswa, isibonelo, ukuguqulwa kwe-stem cell kubantu abano-CLL bakhuphuke ngokuphawulekayo phakathi kuka-2006 no-2016. Ucwaningo lwezocwaningo luzoqhubeka luqhubeka futhi lungase luhlinzeke ngemithi yokwelashwa ngokulawula isikhathi eside noma ukwelashwa kwe-CLL.
Imithombo
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I-National Cancer Institute. Ukwelashwa Kwama-Lymphocytic Leukemia (PDQ) - okwenziwe ngezempilo. Kubuyekezwe 01/29/16. http://www.cancer.gov/types/leukemia/hp/cll-treatment-pdq
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