Ukwelashwa Nokuphathwa Kwe-Post-Transplant Non-Hodgkin's Lymphoma
Ingozi yokuthuthukisa i- lymphoma ikwanda kakhulu emva kokufakelwa komzimba okuqinile, isibonelo, ukuguqula izinso, ukufakelwa kwesibindi, ukuguquka kwenhliziyo noma ukuguqulwa kwamaphaphu. Lezi zitholampilo zibizwa ngezokwelapha ngokuthi "ukuphazamiseka kwe-post-transplant lymphoproliferative" noma i-PTLDs.
Yeka indlela ejwayelekile ngayo i-Lymphoma emva kokufakelwa komzimba?
I-PTLD ihlanganisa izimo ezihlukahlukene ze-lymphoproliferative elandela isitho esiqinile noma i-hematopoietic stem cell transplantation (HSCT) futhi ingase ibe namaphesenti angu-10 abantu abadala okuthunyelwe ukufakelwa.
Uhlu lwamaphesenti angu-1 ukuya kwangu-20 luye lwasetshenziselwa ukulinganisa ukukhubazeka jikelele kokuthunyelwa kwe-LPD ngemuva kokufakelwa.
Kungani Ama-Lymphomas Asebenza Ngemva Kokufakelwa Kwamalungu?
I-post-transplant lymphomas cishe ihlobene njalo nokutheleleka yi-Epstein Barr Virus (EBV) . Ukutheleleka yi-Epstein Barr Virus kubangelwa ukuguqulwa kwe-B-cells (uhlobo lwe-lymphocyte noma i-white cell cell) eliba nomdlavuza. Kubantu abajwayelekile amanye amangqamuzana omzimba omzimba angakwazi ukubhekana nokutheleleka kwe-EBV, kodwa kubantu abaphethe izidakamizwa, izidakamizwa eziphezulu ezivimbela amasosha omzimba kumele zenziwe. Njengoba kungekho lutho lokulawula ukutheleleka, amathuba okuthuthukisa i-lymphomas akhule.
Yiziphi Izinto Ukwandisa Ingozi Yokuthumela I-Lymphoma Emva kokutshala?
Izici ezimbili eziyinhloko ezinquma amathuba okuthola i-lymphoma yizi:
- Ngabe ukwelashwa okungakanani okudingekayo ku-immunosuppressive kuyadingeka - Uma i-immunosuppression engaphezulu, amathuba amaningi okutheleleka kwe-EBV.
- Isimo se-EBV serology yomamukeli wokufakelwa - Uma lowo muntu eke wangenwa yi-EBV (unomlando wokuba ne-mono) amathuba ukuthi umzimba ukhumbula ukutheleleka futhi igazi selivele linamaprotheni akhethekile okuthiwa ama-antibodies angakwazi ukukhomba nokubulala igciwane. Lokho kungahlolwa ngokuthatha isampula segazi.
I-Post-Transplant Lymphomas ihamba kanjani?
Ngokwesilinganiso, uma i-PTLD izokwenzeka, isikhathi esivamile sokwenza kanjalo cishe ezinyangeni ezingu-6 emva kokufakelwa kokufakelwa kweziguli eziguqulwe ngomzimba kanye nezinyanga ezingu-2-3 kubamukeli be-HSCT, kodwa kubikwe ngokushesha ngemva kweviki elilodwa ngasekupheleni kweminyaka engu-10 emva kokufakelwa.
I-post-transplant lymphomas ivame ukuhlukana ne -Non-Hodgkin lymphomas evamile . Amangqamuzana omdlavuza walesi lymphoma ayingxube yezinhlobo ezahlukene nobukhulu. Ngenkathi iziguli eziningi zibandakanya ikakhulukazi ngamakhansela, ezinye izitho zithinteke kakhulu - into ebizwa ngokuthi 'extranodal' . Lezi zihlanganisa ubuchopho, amaphaphu namathumbu. I-organ yokufakelwa ingafakwa futhi.
I-Post-Transplant Lymphoma isingathwa kanjani?
Uma kunokwenzeka, ukwelashwa kwe-immunosuppressive kufanele kunciphise noma kumiswe. Kulabo abanezinkinga ezincane nezendawo, ukuhlinzeka noma ukushisa imisebe kungase kuvivinywe. Uma kungenjalo, umugqa wokuqala wezokwelapha ngokuvamile u-Rituxan (rituximab) , i-antibody monoclonal ehlasela ikakhulukazi amangqamuzana e-lymphoma. Kuphela uma lokhu kwehluleka kuyimithi yokwelapha. I-Chemotherapy ihlehliswa kuze kube yilapho kudingekile njengabantu abathile abangenakho ukuzivivinya imithi yamakhemikhali bangase bakhulise ingozi yezifo .
Kulabo abahlakulela i-lymphomas ngemuva kokuguquka komnyoba, ukuxilongwa kwe-leukocyte yokunikela kungasebenza kahle.
Ziyini imiphumela kanye ne-Post-Transplant Lymphomas?
Ngokuvamile, i-PTLD iyimbangela enkulu yokugula nokufa, ngokomlando ngamanani okushona ashicilelwe kuze kube ngamaphesenti angama-40-70 ezigulini ezinezakhi eziqinile kanye nesandulela se-90 ezigulini ezilandela i-HSCT. Izidakamizwa ezingezona i-Hodgkin ezenzeka ngemva kokuguqula izidakamizwa zinomphumela ompofu kunamanye ama-NHL. Esinye isibalo esishicilelwe sibe ukuthi cishe ama-60-80% ekugcineni anqotshwa yi-lymphoma yawo. Kodwa-ke, ukusetshenziswa kweRituxan kuye kwashintsha izinga lokusinda, futhi abanye abantu benza ngcono kakhulu futhi bangaphulukiswa.
Ukubandakanyeka kwamanye amalungu, ikakhulukazi ebuchosheni, kunesimo sokuhlushwa okubi.
Imithombo:
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> Metser U, Lo G. FDG-PET / CT ngesifo sokubeletha ngemuva kokufakelwa isifo se-lymphoproliferative. Br J Radiol . 2016; 89 (1057): 20150844.
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