I-Myeloma ne-myeloma eminingi ngamagama ahlukene ngomdlavuza ofanayo. Igama elithi multiple is optional futhi libhekisela ezithombeni eziningi ezivela emathanjeni abantu abanelesi sifo.
I-Myeloma, i- leukemia, ne-lymphoma yizinhlobo ezintathu eziyinhloko zomdlavuza wegazi noma i-hematologic malignancy. Kulezi zintathu, i-myeloma yinto engavamile kakhulu. Amathuba okuthuthukisa i-myeloma yanda ngokukhula kanti abantu abaningi abatholakalisiwe baneminyaka engama-60 noma ngaphezulu. Nakuba kungenzeka kubantu abadala abancane, amaphesenti angaphansi kwesisodwa amacala kulabo abangaphansi kweminyaka engama-35.
Iyini i-Myeloma?
I-Myeloma ingumdlavuza oqala emnothweni wethambo . Abantu abadala abanempilo, i-bone marrow yizicubu eziphilayo ezifakwe emathanjeni angaphakathi angaphansi kwamathambo athile. Lapho, iqhubeka futhi ikhishwa amangqamuzana amasha wegazi abomvu namaseli amhlophe egazini azo zonke izinhlobo, ukuqinisekisa ukuthi unokutholakala okuqhubekayo egazini lakho.
Kodwa-ke, i-myeloma ingumdlavuza ngokukhethekile weli cell cell plasma -uhlobo oluthile olukhethekile lwegazi elimhlophe. Umsebenzi oyinhloko wamangqamuzana e-plasma ukwenza ama-antibodies, amaprotheni amancane afaka abahlaseli bezwe bangaphandle ekubhujisweni komzimba.
Inani eliphilile lamaseli e-plasma libeka yonke iphothifoliyo yama-antibodies ahlukene ukuhlasela igciwane elilodwa. E-myeloma, kukhona 'i-clone' yamaseli e-plasma anzima-amakhophi amaningi e-cell efana ne-plasma emnothweni we-bone enza i-protein efanayo (i -protein monoclonal noma i-protein ) engavamile. Le clone ebulalayo yamaseli e-plasma akalindeli igciwane ukuba lihlasele; ikhiqiza i-protein njalo njalo.
Ngokuqondile ukuthi iseli le-plasma enempilo liba nomdlavuza namanje alingaziwa ngokugcwele, kodwa ososayensi bathola umhlabathi. Okubaluleke kakhulu, manje sekuzwakala ukuthi i-myeloma ingokomndeni wezifo ze-plasma ezihlukile. Abantu abaningi abanezifo ezithile ze-plasma ze-pre-epidemic ekugcineni bakhulisa i-myeloma eminingi.
Izimpawu
Akuwona wonke umuntu onomculo we-myeloma onezibonakaliso ekuqaleni, ngakho ukubamba i-myeloma ekuqaleni kwenkambo yayo kuyinselele. Izimpawu zokubheka zihlanganisa okulandelayo:
- Ubuhlungu be-Bone, ikakhulukazi emhlane noma esifubeni
- Ukukhathala
- Ukulahlekelwa kwesisindo okungenalutho
- Ukutheleleka okuvamile
- Ukudabuka, ukudonsa, kanye / noma ukungabi nesifiso sokudla
- Ukuzwa ukoma ngokweqile
- Ukudideka noma ubuchopho buchopho
- Ubumbulu noma ubuthakathaka emilenzeni
Ngokuvamile izimpawu ze-myeloma zihlobene nemiphumela ethile ye-clone ebulalayo kanye / noma i-antibody-amaprotheni ayikhiqizayo. Ngokwesibonelo:
- Njengoba amangqamuzana angavamile ngaphakathi kwamathambo akha, ubuhlungu besithambo, ubuthakathaka bamathambo kanye nokwahlukana kungenzeka, okungenzeka kube nomonakalo wezinzwa.
- Lapho amangqamuzana e-myeloma eqala ukukhipha amangqamuzana egazi omzimba, abantu bangahlakulela ukubalwa kwamaseli aphansi. Inombolo encishisiwe yamaseli abomvu obomvu, noma i-anemia , ingabamba iqhaza ezimpawu zobuthakathaka nosizi. Ukwehluleka kwamangqamuzana amhlophe egazi kungakwenza ukwenzeke okuthelelekile. Futhi ukuntuleka kweplatelet kungaholela ezinkingeni zokuphuma kwegazi kusukela ekulimaleni okungase kube kubi kakhulu.
- Amaseli e-Myeloma angabonakalisa amanye amaseli ukuba aphule ithambo, akhulule i-calcium engase ifike kumazinga aphezulu egazini. Eyaziwa ngokuthi i-hypercalcemia, lokhu okweqile kwi-calcium yegazi kuhambisana nezimpawu zayo, kufaka phakathi ukoma okwedlulele / ukuvuthwa okwedlulele, ukudideka, ukuqothuka okukhulu, ubuhlungu besisu nokulahlekelwa ukudla.
- Ngezinye izikhathi amaseli e-myeloma akhiqiza amaprotheni awonayo izinso nezinzwa. Lokhu kungaveza isifo sezinso noma, uma kwenzeka kunezinzwa ezithintekayo, ukuphazamiseka, ukugubha noma ukubuthakathaka. Ukulinganisa okunjalo nokubuhlungu ezandleni, izingalo, izinyawo, nemilenze kuthiwa yi-peripheral neuropathy.
- Ukwakhiwa kwamaprotheni e-myeloma nakho kungabangela ukuqina kwegazi-cishe kufana nokwengeza ufulawa obuningi kwi-batter pancake. Lokhu kuqina kuthiwa yi-hyperviscosity. Kunganciphisa igazi ukugeleza ukuya ebuchosheni futhi kubangele ukudideka, isizungu, nezinye izimpawu.
Ingabe ikhona i-Myeloma yangaphambi?
Ukuxilongwa kwangaphambili kwe-myeloma kuyinselele njengoba izimpawu zingase zingabikho kuze kube sezingeni eliphezulu. Ngezinye izikhathi, kungase kube nezibonakaliso ezingacacile ukuthi kuqala zibhekiswe kwezinye izifo. Kodwa-ke, ososayensi baye bahlonza umndeni wezifo ezihlukahlukene ze-plasma, ezinye zazo ekugcineni zingathuthuka kwi-myeloma, njengalezi ezilandelayo:
- I-Monoclonal Gammopathy Yokubaluleka Okungenqunyelwe (MGUS)
- Plasmacytoma, noma i-plasmacytoma yedwa.
I-MGUS
Uma une amakhophi amaningi kakhulu e-antibody efanayo, lokhu kwaziwa ngokuthi i-gammopathy monoclonal noma i-MG. Abantu abane-myeloma bangase babe ne-MG, kodwa akuwona wonke umuntu one-MG onomlando wami. Eqinisweni, kukhona uhlu olude lwezifo oluhambisana nokuba khona kwe-MG kanti eziningi zazo azizona ukwelapha.
Uma umuntu enesi-MG kodwa azikho izikhombisi-ndlela zokuthi yini ebangela lokho, waziwa ngokuthi i-MG yokubaluleka okungaqaliwe noma i-MGUS. Akuwona wonke umuntu onenhlangano ye-MGUS oyoqhubeka nokuthuthukisa i-myeloma, kodwa amanye angase, yingakho ukuqapha kwansuku zonke kuyadingeka.
Nakuba kuyisimo esibuhlungu, i-MGUS ibeka ingozi yokuba i-myeloma ngesilinganiso samaphesenti angu-1.5 ngonyaka. Izinkinga zikhuphuka ngezinombolo eziphakeme zamangqamuzana e-plasma angavamile emnothweni wethambo futhi futhi namazinga aphezulu weprotheni egazini. I-MGUS ivame ukuhlolwa ngaphandle kokuphathwa.
I-Plasmacytoma
Ngezinye izikhathi kukhona ubufakazi obulodwa bokuphela kwesisu esisodwa se-plasma cell cell. Uma lokhu kwenzeka, kubizwa ngokuthi i-plasmacytoma noma i-plasmacytoma yangaphandle yethambo, kunokuba i-myeloma.
I-plasmacytoma eyodwa kuphela ingase ikhule ngaphandle komnkantso wesinye kwenye indawo. Kulesi simo, kuthiwa yi-extramedullary plasmacytoma. Abantu abaningi abane-plasmacytoma yedwa bazoqhubeka nokuthuthukisa i-myeloma eminingi, ngakho ukuqapha okusheshayo kwezimpawu ze-myeloma kubalulekile.
Kwenzekani eMyeloma?
Cabanga ngamathambo akho njengebhola lebhola eligcwele abalandeli. Ibhayisikobho ngayinye yiseli futhi kunezinhlobo eziningi zezinhlobo ezahlukene. Kule nkundla, amangqamuzana e-plasma abalandeli abanikezwa ifulegi ukuze basakaze ngesikhathi sokubonisa i-halftime. Futhi iseli ngalinye le-plasma / fan liqukethe ifulege elimibala elihlukile, elimelela i-antibody eliyingqayizivele elenzayo.
Ngomnkantsha onempilo, ezinye izinhlobo zeseli zingaphezu kwamaseli e-plasma. Ngakho, enkundleni yethu, abalandeli abaningi abanamafulegi anemibala. Noma kunjalo, kukhona abalandeli abanele namaplagigi ezinemibala ukuze bagcwalise inkundla cishe yonke imithunzi yombala wonke-ukuhlukahluka kwezinhlobonhlobo zamagciwane.
Manje ake ucabange ukuthi iseli elilodwa le-plasma eliphethe ifulegi elimpunga liyashintsha futhi likwazi ukuzihlanganisa, libe amafomu amabili afanayo, ngalinye liphethe ifulegi elimhlophe. Bese baba ababili, abane baba ayisishiyagalombili, njalo-bonke babambe amafulegi abo amhlophe. Ekugcineni, kunamafulegi angaphezulu grey kunalindelekile. Amafulegi amhlophe afaka amakhophi amaningi weprotheyini efanayo-amaprotheni omzimba noma i-protein ye-M - ngoba ivela ku-clone eyodwa eyinkinga yamaseli. Lesi silinganiso esiningi ngokweqile seprotheyini e-monoclonal egazini noma emcimbini yinto engatholakala kuhlolwa kwebhu.
Manje cabanga ukuthi iseli elilodwa kusuka ku-clone elibulalayo liyavuka ukuthenga isiphuzo, kodwa libuyele esigabeni esingalungile sokuhlala, liqhubeke lizihlanganisa. I-clone iqala esigabeni esisha, futhi futhi amabili abe amane, amane abe ayisishiyagalombili, njalonjalo.
Lezi clones ezibulalayo ze-plasma cell zingaqala ukuthatha inkundla. Baxosha imigqa kanye nezigaba zokuhlala ezazingama-cell cells omzimba, njengalawo okwenza ukunikezwa kwamaseli abomvu, amaseli amhlophe, amaplatelets, kanye namanye amaseli e-plasma anamapulegi anemibala. Ngakho-ke, njengoba inani lamagilagi agijimi likhuphuka, inani lamaflegigi ajwayelekile, aphethwe yi-polyclonal angancipha.
Futhi ama-clones angalungile angathinta namanye amaseli aseduzane enkundleni. Ama-clones e-Plasma cell angakhipha izithunywa zamakhemikhali ezibangela "abalandeli" abaseduzane ukuba baziphathe ngendlela engafanele. Ezinye zazo (ama-osteoclasts) zizoqala ukungena emanzini enkundla (i- bone resorption ), ukukhulula amafu othuli (calcium) asakazeka kuyo yonke le nkundla nangaphezulu (igazi legazi).
Izinhlobo
Uma i-myeloma iqala, ingavela futhi iveze ngokuhlukile kubantu abahlukene. Amanye amagama asetshenziselwa ukuhlukanisa i-myeloma afaka:
- I-Myeloma engaqondakali
- Smoldering Myeloma
- I-Symptomatic noma i-Active Myeloma
- I-Light Chain Myeloma
- I-Myeloma Nonsecretory
- I-Myelomas ye-genetic sub-izinhlobo ehlukile
I-Asymptomatic vs. Smoldering vs. i-Myeloma esebenzayo / ye-Symptomatic
Kwamanye abantu, kukhona "isigaba" sesifo-isimo phakathi kwe-MGUS kanye ne-myeloma esebenzayo, okungukuthi. Uma lokhu kwenzeka, kubizwa ngokuthi i-myeloma engenamaphutha futhi, ezimweni ezinjalo, kunezibonakaliso ezimbalwa zezifo ezisebenzayo noma i-myeloma igxilile.
Lapho ngibheka i-myeloma, umnto wethambo ugcwele amangqamuzana engeziwe e-plasma. Amaphesenti angaba ngu-10 noma ngaphezulu emangqamuzana omnumalo angase avela kuma-clel ye-myeloma kanye / noma ama-protein wamandla abe ngaphezulu kuka-30 g / L. Kodwa-ke, lapho ngibheka i-myeloma, kusenayo i-anemia, akukho ukuhluleka kwezinso, akukho amazinga e-calcium aphakeme egazini, futhi akukho izindawo ezithambile zethambo. Ukukhwehlela i-myeloma kuvame ukubhekwa kodwa kungelashwa; Kodwa-ke, abacwaningi babheka izinzuzo zokwelapha zakuqala kwezinye izimo.
I-myeloma ephawulekayo noma esebenzayo idinga ukuphathwa. Kukhona amaprotheni e-M egazini noma emcimbini kanye nenani elikhudlwana lamaseli e-plasma emnothweni wethambo. Amabala aphansi angabonakala ezingxenyeni zethambo, ebuthakatha ithambo, ebangela ubuhlungu, futhi akhulise ingozi yezinsalela. Futhi, lezozinto ezingekho ekuchazeni i-myeloma evela phezulu zingase zifinyelele ekusebenziseni i-myeloma esebenzayo.
Amaphrotheni Asiza Ukubeka i-Myeloma
Uhlobo lwamaprotheni amangqamuzana e-myeloma akhiqiza futhi lisiza ekunqumeni ukuthi hlobo luni lwama-myeloma analo. Ama-antibodies amaphrotheni amaningi anemikhakha ehlukene noma amaketanga. Izingxenye ezinzima, noma izintambo ezinzima, izingxenye ezikhanyayo, noma amaketanga alula, zonke zihlangana ndawonye ukwakha i-antibody eyodwa eyodwa.
Ekuqanjweni kwe-antibody noma i-immunoglobulin, izintambo ezinzima zinquma ukuthi iyiphi incwadi elandelayo emva kwe-immunoglobulin (Ig). Ngakho-ke, isibonelo, ingxenye eyindlala evame kakhulu etholakalayo kuma-proteins ama-myeloma i-IgG, elandisa ngamacala angu-60 kuya kwangu-70 wamacala e-myeloma. Okulandelayo yi-IgA. Ngokuvamile, i-IgD noma i-IgE ingabandakanyeka.
Kwezinye izimo, amangqamuzana e-myeloma angaveza kuphela ama-antibodies angaphelele noma angafaka amakhetheni alula kuphela. Lezi zibizwa ngokuthi amaprotheni ama-Bence-Jones futhi amancane kakhulu kangangokuba ngokuvamile adlula ezintsheni emgqeni. Cishe amaphesenti angu-20 azo zonke izigameko ze-myeloma zihlanganisa amaketanga alula kuphela.
Cishe iphesenti elilodwa lazo zonke izigameko ze-myeloma azifihleli amaprotheni amancane okwanele noma amaketanga alula ukuze abonakale nhlobo. Kulezi zimo, izivivinyo ezibucayi ziyasetshenziswa noma izimpawu ze-myeloma kanye nokutholakala kwamangqamuzana angamajwayelekile e-plasma emnkantsheni okuholela ekuxilongweni.
I-Sub-Types ye-Genetic
Kunezinhlobo ezihlukahlukene zezinto ezingezansi zofuzo ezihlobene ne-myeloma. Ukulandelwa kwe-DNA kuye kwacutshungulwa ngakho-ke, kwaziwa ukuthi, ukuba neyodwa yalezi zifo ezingalungile kungathinta noma ukubikezela ukuthi isifo sakho sizosabela kanjani ekwelapheni . Abacwaningi banethemba lokuthi ukuhlaziywa kwezakhi zofuzo kuzoqhubeka nokusiza ekuholeni ekuthuthukiseni ukwelashwa kwe-myeloma.
Izimbangela
Ezimweni eziningi, ososayensi abazi kahle ukuthi i-myeloma iqala kanjani . Amazinga ahluke ngohlanga-abaseMelika-baseMelika abangaphezu kweCaucasian-American kanye namaCaucasian-Amerika angaphezu kwama-Asia-aseMelika-kodwa izizathu aziwa. Izinguquko ezithile zezakhi zofuzo ezitholakala kumaseli e-plasma ziye zabonwa, kodwa yiziphi ezibangela ukuthi lezi zinguquko kuqala zihlale zicacile.
Izidalwa zifakwe kwi-DNA, ehlanganiswe ngama-chromosomes angu-23. Ezingqamuzaneni ezithile ze-myeloma zabantu, izingxenye ze-namba ye-chromosome ayikho, eyaziwa njengokususwa. Lezi zinguquko zibonakala zenza i-myeloma ingabeki kangcono ekwelashweni.
Ezingamaphesenti angaba ngu-50 abantu abane-myeloma, i-clone ebulalayo ine-chromosome nalokho okuthiwa i-translocation-ingxenye ye-chromosome eyodwa ishintshile ngengxenye yenye i-chromosome kumaseli e-myeloma. Uma izinguquko ezinjalo ziphenduka izakhi zofuzo ezibucayi noma zivaliwe, zingakhuthaza ukulimala.
Abacwaningi bakholelwa nokuthi ukungavamile kwamanye amangqamuzana emnothweni wethambo nakho kungadlala indima e-myeloma. Ngokwesibonelo, amangqamuzana omzimba omzimba okuthiwa amangqamuzana e- dendritic angenza izimpawu zamakhemikhali ezibangela amangqamuzana e-plasma enempilo ukuba akhule. Ngakho, ukusayina ngokweqile ngamaseli e-dendritic kungase kusize ekuthuthukiseni i-myeloma.
Ukuxilongwa
Uma izimpawu zibonisa i-myeloma, ukuvivinya kwelabhu egazini kanye / noma kumchamo, ukucabangela kwamathambo, kanye ne-bone marrow biopsy kuvame ukwenza.
Izivivinyo zegazi
- Gcwalisa i-Blood Count (CBC): Lokhu kuhilela ukubala okuzenzakalelayo kwamaseli ezinhlobo ezehlukene ukuze kunqume ukuthi izinombolo zakho zingena ngaphansi kohlobo olujwayelekile noma olungavamile. Lapho amangqamuzana e-myeloma esakazeka emangeni yethambo, ezinye izibalo ze-cell cell zizobe ziphansi. Ukubalwa kwesibalo se-red ebomvu ukutholakala okuvamile.
- I-Immunoglobulins (Ig) I-quantification: I-quantification ye-Ig yenziwe ukuze ubone ukuthi yikuphi, uma ikhona, yezinhlobo eziyisihlanu zama-antibodies, asezingeni eliphezulu-IgA, IgD, IgE, IgG, ne-IgM. E-myeloma, enye yazo ingase ibe phezulu kanti amanye angase abe ngaphansi kunejwayelekile. Amanye amaphethini anokwenzeka.
- I-SPEP ne-UPEP: Lokhu kubhekisela ku-serum protein electrophoresis kanye nomchamo we-protein electrophoresis. Lezi zivivinyo zingakwazi ukubona ukuthi kukhona yini i-monoclonal protein buildup noma i-spike ethintekayo.
- Amaketanga Okukhanya Okukhululekile: Lokhu kuhlolwa kulinganisa inani lamaketanga alula egazini. Lokhu kungenzeka, ngokwesibonelo, esigulini ne-myeloma okungenaye iphrotheni engatholwa yi-SPEP.
I-Bone Marrow Ukuvivinya ne-Biopsies
Abantu abane-myeloma banamaseli amaningi e-plasma emnothweni wabo wamathambo. Ngakho-ke, i- bone marrow biopsy kanye nesifiso senziwa ukuhlola okubalwayo futhi uthole amasampula. Kungenziwa noma ehhovisi likadokotela noma esibhedlela. Izibonelo ze-Biopsy zihlolwe yi-pathologist bese ziqhubeka nokuhlolwa kwe-laboratory.
Ukuvivinya I-Genetic of Cell Cancerous
Izivivinyo ze-Genetic zivame ukuqhutshwa kumaseli angavamile njengengxenye yokuxilongwa nokuhlolwa kwe-myeloma. Ukuhlaziywa kwe-Cytogenic kubhekisela ekuhlolweni okuhlola izinguquko kuma-chromosomes wamaseli e-myeloma.
Izinguquko ezithile kanye nokuhlelwa kabusha kwezakhi zofuzo nazo zisiza odokotela ukubikezela ukuthi ukulimala kungase kuziphatha kanjani. Izivivinyo ezahlukene ezihlukahlukene ziyatholakala futhi zisetshenziselwa ukuhlola umdlavuza womuntu lapho izakhi zitholakele.
I-Amyloid Biopsy
Amazinga aphezulu ama-anti-antibody amaprotheni ajwayelekile abeka iziguli ze-myeloma engozini yokuthuthukisa i-amyloidosis. I-Amyloid yinto ekwazi ukwakha kunoma yiziphi izicubu kanye ne-biopsy kusiza ukuhlonza lesi sifo. Ngokuvamile, le biopsy ihilela ukusebenzisa inaliti ukususa amanye amafutha esiswini.
Izikrini nokufanekisa
Amaseli e-Myeloma ayaziwa ngekhono labo lokwenza okuthiwa i-lytic lesions emathanjeni. Bangase bathathe amanye amangqamuzana okuthiwa i-osteoclasts ukubhubhisa amathambo noma ukubangela izindawo ezithambile ezindaweni ezingenayo ithambo.
Ngokuvamile uchungechunge lwe-x-ray olubandakanya iningi lamathambo lwenziwa. Uma lolu hlobo lokucabangela lwenziwa, luyaziwa ngokuthi ucwaningo lwamathambo noma ucwaningo lwama-skeletal. Ezinye izinhlobo ze-imaging zingasiza kakhulu ezimweni ezithile, njengokuthola i-plasmacytomas engabonakali kuma-x-ray.
Nini Ukubona Udokotela
Cabanga ukwenza i-aphoyintimenti nodokotela wakho uma unemibuzo noma izimpawu eziphikisanayo ezikukhathazayo. Izimpawu ze-myeloma zingaba zingacacile futhi zingenasici.
Uma uthola ukuthi unesifo se-MGUS noma i-plasmacytoma yodwa, kubalulekile ukuthi wena nodokotela wakho nihlale nibheka izinto njengoba lezi zifo ze-plasma cell zingathuthukela kwi-myeloma. Njalo ubuze udokotela wakho noma yimiphi imibuzo ongayithola mayelana nesimo sakho.
Izwi elivela
Uma wena noma othandekayo usanda kutholakala nge-myeloma, kungokwemvelo ukuzizwa udidekile, uthukuthele, ukhululekile, noma konke okungenhla. Ukuxilongwa komdlavuza kuguqula impilo ngezindlela eziningi . Kungasiza ukuzwa izindaba zabanye abantu. Imihlangano yokuphepha, izingqungquthela, ngisho nemithombo yezokuxhumana yindlela enhle kakhulu yokuxhumana nabanye abangabelana ngempi yakho noma babe nakho okufanayo nokuqonda.
> Imithombo:
> Hengeveld PJ, Kersten MJ. Isici se-B-cell esisebenzayo ku-pathophysiology yama-myeloma amaningi: isilungiso sokwelapha? I-Blood Cancer Journal. 2015; 5 (2): e282-.
> Sonneveld P, Broijl A. Ukwelashwa kwe-myeloma eminingi ephindaphindiwe futhi ephikisayo. Haematologica. 2016; 101 (4): 396-406.
> Palumbo A, Anderson K. I-myeloma eminingi. N Engl J Med. 2011; 364 (11): 1046-1060.