Ukubukezwa Kwezinye Izinketho Zokwelapha Ezingeziwe
Ukuphela kokwelapheka kokwelashwa kwe- myelofibrosis eyinhloko (PMF) kuyi- stem cell transplant , kodwa-ke, lokhu kukwelashwa kunconywa kubaguli abaphezulu kanye nabangaphakathi kuphela. Ngisho kuleli qembu, ubudala kanye nezinye izimo zezokwelapha zingandisa izingozi ezihambisana nokufakelwa kwezitshalo ngokuphawulekayo okwenza kube ngaphasi komqondo wokwelapha. Ukwengeza, akubona bonke abantu abane-PMF engozini ephakeme futhi ephakathi komphakathi abazoba ne-donor efanelekile yokufakelwa kwe-stem cell (efanelwe nohlobo lwayo noma ofanelwe nomnikeli ongathinteki).
Kunconywa ukuthi abantu abane-PMF engozini encane bathola ukwelashwa okuhloswe ukunciphisa izimpawu ezihambisana nalesi sifo.
Mhlawumbe udokotela wakho welulekile ukuthi ukufakelwa kabusha akuyona indlela engcono kunazo zonke kuwe, noma akekho umnikeli ofanelekayo ongabonakala, noma awuzange ubekezelele ezinye izindlela zokwelapha zokuqala ze-PMF. Ngokwemvelo, umbuzo wakho olandelayo ungaba-yiziphi ezinye izindlela zokwelapha ezitholakalayo? Ngenhlanhla, kunezifundo eziningi eziqhubekayo ezizama ukuthola izinketho zokwelashwa ezengeziwe. Sizobuyekeza ezinye zala mithi maduzane.
I-JAK2 Inhibitors
I-Ruxolitinib , i-JAK2 inhibitor, yayiyindlela yokwelashwa yokuqala ehloselwe i-PMF. Izinguquko ezakhiweni zeJAK2 zihlangene nokuthuthukiswa kwe-PMF.
I-Ruxolitinib iyindlela yokwelapha efanelekayo kubantu abaneziguquko ezingenakukwazi ukuguqulwa kwe-stem cell. Ngenhlanhla, itholakale ilusizo ngisho nakubantu ngaphandle kokushintshashintsha kwe-JAK2.
Kukhona ucwaningo oluqhubekayo olufuna ukuthuthukisa imithi efanayo (ezinye i-JAK2 inhibitors) ezingasetshenziswa ekwelapheni kwe-PMF kanye nokuhlanganisa i-ruxolitinib nezinye imithi.
I-Momelotinib enye i-JAK2 inhibitor efundelwa ukwelashwa kwe-PMF. Izifundo zakuqala zaphawula ukuthi amaphesenti angu-45 abantu abathola i-momelotinib banciphise usayizi we-spleen.
Cishe isigamu sabantu abafundela sathuthukile ekukhuleni kwegazi futhi amaphesenti angaphezu kwangu-50 akwazi ukuyeka ukwelashwa kwegazi. I-Thrombocytopenia (isibalo esiphansi se-plateslet) singathuthukisa futhi singakwazi ukunciphisa ukusebenza. I-Momelotinib izoqhathaniswa ne-ruxolitinib esifundweni sesigaba sesi-3 ukucacisa indima yayo ekwelapheni kwe-PMF.
Izidakamizwa ze-Immunomodulatory
I-Pomalidomide iyisidakamizwa sokuzivikela (imithi eguqulela isimiso somzimba sokuzivikela). Ihlobene ne-thalidomide ne-lenalidomide. Ngokuvamile, le mithi inikezwa nge-prednisone (imithi ye-steroid).
I-Thalidomide ne-lenalidomide seziye zacutshungulwa njengendlela yokwelapha ku-PMF. Nakuba bobabili babonisa inzuzo, ukusetshenziswa kwabo ngokuvamile kuvinjelwe imiphumela emibi. I-Pomalidomide yasungulwa njengendlela ephansi enobuhlungu. Ezinye iziguli zithuthuka ekukhuleni kwegazi kodwa akukho mphumela owawubonakala ngosayizi we-spleen. Njengoba kunikezwe le nzuzo elinganiselwe, kunezifundo eziqhubekayo zibuka ukuhlanganisa i-polmalidomide namanye ama-agent afana ne-ruxolitinib ekwelapheni kwe-PMF.
Izidakamizwa ze-Epigenetic
Izidakamizwa ze-Epigenetic ziyimithi ethonya inkulumo yezakhi ezithile zomzimba kunokuba ziguqule ngokomzimba. Iklasi elilodwa lala mithi yi-hypomethylating agents, ezofaka i-azacitidine ne-decitabine.
Le mithi okwamanje isetshenziselwa ukwelapha i- myelodysplastic syndrome . Izifundo ezibheke indima ye-azacitidine ne-decitabine zikhona ngezigaba zakuqala. Enye imithi i-histone deacetlyase (HDAC) inhibitors njenge-givinostat ne-panobinostat.
Everolimus
I-Everolimus imithi ebizwa ngokuthi i-mTOR kinase inhibitor kanye ne-immunosuppressant. Ngu-FDA (Ukudla Nezidakamizwa Zokulawulwa Kwezidakamizwa) avunyelwe ukwelashwa kwamanqamu amaningana (isifuba, i-renal cell carcinoma, izicubu ze-neuroendocrine, njll) nokuvimbela ukulahlwa komzimba kubantu abaye bathola ukufakelwa komzimba (isibindi noma izinso). I-Everolimus ithathwa ngomlomo.
Ucwaningo oluqala lubonisa ukuthi lunganciphisa izimpawu, usayizi we-spleen, i-anemia, isibalo seplatelet nesibalo segazi elimhlophe.
Imetelstat
I-Imetelstat iye yafundiswa eziningana ze-cancer kanye ne-myelofibrosis. Ekufundeni kokuqala, kuye kwaholela ukukhululwa (izibonakaliso zokufa kanye nezimpawu ze-PMH) kwabanye abantu abane PMF ephakathi noma ephezulu.
Uma ungaphenduli ekwelashweni kwelayini lokuqala, ukubhalisa esilingo somtholampilo kungakunikeza ukufinyelela emitholampilo yombhalo. Njengamanje, kunezivivinyo ezingaphezu kuka-20 zokwelashwa ezihlola ukhetho lwezokwelapha kubantu abane-myelofibrosis. Ungaxoxa ngalolu khetho nodokotela wakho.
> Imithombo:
> Cervantes F. Indlela engiphatha ngayo i-myelofibrosis eyinhloko. Igazi. 2014; 124: 2635-2642.
> Geyer HL no-Mesa RA. Ukwelashwa kwama-myeloproliferative neoplasms: nini, yiphi i-agent, nokuthi kanjani? Igazi. 2014; 124: 3529-3537.