Incazelo, Izimpawu, Ukwelapha Nokuphawula Kwe-Follicular Lymphoma
I-follicular lymphoma uhlobo oluvamile lwe- non-Hodgkin Lymphoma (NHL) . Ngokuvamile i-lymphoma ekhula kancane evela ku- B-cells (i-lymphocytes B) , uhlobo lweseli elimhlophe legazi.
I-follicular lymphoma ibizwa nangokuthi i - lymphoma engavimbayo noma ephansi yezinga eliphansi, kokubili ngokuziphatha kwayo-ukukhula kancane-nokuthi kubheka kanjani ngaphansi kwe-microscope-engaphansi okungavamile (okungafani kakhulu) kunezinhlamba eziphezulu.
Izingozi Zezingozi
I-follicular ingathinta noma yimuphi kunoma yimuphi unyaka, kodwa ivame kakhulu kubantu abadala. Leyo minyaka yobudala ngesikhathi sokuxilongwa iseduze nango-55, futhi ithinta amadoda nabesifazane ngokulinganayo.
Ukuvama
I-follicular lymphoma yilona uhlobo oluvame kakhulu lwe-lymphoma ekhula kancane, cishe nabantu abangaba ngu-15 000 e-United States abaxilongwa ngonyaka.
Izimpawu Nezibonakaliso
Ukubukeka kwe-follicular lymphoma kuvame ukucashile, ngezibonakaliso ezincane zokuxwayisa ezingahle zingabonakali isikhathi eside. Izimpawu zingafaka:
- Ukwandiswa kwama-lymph nodes - Ukuvuvukala kwama-lymph nodes kwesinye isifunda somzimba yilona uphawu oluvame kakhulu lwe-follicular lymphoma. Lezi nodes zingase zenzeke entanyeni , emgodini , noma ekuguleni, noma zingabonwa ekuhloleni ukuhlolwa kwezinye izifunda zomzimba (njengama- lymph node mediastinal emathunjini noma esifubeni se- retroperitoneal esiswini). (Isikhungo sokufunda i-lymph node sixoxa ngomsebenzi we-lymph nodes nezindawo ngokujula okukhulu.)
- Ukushisa komsuka ongaziwa (FUO) - Ukushisa okuphakeme (okungaphezu kuka-100.4 degrees F noma ama-38 degrees C) okukhona kwezinsuku ezintathu noma ngaphezulu ezilandelanayo ngaphandle kwesizathu esizwakalayo kungaba uphawu lwe-lymphoma. Esikhundleni sokuthi uhlobene nokutheleleka okungatholakali, kucatshangwa ukuthi i-FUO ibangelwa izindlela zokumaketha zamakhemikhali ezihlobene nomdlavuza ngokwawo okwandisa izinga lokushisa komzimba.
- Ukulahleka kwesisindo okungenalutho - Ukulahleka kwesisindo esingachazwanga kuchazwa njengokulahlekelwa kwamaphesenti angu-5 kuya kwezingu-10 zesisindo somzimba (isibonelo, ama-7.5 kuya kwangu-15 amakhilogremu kumuntu onamakhilogremu angu-150) esikhathini esingangezinyanga ezingu-6 noma ngaphansi.
- Izithukuthuku zobusuku - Ukujula ebusuku kuhlukile ekukhanyeni okushisayo nokukhukhuma ngezikhathi eziningi ukuthi bahlambalaza futhi abantu badinga ukuguqula izigqoko zabo zokulala nokulala, ngezinye izikhathi izikhathi eziningana ebusuku.
- Ukukhathala - Ukukhathala komdlavuza ngokuvamile kuvame "ukukhathala okuvamile" ngoba akuthuthuki ngobusuku obuhle bokulala noma indebe yekhofi.
- Ukuphelelwa umoya
- I-Itching Generalized - Itching ijwayele ukuvela wonke umzimba futhi ingaba kakhulu.
Izimpawu ze-B ze-lymphoma zihlanganisa izimpawu ezintathu eziyinhloko ezingasiza ekubikezeni ukuthi umdlavuza uzoqhubeka kanjani uphendule ukwelashwa futhi uhlanganise:
- Fever
- Ukulahlekelwa kwesisindo okungenalutho
- Ukuphuza ukuthuka ebusuku
Ukuxilongwa
I-follicular lymphoma ivame ukuba ne- lymph node biopsy . Lokhu kungenziwa njenge-biopsy yokuhlinzwa (enezinamba ezingenakwenzeka ezinjengezintanyeni) noma njenge-core nucleal biopsy (ngenxa yamanothi ajulile emzimbeni).
Isampula encane ye-node ethintekile ithathwa futhi ihlolwe ngaphansi kwe-microscope yi-pathologist. Izici ze-node ethintekile zikhomba ukuthi kukhona i-lymphoma.
Ngaphezu kokubonakala ngaphansi kwe-microscope, i- immunohistochemistry izivivinyo zenziwa ukuhlola ama- tumor marker markers ze-Lymphoma futhi zithole uhlobo lwe-non-Hodgkin lymphoma .
Isizathu Sokuba Sibizwa ngokuthi 'I-Follicular' Lymphoma
Njengama-lymphomas amaningi, i-follicular lymphomas ithinta kakhulu i- lymph nodes . Lapho ama-lymph nodes abathintekayo yi-lymphoma abonakala ngaphansi kwe-microscope, abonisa izakhiwo ezizungezile ezibizwa ngokuthi "i-follicles." Ngakho-ke i-lymphoma ibizwa ngokuthi i-follicular lymphoma.
Uvivinyo Ngemuva kokuthola ukuhlolwa
Ngaphandle kokuhlolwa okuhlobene ne-biopsy ngenhla, ezinye izivivinyo eziningi zidingeka uma i-follicular lymphoma iqala ukutholakala.
Lawa avumela udokotela ukuthi abone ukuthi isifo siphelele kangakanani nokuthi yiziphi izitho ezithintekayo. Ukuhlolwa kwegazi, ukuhlolwa kwe-CT kanye nokuhlolwa komnyofu ngokuvamile kuyadingeka.
Ucwaningo olusha luye lwahlola nokusetshenziswa kohlelo lwe-PET / CT ukuqapha follicular lymphoma, ngokwesibonelo, uma imiphumela ye-CT scan ingacacile. Ku-PET-CT, ithegi enomsakazo (18F-fluorodeoxyglucose) ifakwe egulini ngaphambi kwe-CT scan kanye nezindawo zezifo ezisebenzayo zikhanyisa uma zithatha i-glucose ye-radioactive. Lokhu kusiza ukuhlukanisa izindawo ezikhuthele zomdlavuza ezindaweni zesikhumba esibucayi ezingabonakala zifana nezindlela ze-CT.
Izigaba
Isigaba se-follicular lymphoma sibonisa ukuthi lesi sifo sisakaze kangakanani futhi kubalulekile ekukhetheni ukwelashwa okungcono nakwekulinganisa ukubikezelwa kwesifo. I-lymphoma isakazeka kuma-lymph nodes kanye nezinye izitho emzimbeni kufaka phakathi umongo wethambo. Kunezigaba ezine ze-lymphoma ezihlanganisa:
- Isigaba I - I-lymph node eyodwa kuphela (noma i-lymph structure) ehilelekile.
- Isigaba II - Izakhi zamakhansela amabili noma ngaphezulu (noma izakhiwo zethrifu) zihilelekile kodwa kuphela ngakwesinye (ngaphezulu noma ngezansi) umdwebo.
- Isigaba III - Izakhi zamathambo (noma izakhiwo) zombili zomcibisholo zihilelekile.
- Isigaba IV - I-lymphoma ikhona emnothweni wethambo kanye / noma izicubu noma izitho ezingaphandle kwezakhi zamakhansela noma izakhiwo zethrifu.
Ngaphandle kwenombolo, i-lymphomas nayo inikezwa ngokuthi i-A noma i-B, ne-A okusho ukuthi ayikho izimpawu ze-B ne-B ebonisa ukuthi kukhona izibonakaliso ze-B ezibalwe ngenhla ngaphansi kwezimpawu).
Ukuqhubeka
I-follicular lymphoma ngokuvamile isifo esikhula kancane futhi ngokuvamile ihlala ingabonakali isikhathi eside emzimbeni ngaphambi kokuba itholakale. Njengoba lezi zimpawu zifihlekile, lesi sifo sivame ukuthuthuka ngaphambi kokuba kutholakale ukuxilongwa, kanti abantu abaningi bathola ukuthi i-lymphoma isigaba sesi-III noma IV.
Ngisho nasezikhungweni ezithuthukisiwe zesifo, noma kunjalo, ngokuvamile akuyona ingozi esheshayo ekuphileni ngesikhathi sokuxilongwa. Lesi sifo sivame ukuba nesifundo "sokulinda nokuxubha", okusho ukuthi sishaya futhi siphindaphinda izikhathi eziningana eminyakeni eminingana. Yize kungekho zodwa zokwelapha eziphefumulayo ezinyathelweni eziphambili, iziguli eziningi zisinda iminyaka engu-8 kuya kwezingu-10 noma ngaphezulu ngokuphathwa.
Ukuguqulwa
I-lymphoma yezintambo ivame ukuguquka ngesinye isikhathi, isifo esibhebhezelayo sibe nesifo esiqhubekayo. Lokhu kubizwa ngokuthi yizinguquko. Izinguquko zingase zenzeke kuwo wonke amaseli, noma kuphela endaweni ethile yomdlavuza. Ukuba khona kwezimpawu ze-B kwandisa ithuba lokuthi lesi sifo sizoguqulwa esikhathini esizayo esiseduze. Ngemuva kokuba i-lymphoma ye-follicular "iguqulwe" ijwayele ukuphathwa ngendlela efanayo ne- B-cell lymphoma enkulu .
Izimbangela
Asiqiniseki ukuthi yini ebangela i-lymphomas, nakuba kunezici ezithile eziyingozi ezihambisana nengozi ekhulayo. Ezinye izici ezingozini ezihambisana ne-lymphoma , ne-follicular lymphoma (FL) ngokukhethekile, zifaka:
- Ukudla okuphansi kwezithelo nemifino
- Amazinga aphansi womsebenzi womzimba
- Ukubhema - Ngokungafani nezinye i-lymphoma engeyona i-Hodgkin, ingozi ye-FL yanda kubantu abathuma.
- Ukuphuza utshwala - Ukusetshenziswa kotshwala kungathinta ingozi kunoma iyiphi indlela; Inani elincinci lewayini lihlotshaniswa nobungozi obuthakathaka futhi obuphakeme nsuku zonke utshwala buhlobene nobungozi obandayo.
- Ubudala (njengoba kuphawuliwe ngenhla, i-FL yanda ngokukhula)
- Ukukhuluphala
- I-Immunosuppression
- Ukuvezwa kwemvelo kuma-pesticides, ama-solvents ezimboni, nama-hydrocarbons
- Ukwehluleka kokubeletha kungabangela ezinye izimo.
- Ngokungafani nezinye izinhlobo ze-non-Hodgkin's lymphoma, i-FL ayixhunyiwe ne-Epstein-Barr virus infections, i-H.pylori.
- Ukukhanya kokukhanya kwe-UV kuhlotshaniswa nomngcipheko wehle . (I-Vitamin D ingadlala indima yokuzivikela ngokumelene ne-FL).
Ukwelapha
Kunezinketho eziningi zokwelashwa ezitholakalayo ze-follicular lymphoma , okhethweni oluhle oluphathelene nesigaba somdlavuza, ukuhlukumeza (ibanga), nezinye izimo zezokwelapha onayo, impilo yakho jikelele, nokuthi yiziphi izifo oye wazenza esikhathini esidlule. Izifo zakuqala, ukushisa imisebe yedwa kungase kube yilokho okudingekayo. Ngezifo ezisezingeni eliphezulu, izidakamizwa ezingezansi zivame ukusetshenziselwa inhlanganisela (bheka ukwelashwa kokuhlanganiswa ngezansi). Izinketho zingafaka:
Lindela futhi ubuke - Uma i-follicular lymphoma ingabangeli izimpawu, ukulinda okuqapha kungase kube "ukwelashwa" okukhethwa kukho. Ngokulinda okuqaphele, uzobe uhlolwe ngokucophelela ngezivivinyo nokucabangela ukuhlolwa ukuze ukwelashwa kuqalwe lapho umdlavuza uqala ukuqhubeka. Lokhu kungabonakala kuthusa, nakuba kutholakale ukuthi izinga lokusinda alishintshi uma le ndlela isetshenziswa.
Ukwelashwa kwamafutha - Isigaba, I follicular lymphomas, ukwelapha imisebe kungase kube yilapho kuphela ukwelashwa okudingekayo, futhi kungase kuphulukiswe lesi sifo. Ukwelashwa kwemisebe yasensimini okubandakanyekile (i-IFRT) ngokuvamile kuyindlela yokusebenzisa imisebe esetshenzisiwe. Ngokungafani nokwelashwa kwemisebe yensiza enwetshiwe, i-IFRT inikeza imisebe kuphela kumathiski ahloselwe, ukuvikela izicubu ezinempilo. (Ukwelashwa kwezidakamizwa kuthatha ingozi yamagciwane wesibili futhi lokhu kunciphisa leyo ngozi.)
I-Chemotherapy - I-Chemotherapy ivame ukusetshenziswa ngezimpendulo ezinhle. Kuvame ukusetshenziselwa njengengxenye yokwelapha okuhlanganisiwe (bheka ngezansi).
Ukwelapha okuhloswe - Ukwelashwa okuhlosiwe kusebenzisa imithi eqondisa ngokuqondile amaseli omdlavuza noma izindlela zokubonisa ezihilelekile ekukhuleni kwesisu. I-antioclonal antibody Rituxan (rituximab) ivame ukusetshenziswa (bheka imithi yokwelapha) kanye ne-chemotherapy futhi yenza umehluko omkhulu emazingeni okusinda. Ama-antibodies e-monoclonal afana ne-rituximab yi-antibodies eyenziwe ngabantu abakhelwe ukunamathisela kumakethi athile avela kumaseli e-lymphoma (ama-CD markers). Bobabili i-rituximab ne- Gazyva (obinutuzumab) bahlasele uphawu lwe-tumor ye-CD 20 .
I-Treanda (i-bendamustine) itholakale nokwandisa ukusinda okungahambisani nokuqhubekayo kodwa kunomphumela omkhulu wemiphumela emibi. I-Gazyva (obinutuzumab) kanye ne-bendamustine ingasebenza kulabo abangaphenduli ku-rituximab.
I-radioimmunotherapy - i-Radioimmunotherapy yindlela yokwelapha lapho imithi (ngokuvamile i-antibody monoclonal) ihlanganiswa nezinhlayiya zemisebe yokuvumela ukuthi izidakamizwa zinikeze imisebe ngokuqondile ngamaseli omdlavuza. Isibonelo nguZevalin (yttrium-90 ibritumomab tiuxetan).
Ukuhlolwa kwemitholampilo - Izidakamizwa eziningi kanye nezinqubo zenzelwa ukuhlolwa kwezigameko zokwelashwa , okubandakanya izidakamizwa ze- immunotherapy Keytruda (pembrolizumab), ukuguqulwa kwe-cell stem , nokuningi. Nazi ezinye zezinto zakamuva ezitholakalayo ocwaningweni lymphoma.
Imithi yokwelapha
Kunezinhlobo zokwelapha eziningana ezingasetshenziswa kokubili ekuqaleni noma uma i-lymphoma follicular iqhubeka. Lokhu kufaka phakathi
- I-R-Bendamustine (i-rituximab ne-bendamustine) - Le nhlanganisela ibonakala ibe nemiphumela emibi kakhulu (i- peripheral neuropathy kanye nokulahleka kwezinwele).
- I-Treanda (bendamustine) yedwa
- Rituximab yedwa
- R-CHOP (rituximab, cyclophosphamide, doxorubicin, i-vincristine, ne-prednisone)
- I-R-CVP (i-rituximab, i-cyclophosphamide, i-vincristine, ne-prednisone)
- I-Fludara (i-fludarabine) ne-rituximab
- I-Zydelig (idelalisib) noma ngaphandle kwe-rituximab
- I-Revlimid (lenalidomide) noma ngaphandle kwe-rituximab
Ukwelashwa Kwe-Maintenance - Uma i-follicular lymphoma isabela, ukwelashwa okuhlosiwe njengokuthi i-rituximab ingaqhubeka iminyaka embalwa ukusiza ukukhulisa ukuxolelwa .
Okuqhamuka uma udla imishanguzo
Imiphumela emibi yokwelashwa kwakho iyoxhomeka ekwelapheni okwamukelayo. Ngokwelashwa okuhlosiwe njenge-rituximab, umphumela ovame kakhulu ohlangothini oluthile ukuphendula okweqile ngesikhathi se-rituximab infusions . Ezinye imiphumela emibi ingabandakanya ukubalwa kwegazi okuphansi kanye nokukhwehlela noma ukuphuma komzimba.
Isibikezelo
Uma i-lymphoma ye-follicular itholakale ekuqaleni, ingase ikwazi ukuphilisa ngemithi yokwelashwa. Kodwa ngisho nezigaba ezithuthukisiwe zesifo, abantu bangaphila iminyaka eminingi ngokuphulukiswa. Ithuluzi elibizwa ngokuthi i-Follicular Lymphoma International Prognostic Index noma i-FLIPI ngezinye izikhathi lisetshenziselwa ukuthola umbono mayelana nokuchazwa kwakho okuqondile. Le nkomba ibheka izici eziningana ezihlukene futhi inikeza inombolo elinganisela izinga lokusinda lonyaka weshumi.
Khumbula ukuthi kunezici eziningi ezehlukene ezithinta ukubikezela ngomdlavuza, futhi ngezinye izikhathi abantu baphila isikhathi eside kunalindelekile, noma ngokufanayo. Siyazi ukuthi ukusetshenziswa kogwayi, ukukhuluphala, nokusetshenziswa kotshwala kuhlotshaniswa nokusinda okunomsoco, ngakho-ke indlela yokuphila enempilo ibaluleke kakhulu.
Ukubhekana
Ukwelashwa kwe-lymphoma kuyashintsha ngokushesha. Kubalulekile ukufunda konke ongakwenza mayelana nomdlavuza wakho. Hlola lezi zeluleko zokucwaninga umdlavuza wakho ku-inthanethi . Izifundo zisitshela ukuthi abantu abafundiswa ngomdlavuza wabo abazwa nje ukulawula futhi banikezwe amandla, kodwa bangase babe nemiphumela engcono.
Cela usizo futhi uvumele abanye bakusize. Cabanga ukuthi uhileleke eqenjini lokusekela kanye / noma emphakathini wokusekela i-lymphoma. Kungakhathaliseki ukuthi abangani bakho nomndeni wakho banothando kangakanani, kungaba okubaluleke kakhulu ukukhuluma nabanye ababhekana nezinselele ezifanayo.
Ngaphezu kwakho konke, khumbula ukuthi ukuthuthuka okuphawulekayo kuyenzeka ekwelapheni kwamagciwane efana ne-follicular lymphoma. Yiba ngummeli wakho njengomuthi wesifo somdlavuza futhi ufunde mayelana nalezi zitholakalayo. Kukhona ithemba elikhulu.
Ukunakekelwa
Uma uzibuza ukuthi yini oyithandayo, ungase ufise ukuhlola ukuthi yini abaphila ngayo emdlalweni owathi lapho ebuzwa umbuzo: yini ngempela ehlala nomdlavuza ? I-follicular lymphoma, ekubeni ngumdlavuza okhula kancane, uvame ukuvela iminyaka eminingi. Ngamanye amazwi, kuyimarathon futhi akuyona i-sprint. Thatha isikhashana ukuthi ufunde ukuthi ungayinakekela kanjani njengoba unakekela othandekayo ngomdlavuza.
Imithombo
Adams, H., noT. Kwee. Inani lePrognostic le-FDG-PET yesikhashana e-R-CHOP-Ephathekayo ehlukaniswa kakhulu ye-B-Cell Lymphoma: Ukubuyekezwa kwesistimu kanye nokuhlaziywa kwe-Meta-Analysis. Ukubuyekeza Okubalulekile ku-Oncology ne-Hematology . 2016. 106: 55-63.
I-ambinder, A., Shenoy, P., Malik, N. et al. Ukuhlola Izingozi Ze-Follicular Lymphoma. Intuthuko e-Hematology . 2012. 2012: 626035.
UBurke, J., van der Jagt, R., Kahl, B. et al. Umehluko ku-Quality of Life phakathi kwe-Bendamustine-Rituximab no-R-CHOP / R-CVP ezigulini ezinezidakamizwa ezingenakubalwa ezingenakulinganiswa okungeyona i-Hodgkin Lymphoma noma i-Mantle Cell Lymphoma. I-Clinical Lymphoma, i-Myeloma ne-Leukemia . 2016. 16 (4): 182-190.
Flinn, I., van der Jagt, R., Kahl, B. et al. Ukuhlolwa okungahleliwe kwe-Bendamustine-Rituximab noma i-R-CHOP / R-CVP ku-First Line Line Treatment of Indolent NHL noma i-MCL: Ucwaningo lwe-BRIGHT. Igazi . 2014. 123 (19): 2944-52.
Gascoyne, R., Nadel, B., Pasqualucci, L. et al. I-Lymphoma ye-Follic: I-State-of-the-Art ICML Workshop ku-Lugano 2015. I-Hematologic Oncology . 2017 Apr 4. (Epub ngaphambi kokuphrinta).