I-leukemia, umdlavuza wezingqamuzana ezenza igazi, uvame ukucatshangwa njengesimo esithinta izingane kanye nentsha-eqinisweni, ngumdlavuza ovame kakhulu wobuntwana. Kodwa-ke, i-leukemia iphinde ithinte abantu abadala asebekhulile nabantu abangaphansi kweminyaka engama-60 yobudala, ikakhulukazi.
Ngenkathi ukwelashwa kubantu asebekhulile kungaba yinselele nakakhulu, namhlanje kunenani elikhulayo lokukhetha-ngisho noma usekhulile ngokwanele ukukhumbula u-Eisenhower noJFK.
Amakilasi amasha omuthi avela angasiza ekulwa nesifo, ngisho nalapho umzimba wakho ungeke uthathe umonakalo wokubambisana kwamakhemikhali amakhulu. Lokho kusho ukuthi ngisho nasezikhathini zanamuhla, i-leukemia iyisitha esinamandla sabaningi.
Izinhlobo ze-Leukemia ku-Older Adult
I-lymphocytic leukemia (CLL) engavamile kakhulu yi-leukemia ejwayelekile kunazo zonke kubantu abadala, eneminyaka yobudala ehlolwayo cishe iminyaka engu-71. I-myeloid leukemia (AML) enamandla ihlanganisa isibili esilandelayo kubantu abadala, eneminyaka yobudala ekuxilongweni kweminyaka engu-67; futhi amaphesenti angaphezu kwezingu-60 eziguli ezisanda kutholakala nge-AML zingaphezu kuka-60. Ngakho-ke, i-CLL ne-AML zibhekwa kabanzi kakhulu lapha, noma kunjalo, abadala abadala bangathuthukisa ezinye izinhlobo ezimbili ze-leukemia, futhi. Ukudala iminyaka engaphezu kwengu-70 kuyisici esiyingozi kumuntu omdala we-acute lymphoblastic leukemia (KONKE), okubizwa nangokuthi i-adult lymphocytic leukemia. Futhi mayelana ne-lemonemic myelogenous (CML) engapheli, cishe amaphesenti angu-50 weziguli ezine-CML zineminyaka engama-66 nangaphezulu.
Abantu Abadala Abaqhathaniswa Ne-Leukemia
I-CLL ne-AML yizinhlobo ezivame kakhulu ze-leukemia ezizovela kamuva ekuphileni. Kulaba ababili, i-AML yisifo esisheshayo ngokushesha. Ukulinganisa lezi zimbi ezimbili (zonke izigaba zamaqembu) ngo-2016 zifana nalokhu:
- Amacala amasha angu-18 960 kanye nokufa kwabangu-4 660 kusuka ku-CLL
- Amacala amasha angu-19 950 kanye nokufa kuka-10 430 ku-AML.
I-CLL ne-AML ziyizifo ezihluke kakhulu, ezibonisa umehluko ophawulekayo phakathi kwama-leukemi ase-acute futhi angapheli, ngokuvamile. Wonke ama-leukemia aqala lapho amangqamuzana omnyofu-imboni yomzimba wakho ekwenzeni amangqamuzana egazi amasha-aqala ukukhiqiza amangqamuzana egazi amhlophe angavamile. Ama-stem cells emnzini wethambo avame ukuphakamisa onke amangqamuzana egazi lakho njalo, okwenza amangqamuzana amasha athathe isikhundla salowo omdala. I-leukemia enamandla ihilela amangqamuzana amancane adala igazi futhi ajwayele ukuthuthuka ngokushesha kakhulu. I-leukemia engapheli ihlanganisa amangqamuzana egazi ayenziwe ngegazi abuye avuthiwe, kodwa namanje i-leukemia engavamile, futhi engapheli ivame ukukhula kancane kancane, phakathi nezinyanga nezinyanga.
CLL
I-CLL ngumdlavuza wamangqamuzana amhlophe egazi emndenini we-B-lymphocyte. I-B-lymphocytes, noma ama-B-amangqamuzana, yi-lymphocytes engasetshenziswa futhi iholele ekukhiqizeni i-antibody. Olunye uhlobo lwe-lymphocytes yi-T-cells, efana namasosha omzimba, noma amaseli esosha.
I-CLL ayivame ukudala izimpawu ekuqaleni, futhi umuntu ngeke asazi ukuthi une-CLL ekuqaleni. Eqinisweni, njalo, abantu bathola ukuthi bahlolwa ngokuhlolwa kwegazi njalo. Uma i-CLL ibangela izimpawu, ezinye zezinto ezivame kakhulu: zizwa ukhathele kakhulu futhi zibuthakathaka; noma une- lymph nodes evuvukile entanyeni, ngaphansi kwengalo noma e-groin; noma ugule izifo kalula kunejwayelekile; noma ube nemfiva, noma ukuthuthumela okukhulu ngesikhathi sasebusuku; noma ukulahlekelwa isisindo ngaphandle kokuzama.
Ku-CLL, amangqamuzana omdlavuza atholakale atholakala kakhulu egazini, emnothweni we-bone kanye ne-lymph nodes. Isimo esihlobene, esibizwa ngokuthi i-lymphocytic leukemia, noma i-SLL, ngumdlavuza oqala emndenini wamaseli we-B, njenge-CLL, noma kunjalo, umuntu onama-SLL akanalo izinombolo eziphezulu zamaseli amhlophe egazini lakhe.
Ukuxilongwa kwe-CLL kudinga ukuhlolwa kwegazi, futhi inani lamaseli e-B egazini lakho kufanele limiswe. I-CLL ithola ukuthi kukhona okungenani ama-B-5 angama-B-cell angavamile nge-ml ngayinye yegazi, futhi ama-B-cells kufanele abe "amakhophi" noma ama-clones weselula elifanayo lomzali oyingozi. Lokhu kubizwa ngokuthi yi-monoclonality.
Amaseli e-CLL nawo kudingeka ahlolwe ukuze abone ukuthi yini ebusweni bawo. Kungenzeka ukuthi bananoma yimaphi amamaki amaprotheni noma amamaki. Ama-Laboratories abhekisela kulezi zincwadi zamaphrotheni usebenzisa i-CD izincwadi ezilandelwa ngencazelo yezinombolo. Ku-CLL, amaseli angase abe nomaka okuthiwa i-CD5, i-CD19, ne-CD23 ebusweni bawo; abanye bangase babe ne-CD20, kodwa akekho i-CD10. Kwezinye izimo, kudingeka ube nezinye izivivinyo ezenziwe ngaphezu kokuhlolwa kwegazi, njenge-lymph node biopsy noma i-bone marrow biopsy-noma kunjalo, lokhu akuyona into evamile yokuxilongwa kwe-CLL.
CLL vs. MBL
Ucwaningo lubonisa ukuthi amaphesenti amathathu kuya ku-5 abantu abangaphezu kweminyaka engu-40, uma behlolwe ngezivivinyo ezibucayi, babonisa inani le-clonal ye-lymphocytes, njenge-CLL. Lokhu kutholakala kwaholela ekwakheni ukuxilongwa kwe-MBL, okubhekwa njengesimo sangaphambili se-CLL.
Uma unama-B-cell angu-5 000 angaphansi kuka-5 000, akukho ukukhuliswa kwe-lymph node futhi akekho ezinye izimpawu ze-CLL, ungase utholakale unesifo se-B-lymphocytosis monoclonal (MBL). Lokhu kuvamile kubantu abadala, futhi akusengumdlavuza. Abantu abambalwa abane BML bayaqhubeka nokuthuthukisa i-CLL; Nokho kukhona ukuthi kungenzeka, ngakho-ke ukulinda okulindile kunconywa.
Ngisho noma uthola ukuxilongwa kwe-CLL, isinqumo sokuphatha singase singabi isiphetho esandulele. Esikhathini esidlule, odokotela batshele iziguli nge-CLL ukuthi isikhathi "sokulinda" kufanele silandele ukuxilongwa kuze kube yilapho lesi sifo siphuthuka, ngesikhathi lapho ukwelashwa kuzoqala khona. Nakuba lokhu kungase kube njalo ezimweni eziningi, kunokuqonda okuqhubekayo ukuthi amacala ahlukene we-CLL angaziphatha ngendlela ehlukile, futhi ezinye izimo ze-CLL zingase zibize ukwelashwa okusheshayo okusheshayo.
Ingxenye yokuhlela ukuthi wena nodokotela wakho uzokwenzela ukuthola ukuthi ukwelashwa kwe-CLL yakho kufanele kuqale. Isinqumo senziwe ngokusekelwe kumpawu ze-CLL, imiphumela yokuhlolwa kwelebhu kanye nokuhlolwa kwesiteji. Ku-CLL, uhlelo lwesiteji se-Rai selusetshenziswa, kusukela ku-Stage I ukuya eSiteji IV. Kukhona nesistimu yesiteji se-Binet ye-CLL ehlukanisa izigaba A, B, no-C, kodwa akusizo ekunqumeni ukuthi uzoqala nini ukwelashwa.
Odokotela bahlukanisa izigaba ze-Rai zibe ngamaqembu aphansi, aphakathi, futhi aphezulu kakhulu lapho ekhetha ukhetho lwezokwelapha.
- Isigaba esingu-0 sibhekwa njengengozi ephansi.
- Izigaba I no-II zibhekwa njengengozi ephakathi.
- Izigaba III no-IV zibhekwa njengengozi enkulu.
Kubantu abane-CLL ye-RAI izigaba 0, mina no-II, kungenzeka ukuthi ukwelashwa kungase kungadingeki ngokushesha. Kodwa-ke, kumuntu onesifo sokuqala kanye ne-CLL-esebenzayo ngokufaka khona kwezimpawu ze-CLL njengokukhathala okukhulu noma umkhuhlane, ukukhukhumeza ebusuku noma ukulahleka kwesisindo okungenhloso-ukulashwa kuneluleka.
Ezinye izici kanye nesiteji ngezinye izikhathi zicatshangelwa uma zibuka izindlela zokwelapha. Izinto ezihlotshaniswa nezikhathi zokusinda ezimfushane zibizwa ngokuthi yizici ezimbi zokubikezela, kuyilapho izici ezihlobene nokusinda isikhathi eside ziyizici ezibikezelayo zokubikezela.
Izici ezithile ezihlobene namaphrofayli we-leukemia wezakhi zofuzo kanye nempawu zomhlaba nazo zisetshenziselwa: ZAP-70, CD38, kanye nesakhi sofuzo sosizo lwe-IGHV ukwahlukanisa amacala e-CLL ngamaqembu amabili, okukhula kancane nokukhula ngokushesha. Abantu abanomusa okhula kancane we-CLL bavame ukuhlala isikhathi eside futhi bangakwazi ukubambezela ukwelashwa isikhathi eside.
Imithi etholakalayo ye-CLL ivame ukuwela emikhakheni emikhulu yezokwelapha ezifana ne-chemotherapy, ukwelashwa okuhlosiwe, i-immunotherapy, i-immunomodulators, ne-steroids. Akuwona wonke ukwelashwa okufanele bonke abantu abane-CLL. Uma odokotela abaningi befunda ngezinhlobo ezahlukene ze-CLL, izindlela zokwelapha ezithe xaxa zingase zifanele amanye amacala we-CLL kodwa hhayi amanye.
Ezinye zezokwelapha ziphenya futhi zingafinyeleleka kuphela uma ufaka uhlolo lweklinikhi. Ngokususelwa ekuvivinyweni kwemitholampilo, uma ukwelashwa kunqunywe ukuthi kuphephile futhi kuphumelele ku-CLL, lesi sidakamizwa sivunyiwe yi-FDA futhi siyatholakala kabanzi.
Iminyaka yobudala kanye nempilo ejwayelekile nayo ibalulekile ekucabangeni ekwelapheni. Isibonelo, ezinye zokwelashwa kokuqala kwe-CLL zingase zikhethwe njengezifanele kakhulu kubantu abancane nabanempilo abane-CLL; ezinye izindlela zokwelapha zokuqala noma izilawuli zingase zibhekwe kangcono kulabo asebekhulile noma empilweni embi.
Ukunakekelwa okusekela kuyindlela yokwelapha engelapheki umdlavuza kodwa ihlose ukwenza impilo ne-CLL ibe ngcono nakakhulu kuwe. Ukunakekelwa okusekelayo kufaka phakathi izinto ezifana nemigomo, ukumpontshelwa igazi, imithi yokuvimbela, ngisho nokusiza ngokunakekelwa kokunakekelwa uma kukhona odokotela abaningi abathintekayo.
Abantu asebekhulile abane-AML
Ngokwe-American Cancer Society, ngokuvamile i-myeloid leukemia isifo sesabantu asebekhulile futhi engavamile ngaphambi kweminyaka engama-45. Isilinganiso seminyaka yesiguli nge-AML sineminyaka engama-67.
Izimpawu ze-AML zivame ukuhlobana nokubala kwegazi okuphansi komuntu. Lapho amangqamuzana e-leukemia ethatha phezu komnkantso wamathambo, aphuma ngaphandle kwamaseli avamile okwenza igazi, okubangelwa ukuntuleka kwegazi lakho. Ukuntuleka kwamangqamuzana egazi abomvu kuholela ekudleni kwegazi futhi izimpawu ezinjengobuthakathaka futhi bekhathala ngokweqile. Ukuntuleka kwamangqamuzana amhlophe egazini kuholela ku-neutropenia, okungenzeka kube nezibonakaliso ezifana nomkhuhlane kanye nokutheleleka. Ukuntuleka kwamaplatelets kuholela ku-thrombocytopenia kanye nezimpawu ezifana nokuphuma okungavamile noma ukulimala . Futhi inhlanganisela yalezi zimpawu zivamile.
Ekuxilongweni kwe-AML, kunezinhlawulo ekuhlolweni kwegazi; Nokho, ngokungafani nokuxilongwa kwe-CLL, isifiso somswakama wethambo / i-biopsy ngokuvamile kudingeka ukuba ihlolwe futhi ihlolwe i-AML. Ama- subtypes amaningi a-AML manje ayaziwa ukuthi ayatholakala.
Ngemuva kokuxilongwa kwe-AML, kanye neqembu lakho lokunakekelwa kwezempilo, uthuthukisa umqondo wemigomo yokwelashwa, kanye nemiphumela emibi yokwelashwa. Cishe isigamu seziguli ze-AML ezindala ziya ekuxoxweni ngemuva kokwelapha kokuqala, ngokusho kwe-American Cancer Society. Abantu abafinyelela ekuxoxweni okuphelele banomkhwalithi othuthukisiwe wokuphila uma kuqhathaniswa nalabo abagulayo abathola ukwelashwa okuhambisana nokwelashwa, mhlawumbe ngenxa yokungenisa izifo ezimbalwa, ukugonywa, kanye namagciwane. Abasindile be-AML besikhathi eside bamelelwa kuwo wonke amaqembu; Kodwa-ke, ukubuyela emuva ngemuva kokwelashwa kokuqala kuvamile kakhulu. Ngokuvamile, iziguli ezine-AML ziyakhuthazwa ukuba zibhalwe ezivivinyweni zokwelashwa ukuze zizitholele izindlela zokwelapha ezintsha kanye nezinhlanganisela ezinethemba lokuthuthukisa imiphumela yazo.
Kulabadala asebekhulile noma ngokuvamile abagula kakhulu, noma abanomsebenzi omzimba ompofu, ngezinye izikhathi ukunakekelwa okusekelayo kanye / noma imithi ekhiphethini encane ekhethiwe. Ukunakekelwa okusekelayo kuhlanganisa ukumpontshelwa igazi, ama-antibiotic kanye neminye imithi esiza impilo yomuntu kodwa ingayisusi umdlavuza.
> Imithombo:
> I-American Society of Hematology. Ukwelashwa kweziguli asebekhulile ezine-leukemia ezinamandla.
> Chiorazzi N, Rai K, Ferrarini M. Chronic Lymhocytic Leukemia. N Engl J Med. 2005; 352: 804-15.
> Izinkombandlela ze-NCCN. I-Lymphocytic Leukemia engapheliyo. Inguqulo 1. 2016.