Izinyathelo Ezivela Ekucwaningweni Kwegazi Legazi
Unyaka ngamunye i-American Society of Hematology (ASH) inomhlangano oveza ucwaningo lwamuva ngemithi kanye nokunye ukwelashwa. Imithi exoxwe ngayo kulo mhlangano ikhona kuzo zonke izigaba ezahlukene zokuthuthukiswa kwemitholampilo. Ngamanye amazwi, ezinye zazo ziyimithi yamanje, ivivinywe futhi iqinisile, ivunyiwe kakade futhi isebenza, kanti abanye bahlolisisa imithi, okusho ukuthi asazi okuningi ngabo okwamanje.
Thatha i-rituximab, isibonelo. Ngo-2016, i-Rituximab ibhekwa ngokuthi "imithi yokudala" eyasetshenziswa iminyaka ukuphatha izinhlobo eziningi ze-non-Hodgkin lymphoma. Imidala emidala, imithi eningi engasungulwa isengenza amagagasi kwenye yalezi zinkomfa, isibonelo, lapho kutholakala ukusetshenziswa okusha.
Ezinye izidakamizwa ezixoxwa nge-ASH zikhona esiteji sokuqala sokuthuthukiswa-okungukuthi, ukutholakala okwabelwanayo kubaluleke kakhulu. Ngokuvamile, lezi zifundo zichazwa "izifundo zesigaba-I." Isigaba I sibhekisela ekuvivinyweni kokwelashwa okuvivinya izidakamizwa ezintsha noma ukwelashwa eqenjini elincane labantu-okokuqala ukuqala ukubona ukuthi kusebenza yini, ukuthola isisindo esiphephile ububanzi, nokukhomba imiphumela emibi. Izilinganiso ze-Phase I zifana nembewu: ungase uthole ekugcineni uthole isitshalo noma izithelo ongabonisa umklomelo lapho ubulungiswa bezwe, kodwa ungathola nokuhluleka ukuhluma noma isitshalo esingatheli izithelo eziningi.
Ucwaningo nge-DLBCL
Ukusakaza i-B-cell lymphoma enkulu, noma i-DLBCL, i-lymphoma ekhula ngokushesha.
Uhlobo oluvame kakhulu lwe-lymphoma kubantu abadala, futhi luvela kuma-blood cell e-B-lymphocytes-amhlophe aholela ekukhiqizeni kwama-antibody kumzimba wokuzivikela omzimba. Abantu abahlukahlukene banezinhlobo ezahlukene ze-DLBCL futhi abacwaningi baphenya okukhethwa kukho okusha kweziguli ezine-DLBCL .
Rituximab Plus CHOP noma DA-EPOCH-Rituximab
Isifundo sesigaba se-III sasineziguli ezingu-524 ezibhalisiwe (262 engxenyeni ngayinye yokwelashwa) phakathi kukaMeyi 2005 noMeyi 2013. Lolu cwaningo lwaqhathanisa ukwelashwa kwe-R-CHOP kanye nokwelashwa kwe- DA-EPOCH-R, ukwelapha okunamandla kakhulu, ngokulindela ukwandisa ukusinda iziguli ezinezigaba ezitholakale zitholakale kamuva II noma ngaphezulu kweDLBCL.
Abahlanganyeli babeneminyaka engama-18 ubudala futhi abanalo i-HIV. Kuze kube manje, i-DA-EPOCH-R yayihlotshaniswa nokudla okunobuthi kanye nemiphumela emibi, futhi bekungekho umehluko phakathi kwamaqembu ngokulandela izinzuzo zokwelashwa ezifundwayo. Noma kunjalo, abaphenyi bafuna ukubona ngamagqebhezana athile abantu abane-DLBCL futhi ngabe ngeke bazuze yini nge-DA-EPOCH-R kuzoboniswa ngamaqembu angaphansi. Ukuhlaziya kuyaqhubeka.
I-Obinutuzumab Plus CHOP noma i-Rituximab Plus CHOP
Lokhu kwaba esinye isifundo se-III kanye nabahlanganyeli abangu-1,418 bahlola ukusebenza nokuphepha kwe- obinutuzumab vs. rituximab plus CHOP kuziguli ezine-DLBCL. Ababambe iqhaza baneminyaka engu-18 ubudala noma ngaphezulu futhi bangaphathwa kabi nge-DLBCL. Ngokubanzi, kwakungekho umehluko ophawulwe phakathi kwamaqembu amabili ngokwezinzuzo zokusinda, futhi izenzakalo ezimbi kakhulu zabikwa iziguli ku-obinutuzumab-CHOP kuneqembu rituximab-CHOP. Ngokuvamile, amanani okufa aphezulu futhi ahoxiswa ukwelashwa okuvame kakhulu ku-obinutuzumab -CHOP ingalo.
Noma kunjalo, uphenyo uhlela ukubheka amaqembu angaphansi kwe-DLBCL ukuze azame futhi athole noma yiziphi izinzuzo noma izingozi ezingabonakali eqenjini lonke.
I-Lenalidomide ezigulini ezine-DLBCL ezibuyiselwe
Abantu abangakufanelekeli ukufakelwa komnkantsha wamathambo noma abhekana nokuphindaphinda ngemva kokufakelwa komnyoba banamathuba amancane okwelapha, ngakho-ke iqembu elilodwa lokucwaninga libheke ekusebenziseni imithi yokwandisa ukusinda kulezi ziguli.
Bathole ukuthi i-agent ye-lenalidomide ingumfundi ofanelekile ngoba yisidakamizwa somlomo, esebenzayo ngokumelene ne-DLBCL engathathwa iminyaka enephrofayli eyamukelekayo yobuthi.
Ucwaningo lubonise ukuthi iziguli ezindala ezinezinhlobo ezahlukene ze-DLBCL zithole inzuzo yokwelashwa kwe-lenalidomide yokwelashwa okuthuthukisiwe. Ukwelashwa kwesondlo kusho ukwelashwa komdlavuza ngemithi, ngokuvamile kulandela ukwelashwa kokuqala.
Ucwaningo lwe-Follicular Lymphoma
I-follicular lymphoma yilona uhlobo oluvame kakhulu lwe-indolent-okungukuthi, i-slow-growing-lymphoma. Ngenkathi i-obinutuzumab ingabonakali ukunikeza izinzuzo ezicacile okwamanje esifundweni se-DLBCL okukhulunywe ngenhla, kwakungeyona indaba ye-obinutuzumab ku-lymphoma ye-follicular.
Ukwelashwa Okusekelwe Ku-Obinutuzumab Ukwandisa Ukusinda Okungenakuqhubeka Kweziguli Eziphethwe Ngama-Lymphoma Ezingekho Ngaphambili
Isivivinyo se-GALLIUM saba isigaba se-3 sesifundazwe siqhathanisa ukusebenza nokuphepha kwe-rituximab noma i-obinutuzumab nge-chemotherapy elandelwa isondlo njengokwelashwa kokuqala kwe-indolent non-Hodgkin lymphoma.
Ezigulini ezine-follicular lymphoma ezingaphenywanga ngaphambilini, isimiso se-obinutuzumab-based chemotherapy kanye nesimiso sokulondoloza siphumelele ekuthuthukiseni okunempilo ekusindeni ngaphandle kokuthi lesi sifo siphumelele-ukunciphisa amaphesenti angama-34 engozini yokuqhubekela phambili ngokuphathelene ne-rituximab-based therapy. U-Obinutuzumab ube nemvamisa ephezulu yezinye izenzakalo ezimbi njengezimpendulo ezihlobene nokunyuswa, ukubalwa kwegazi okuphansi, nokutheleleka. Abacwaningi baphetha ukuthi uhlelo lokusekelwa kwedatha obinutuzumab lusezingeni eliphakeme lokunakekelwa kweziguli ezingaphathwa kabi nge-follicular lymphoma.
Ucwaningo nge-Hodgkin Lymphoma
Kunezinhlobo ezinhlanu ezinkulu zeHodgkin lymphoma (HL) umuntu angatholakala ukuthi unayo. I-Classical Hodgkin lymphoma yigama elidala elisetshenziselwa ukuchaza iqembu lezinhlobo ezine ezivamile ezihlanganisa amaphesenti angaba ngu-95 azo zonke izimo ze-HL emazweni athuthukile.
I-Immune Checkpoint Inhibition Yokubuyiselwa I-Classical Hodgkin Lymphoma
I-Classical Hodgkin lymphoma ibonakala ibe nezinguquko zofuzo ezizokwenza kube lula ekilasini elisha lemithi ebizwa ngokuthi i-immune checkpoint inhibitors , esekelwe kwizifundo zangaphambilini. Ngakho-ke, iqembu lokucwaninga e-ASH libheke iziguli ezingu-210 eziphathwe izifo eziphikisayo noma ziphinde zibuyele HL ukuze zibone ukuthi i-inhibitor yokuhlola i-pembrolizumab ingayenza kanjani.
Amanye amangqamuzana omdlavuza akhiqiza kakhulu i-PD-L1, futhi lokhu kuyasiza ukuba babalekele ukuhlaselwa komzimba. I-Pembrolizumab ingasiza ukubeka lokho. Ukuvinjelwa kwe-PD-1 ne-pembrolizumab kusebenze ngamaqembu weziguli ezine-classic HL ezaye zandulelwa kakhulu nezinye izifo. I-Pembrolizumab yayinezinga eliphezulu lokuphendula ngisho nasesifo esasimelana ne-chemotherapy. Imiphumela eyengeziwe, kufaka hlangana ukuthi impendulo ihlale isasebenza kangakanani kulindeleke emhlanganweni.
Ucwaningo nge-leukemia
Ukwelashwa Okusekela Iziguli Nge-AML - Eltrombopag
Kulezi ziguli ezithatha imithi ekhemotherapy ejulile ye -lemonemic i-myelogenous lemonem (AML) , ngezinye izikhathi izibalo zeplatelet zihlala ziphansi ngemuva kwe-chemotherapy, futhi lokhu kungaholela engozini enkulu yokwelapha, isidingo samaphilisi amaningi weplatelet kanye neziguli zingahlakulela ukusabela kwamagciwane kumaplatelet, konke okusebenza ukuvimbela intuthuko.
Ngonyaka we-2016 iqembu libike ukuthi lisebenzisa i-eltrombopag, umuthi okhuthaza umzimba ukuba wenze amaplatele amaningi, kubantu asebekhulile ababengelashwa nge-AML.
Imiphumela yayiyimpumelelo-lokhu kwakuyisifundo se-pilot I-phase-kodwa kubonakala sengathi siphumelele ngokwenza abantu bakwazi ukuphumula ngokushesha kusuka ku-chemo ukuze bangadingi igazi elilodwa. Kube nokukhathazeka ukuthi i-agent efana ne-eltrombopag ingase iqhubekele phambili ukuqhuma kwe-leukemia, ngaphezu kwezinzuzo ezingasiza ngokusiza ama-platelet alulame, nokho, kuze kube manje kulolu cwaningo akukho bufakazi bokuthi leyo ngozi ingokoqobo.
Ukubuyiselwa emuva noma ukukhipha isifo se-Acute Lymphoblastic Leukemia (KONKE)
Ayikho irejista ejwayelekile ye-ALL evuliwe. I-Inotuzumab ozogamicin yindlela yokwelashwa ekhethiwe ye-FDA yeziguli ezine-leukemia (i-ALL) ephindaphindiwe noma ephikisayo. Ngesilingo esisodwa somtholampilo, i-inotuzumab ozogamicin yakhiqiza ukuthuthukiswa okuphawulekayo ngaphezu kwe-chemotherapy ejwayelekile ezigulini ezine-ALL refractory to, noma ezingaphenduli, nezinye izindlela zokwelashwa.
I-Inotuzumab ozogamicin iyinhlanganisela yokuphenyisisa e-antibody-izidakamizwa ezakhiwe i-antibody ehlanganiswe ne-agent ekwazi ukubulala amangqamuzana omdlavuza. Uma lo muthi ubophezela kumathe obizwa nge-CD22 kumaseli omdlavuza, wona angena ngaphakathi esitokisini lapho enza ukuthi i-DNA iphule, okuholela ekufeni kweseli.
Okushiwo yiCwaningo
Ngenkathi izingqungquthela zijwayele ukuhlinzeka ngosizo lwezokwelapha ngocwaningo lwamuva, ulwazi luvame ukuthakazelisa kulabo abathintekayo abanezimo, kanye nabathandekayo babo. Uma uvakashela udokotela wakho buza ukuthi yini okusha emkhakheni-ukuba owazi kungakusiza uzizwe ukhululekile ekulawuleni impilo yakho.
> Imithombo:
> 469 Isigaba III Isifundo Esihleliwe Sama-R-CHOP Versus DA-EPOCH-R kanye Nokuhlaziywa Kwama-Molecular of Untreated Diffuse Large B-Cell Lymphoma: CALGB / Alliance 50303
> 474 I-Lenalidomide Maintenance ithuthukisa ngokuphawulekayo izibalo zokusinda ezigulini ezine-BD Cell Lymphoma (e-RDLBCL) ephindaphindiwe e-Relapsed Broadcasting Stem Cell Transplantation (ASCT): Imiphumela Yokugcina Ye-Triticentre Phase II Trial
> 470 I-Obinutuzumab noma i-Rituximab Plus CHOP ezigulini ezineziguli ezingenakubalwa ezingasaphathwa nge-B-Cell Lymphoma: Imiphumela yokugcina evela ku-Label-Open, Study Randomzed Phase 3 Study (GOYA)
> 1107 I-Pembrolizumab E-Relapsed / Refractory yama-Classical Hodgkin Lymphoma: Ukuphela Kwezinto Eziyinhloko Ekuhlaziyweni KweSigaba 2 I-Keynote-087 Isifundo
> 447 Isikhali Esisodwa, Isigaba II Isifundo Se-Eltrombopag ukuze Sithuthukise I-platelet Count Recovery in Iziguli Ezigugile Ne-Acute Myeloid Leukemia Ephulukisayo Ukuphulukiswa Kwe-Remuction Therapy
> Ukukhishwa kwe-Obinutuzumab-Based Based and Maintenance Kunweba Ukuphulukiswa Okungenayo Okuqhubekayo (PFS) Kwabagulayo abane-Follicular Lymphoma Engaphambilini Engayiboni: Imiphumela Eyisisekelo Ye-Phase Randomised 3 GALLIUM Study