I-Myelodysplastic syndrome, noma i-MDS, ihlanganisa izinkinga ezihlukahlukene ezithinta ukusebenza komnkantsha wethambo. Umnkantsha we-bone wenza amasha amangqamuzana egazi abomvu, amaseli amhlophe nama-platelets wokuqhaqhaza, umsebenzi omningi ompofu ungabangela ukuphazamiseka kwegazi, ukubalwa kwamaselula, nezinye izinkinga.
Ukukhathazeka okukhulu nge-MDS yi-a) lezi zibalo eziphansi nazo zonke izinkinga ezihlobene; futhi b) ikhono le-MDS lokuguqula umdlavuza - i- leukemia enkulu ye- myeloid, noma i-AML.
Izinhlobo ezahlukene ze-MDS ziphathwa ngokuhluke kakhulu. Akuzona zonke izindlela zokwelapha ze-MDS ezifanele zonke iziguli ezine-MDS. Izinketho zokwelashwa kwe-MDS zibandakanya ukunakekelwa okusekelayo, ukwelashwa okunamandla kakhulu, ukwelashwa okunamandla okukhulu, kanye / noma ukuhlolwa kwekliniki.
Ukucatshangelwa Ukwelashwa
Lapho ukhuluma ngesiphakamiso sakho se-MDS yokwelashwa nodokotela wakho, izinto ezibizwa ngokuthi iziguli zingaba zibaluleke kakhulu. Izibonelo zezici ezihlobene neziguli zifaka okulandelayo:
- Indlela owawusebenzelana ngayo nemisebenzi yansuku zonke ngaphambi kokuxilongwa kwe-MDS
- Ezinye izimo zezokwelapha onakho
- Iminyaka yakho
- Izindleko zezimali zezokwelapha ezihlukahlukene
- Yiziphi izingozi zokwelashwa ezamukelekayo kuwe
Izimpawu zendlela yakho ethile ye-MDS nazo zibaluleke kakhulu. Izibonelo zezici ezithile nokuthola okulandelayo zifaka lokhu okulandelayo:
- Amakhamera nemiphumela yokuhlolwa kofuzo lomnyobo wakho, okusiza ekutholeni izinketho ezitholakalayo kuwe, amathuba okuthi i-MDS yakho izoqhubeka ne- leukemia , futhi yimiphi imiphumela engayilindela kwezinye izindlela zokwelapha.
- Ukuthi i-MDS yakho ithinta kanjani inani lamaseli enempilo egazini lakho elijikelezayo
- Yeka ukuthi isifo sakho sinzima kanjani ngokuya kwenani lamasosha "aqhuma" amancane emnkantsheni wakho
Imigomo yakho yalokho ofuna ukuphuma ekwelashweni ibuye ibe yingxenye ohlelweni. Izibonelo zemigomo ehlukene yokwelashwa zifaka okulandelayo:
- Ukuze uzizwe ungcono
- Nciphisa isidingo sakho sokuba nokumpontshelwa okuningi
- Thuthukisa i- anemia yakho, i- neutropenia , ne- thrombocytopenia
- Finyelela ukuxolelwa
- Phulukisa i-MDS yakho
Buka futhi ulinde
Kulezi ziguli ezine-MDS engozini encane njengoba kuzinqunywe yiSystem International Prognostic Scoring System, noma i-IPSS, nokubalwa okuphelele kwegazi (CBC) , ngezinye izikhathi indlela engcono kakhulu yokwelashwa iyabonwa futhi ixhaswe, njengoba kudingeka.
Kulesi simo, kuzodingeka uhlolwe ngenxa yezinguquko emrheni wakho ongase ukhombise ukuqhubeka kwesifo. I-CBCs njalo, kanye ne- aspirate yamathambo kanye ne-biopsy , ingaba yingxenye yokuqapha.
Ukunakekela okusekelayo
Ukunakekelwa okusekelayo kubhekisela emithonjeni yokwelapha nokuphatha i-MDS; lezi zindlela zokwelapha zingathuthukisa kakhulu isimo somuntu, kodwa ziyeka ukuhlasela ama cell cells okwenza i-MDS.
Ukuthungathwa
Uma igazi lakho liqala ukuwa futhi uthola izimpawu, ungazuza ngokumpompela kwamaseli abomvu noma amaplatelet. Isinqumo sokumpompela sizoxhomeka kwezinye izimo zezokwelapha onakho nokuthi uzizwa kanjani.
I-Iron Overload ne-Chelation Therapy
Uma uqala ukufuna ukumpontshelwa igazi njalo ngenyanga, ungase ube engozini yokuthuthukisa isimo esibizwa nge-iron overload.
Amazinga aphezulu ensimbi egazi elibomvu lokufelwa kwegazi angabangela ukwanda kwezitolo zensimbi emzimbeni wakho. Amazinga anjalo aphezulu ensimbi angalimaza izitho zakho.
Odokotela bangaphatha futhi bavimbele inqwaba ye-iron kusuka ekumpontsheni okuningi ngokusebenzisa imithi ebizwa ngokuthi i-iron chelators, ehlanganisa ukwelapha ngomlomo, i-deferasirox (i-Exjade), noma ukumnika okubizwa nge-deferoxamine mesylate (i-Desferal). Imihlahlandlela yokuzilolonga yiNational Comprehensive Cancer Network, noma i-NCCN, unikeza indlela udokotela wakho angasebenzisa ukunquma uma udinga ukwelapha kwe-iron chelation.
Izinto Ezikhulayo Abanye abantu abane-anemia ye-MDS bangase bazuze ekutholeni izici zokukhula ezibizwa ngokuthi i-erythropoietin stimulation agents noma amaprotheni (ESAs).
Izibonelo zama-ESA zihlanganisa i-epoetin alfa (i-Eprex, i-Procribe noma i-Epogen) noma i-darbepoetin alfa ende (Aranesp) ende. Le mithi inikezwa njengomjovo emaqenjini akho amafutha (injection yangaphakathi). Nakuba lezi zidakamizwa zingasizo zonke iziguli ze-MDS, zingasiza ekuvimbeleni ukumpontshelwa igazi kwabanye.
Udokotela wakho anganikeza ukuthi akuqale ku-factor colonating factor , njenge-G-CSF (Neupogen), noma i- GM-CSF (leukine) , uma inani lakho legazi elimhlophe liba liphansi ngenxa ye-MDS yakho. Izinto ezivuselela i-colony zisiza ukuthuthukisa umzimba wakho ukukhiqiza ukugula okuningi ukulwa namaseli amhlophe egazi okuthiwa i-neutrophils. Uma izibalo zakho ze-neutrophil ziphansi, usengozini ephakeme yokuthuthukisa ukutheleleka okuyingozi. Hlola amehlo akho noma yiziphi izimpawu zokutheleleka noma umkhuhlane, futhi ubone umhlinzeki wezempilo ngokushesha ngangokunokwenzeka uma ukhathazekile.
Ukwelashwa Okuphansi
Ukwelapha okunamandla okuphansi kusho ukusetshenziswa kwamakhemikhali noma ama-agent aphansi kakhulu okubizwa ngokuthi yi-biologic response modifiers. Lezi zokwelashwa zihlinzekwe ikakhulukazi ekuhlinzekeni iziguli, kodwa ezinye zazo zingadinga ukunakekelwa okusekelayo noma ukuhlala esibhedlela ngezikhathi ezithile ngemuva kwalokho, isibonelo, ukuphatha ukutheleleka okuphumela.
I-Epigenetic Therapy
Iqembu lemithi ebizwa ngokuthi i-hypomethylating noma i-demethylating agents yizona zikhali ezisanda kulwa nokulwa ne-MDS.
I-Azacitidine (i-Vidaza) ivunyiwe yi-FDA ukuze isetshenziswe kuzo zonke izigaba zeFrench-American-British (FAB) nazo zonke izigaba ze-IPS zezinhlekelele ze-MDS. Lo muthi uvame ukunikezwa njengemjovo engaphansi kwezinsuku ezingu-7 ngokulandelana, zonke izinsuku ezingu-28 okungenani imijikelezo engu-4-6. Ucwaningo lwe-azacitidine lubonise izinga lokuphendula ngamaphesenti angu-60, cishe amaphesenti angama-23 athola ukukhululwa okukodwa noma okuphelele kwesifo sabo. I-Azacitidine ivame ukubangela ukwehla kokuqala kwe-cell cell ukubalwa okungase kungabuyiselwa kuze kube ngemva komjikelezo wokuqala noma emibili.
Olunye uhlobo lwe-hypothehylating agent elisebenzisela ukwelashwa kwe-MDS yi-decitabine (i-Dacogen). Okufana kakhulu nokuhlelwa kwe-azacitidine, futhi i-FDA ivunyelwe kuzo zonke izinhlobo ze-MDS. Imithi yokwelashwa ngokuvamile yayihlotshaniswa nokudla okunamandla-okunamandla kakhulu, ngakho-ke futhi kubhekwa njengokwelashwa okunamandla kakhulu. I-decitabine inganikezwa ngaphakathi noma ngaphansi. Ucwaningo olulodwa lapho i-decitabine yanikezelwa khona phakathi kwezinsuku ezingu-5 kubonise izinga eliphelele lokuxoxisana ngamaphesenti angu-40. Iminye imigomo yokulinda iyaphenywa.
I-Immunosuppressive Therapy ne-Biologic Response Modifiers
Ku-MDS, amangqamuzana egazi abomvu, amangqamuzana amhlophe egazi kanye namaplatelet abulawa noma afe ngaphambi kokuba akhule ngokwanele ukuba akhululwe emsakeni wamathambo aye egazini. Kwezinye izimo, i-lymphocytes (uhlobo lwe-white cell cell) yilezi zinto. Kulezo ziguli, kungase kuphumelele ukusebenzisa imithi efaka umthelela wesimiso somzimba.
Amakhemikhali angewona amakhemikhali, ama-low-intensity agent (ama-modifiers response biologic) afaka anti-thymocyte globulin (ATG), i-cyclosporine, i-thalidomide, i-lenalidomide, i-anti-tumor necrosis ye-factor receptor fusion amaprotheni, kanye nama-vitamin D afanayo. Zonke lezi zibonise okungenani ezinye ezivivinyweni zakuqala, kodwa abaningi banesidingo sezilingo eziningi zokwelashwa ukuze baqonde ukusebenza kahle kwezinhlobo ezahlukene ze-MDS.
Abantu abanehlobo oluthile lwe-MDS olubizwa ngokuthi i-5q-syndrome, lapho kunesici esingokwemvelo ku-chromosome 5, ingaba nempendulo kwisidakamizwa esibizwa nge-lenalidomide (Revlimid). Ngokuvamile, i-lenalidomide isetshenziselwa iziguli ezine-IPS eziphansi noma ezisezingeni eliphansi eliphansi le-MDS ezixhomeke ekuxhaseni kwegazi. Ekucwaningweni kwe-lenalidomide, iziguli eziningi ziye zanciphisa izidingo zokumpontshelwa igazi - cishe amaphesenti angu-70, empeleni - kodwa zaqhubeka zithola amaphaletlet aphansi kanye nezibalo ze-neutrophil. Izinzuzo zokwelapha i-MDS, noma i-subtypes engaphezu kwe-5q-syndrome nge-lenalidomide zisacwaningwa.
Ukwelashwa Okuphezulu Kakhulu
I-Chemotherapy
Iziguli ezithile ezinezinkinga eziphezulu ze-MDS, noma izinhlobo ze-FAB RAEB no-RAEB-T, zingaphathwa nge-chemotherapy ejulile. Le chemotherapy, uhlobo olufanayo olusetshenziselwa ukwelashwa i-acute myelogenous leukemia (AML), lihlose ukubhubhisa inani lamangqamuzana angavamile emnothweni wethambo oholela ku-MDS.
Nakuba i-chemotherapy ingaba usizo kwezinye iziguli ze-MDS, kubalulekile ukucabangela ukuthi iziguli ezindala ezinezinye izimo zezokwelapha zibhekana nezingozi ezingeziwe. Izinzuzo ezikhona zokwelashwa kufanele zivelele ingozi ehilelekile.
Ukucwaninga kuqhubeka ukuqhathanisa imiphumela ye-chemotherapy ejulile ngaphezu kwe-azacitidine noma i-decitabine.
Ukufakelwa kweStem Cell
Iziguli ezinengozi enkulu ye-IPSS MDS zingakwazi ukufeza ukwelashwa kwesifo sabo nge- allogeneic stem cell transplantation . Ngeshwa, isimo esingozi kakhulu sale nqubo sinciphisa ukusetshenziswa kwayo. Eqinisweni, ukufakelwa kwe-allogeneic stem cell kungaba nesilinganiso sokufa okuhlobene nokwelashwa okungaba ngu-30%. Ngakho-ke, le mithi ngokuvamile isebenzisa kuphela iziguli ezincane eziphilile.
Ucwaningo lwamanje luphenya indima ye- non-myeloablative okuthiwa "mini" yokudlulisela kweziguli ezindala ezine-MDS. Yize lezi zinhlobo zokufakelwa ngokuvamile zicatshangwa ukuthi ziphumelela kangcono kunezingxenyana ezijwayelekile, ukwehla kwabo kwesibisi kungabenza kube yinketho yeziguli ezingenakufanelekile.
Isifinyezo:
Ngenxa yezinhlobo ezahlukene ze-MDS nezinhlobo ezihlukahlukene zesiguli, ayikho ubukhulu bomuntu oyifanayo-wonke ukwelashwa. Ngakho-ke kubalulekile ukuthi iziguli ze-MDS zixoxisane nazo zonke izinketho ngethimba labo lokunakekelwa kwezempilo, futhi zithole ukwelapha okuzobanikeza izinzuzo ezingcono kakhulu ngenani eliphansi lokushisa.
Ukuhlolwa kwemitholampilo ngemithi emisha ye-MDS iyaqhubeka, ngakho hlala ubukele. Ngokwesibonelo, i- ruxolitinib (i-Jakafi) iphhenyelwa ukwelashwa kweziguli ezine-MDS ezisezingeni eliphansi noma eliphakathi-1.
Imithombo:
I-Greenberg PL, i-Attar E, uBennett JM, et al. Ama-Syndromes e-Myelodysplastic: Imihlahlandlela Yokuzivocavoca Emtholampilo ku-Oncology. I-JNCCN. 2013; 11 (7): 838-874.
Kantarjian H, O'Brien S, Giles F, et al. I-Decitabine isimiso sezinga eliphansi (100 mg / m2 / Course) ku-myelodysplastic syndrome (MDS). Ukuqhathaniswa kwezinhlelo ezi-3 zama-dose ezahlukene. Igazi. 2005; 106 okungabonakali. I-Asbtract 2522.
Malcovati L, Hellström-Lindberg E, Bowen D, et al. Ukuxilongwa nokwelashwa kwe-syndromes eyinhloko ye-myelodysplastic kubantu abadala: izincomo ezivela e-European LeukemiaNet. Igazi . 2013; 122 (17): 2943-2964.
I-Nimer, S. "I-Myelodysplastic Syndromes" Igazi ngoMeyi 2008. 111: 4841- 4851.
UScott, B., Deeg, J. "I-Myelodysplastic Syndromes" Ukubuyekezwa Kwaminyaka Yonke Yezokwelapha 2010. 61: 345-358.