Ukuphononongwa kweStem Cell Transplantation kwi-Primary Myelofibrosis
Ukukhetha unyango olufanelekileyo kwi- myelofibrosis ephambili kunokuba ngumngeni. Ngokuqhelekileyo akukho nto ikhethiweyo. Kukho unyango oluninzi lwe-myelofibrosis ephambili, kodwa i-hematopoietic stem cell transplantation (ebizwa nangokuthi ukutsalwa komongo we-bone) yonyango.
Kutheni Akubakho Wonke umntu Ukufumana Ukutshiza?
Uphilisa izandi ezimangalisayo, ngoko unokuzibuza ukuba kutheni wonke umntu onesi-primary myelofibrosis akafumani ukutshintshwa.
Yonke into ngokumalunga nobungozi kunye nenzuzo.
Utyando kwi-myelofibrosis ephambili luqhutywa yinkalo yobungozi esekelwe kwimpawu kunye neempawu ozifumanayo. Ukuba awunayo impawu okanye unempawu ezinobungozi obuncinane, ukuhlala kusisifo emva kokuxilongwa kuyinto eyi-15.4 iminyaka. Kule meko, iingxaki ezinokubakho (i-acute okanye isifo esingapheliyo kunye nesifo kunye nokufa) ezihambelana nokutshintshwa kwezinto ezidlulileyo kunenzuzo yonyango. Ucwaningo luye lwabonisa ukuba ukusinda kweminyaka emihlanu kubantu abanomngcipheko ophantsi okanye isifo esisemgangathweni-1 sasiba ngaphantsi xa befumene i-hematopoietic stem cell transplant. Nangona kunjalo, kwisifo esiphakathi-2 kunye nesifo esiphezulu, ukusinda kweminyaka emihlanu kuphuculwe kubantu abafumene ukufakelwa kokuthelekiswa kwabo bangenalo.
Ukuba une-intermediate-2 okanye i-myelofibrosis ephambili yengozi ephezulu, ukutshintshwa kwe-cell stem (HSCT) yonyango olukhethiweyo. Ngenxa yokuba iminyaka yobudala iphakamisa umngcipheko wenkxalabo enxulumene nokufakelwa (ngokubhekiselele kwinqanaba lesibini kwi- graft againstus hostus disease ), i-HSCT igcinwe ngokusesikweni kubantu abane-myelofibrosis ephambili phantsi kweminyaka eyi-60.
Ekubeni iminyaka yobudala yabantu abane-primary myelofibrosis ekuxilongweni yi-67, oku kubaluleke kakhulu kunqanda inani labantu abane-myelofibrosis ephambili abangabakhona ukuba babe ngabaviwa abalukhuseleko. Ukongezelela, umnikeli okhethiweyo we-HSCT uhambelana nomntakwabo. Umntakwabo opheleleyo (umama onjalo kunye nonina njengommkeli) unalo ithuba elilodwa lokuba ngumdlalo, ukukhawulelana nombolo yabantu abangakwazi ukufumana le nyirha.
Ukugqithiswa Kwangemva kokutshintshwa
Okwangoku, ama-40 ukuya kuma-60 ekhulwini abantu abaneemelofibrosis eziphambili ezithengiswayo baphila iminyaka emithathu ukuya emine. Kukho ubungqina bokubonisa ukuba uphantsi kwe-splenectomy (ukususwa kokutyunjwa kweseyile) ngaphambi kokutshintshwa kwintsebenziswano kuhambelana neentlawulo zokusinda eziphuculweyo ngokukodwa kumadoda, kodwa isizathu sokuba oku kuqondwa ngokupheleleyo. Ukongezelela, abantu abahlakulela i-myelofibrosis emva kwe- polycythemia vera okanye i- thrombocythemia ebalulekileyo ibonakala ibe nezinga elingcono lokusinda emva kokutshintshwa kunabantu abano-myelofibrosis.
Ngubani Ongenakufaneleka?
Abanye abantu abanesifo esiphezulu kakhulu ababaviwa kubaHSCT. Oku kubaluleke kakhulu ngokumiselwa kwimeko yokuphila emva kweHSCT.
Izinto ezinjenge-pleen enkulu (ngaphezulu kweeyintshi ezisibhozo ngaphantsi kwembhobho) kunye negazi elingaphezu kwama-20 phambi kokutshintshwa (ngakumbi ukuba ngaba bobabini) baye badibaniswa nokuphila okungaphantsi kweminyaka emihlanu emva kokutshintshwa.
Kuthiwani Ukuba Awufaneleki?
Ngoko ke unyanzeliswa ukuba unomngcipheko omkhulu we-myelofibrosis kodwa ungenakufaneleka kwi-HSCT okanye ungenayo umnikezeli? Ukuba unempawu ezifana nokunyusa ubuhlungu benteni, ukukhathala, iintlungu zethambo, ukukhupha ebusuku, njl, i-ruxolitinib inokuba yonyango olululo.
I-Ruxolitinib iboniswe ukunciphisa iimpawu, ukunciphisa ubukhulu bepen, nokuphucula i-anemia kubantu abane-myelofibrosis ephambili. Enye indlela eya kwi-HSCT inokubhaliswa kwilingo leklinikhi. Oku kuya kukunika ufikelelo kumachiza afundiswa njengonyango onokuthi uphumelele kwi-myelofibosis yokuqala.
Akulula ukufunda ukuba awufanelanga unyango, kodwa khumbula ukuhlola zonke iinketho zakho.
Ixesha elizayo loTshintsho njengeNyango
Ngokuphuculwa kwonyango olujikeleze ukutshintshwa kwezityalo, ezifana ne-regimen esetyenziselwa ukucwangcisa umongo we-bone ngaphambi kokutshintshwa kunye nemichiza ekhuselweyo yokukhusela isifo sokubambisana nesifo, iziganeko ezithengiswayo ziqhutyelwa kubantu abangaphezu kweminyaka engama-60 kunye nabanye abaxhasi (izihlobo ehambelana ngokufanelekileyo okanye ehambelana nabaxhasi abangabandakanyekanga).
Amanye amaziko aya kutshintsha abantu nge-myelofibrosis ukuya kuma-75 ubudala.
Ngethemba, kunye nokuphucula okuqhubekayo, i-HSCT iya kufumaneka kubantu abaninzi abane-myelofibrosis. Ngenxa yokuba i-myelofibrosis ephambili yimeko engavumelekanga, kuya kuthatha iminyaka ngaphambi kokuba siqonde ngokucacileyo indima yabaxhasi abanye kwi-HSCT kule ngxaki.
Imithombo:
I-Ballen K. Indlela yokulawula umbuzo wokutshintshwa kwi-myelofibrosis. Journal Cancer Journal. 2012: 2: e59.
Tefferi A. Ulawulo lwe-myelofibrosis ephambili. Ku: U-UpToDate, i-Post TW (Ed), UpToDate, i-Waltham, MA. (Kufumaneka ngoJuni 29, 2016.)