Uhlobo lweCarcer Blood liyabonakala ngokubanzi kubantu abadala
I-lemonem ye-leememia (AML) enomdla luhlobo lomhlaza oqala ekuqaleni emnxeni wethambo apho iiseli zegazi ziveliswa kwaye zihamba ngokukhawuleza kwiiseli zegazi ngokwazo. Ukusuka apho, umhlaza ungasasazeka kwezinye iindawo zomzimba kuquka nesibindi, i-spleen, isikhumba, ingqondo kunye nomgca womgca.
I-AML ichaphazela abantu abayizigidi ngonyaka kwaye ikhokelela ekufeni kwabantu abayi-150,000.
EUnited States yedwa, iimeko eziphakathi kwe-10 000 neye-18,000 zifunyaniswa rhoqo ngonyaka.
Ngokungafani nezinye i-leukemia , ezithatha ukubetha intsha, i-AML ixhaphaza kakhulu abantu abadala abangaphantsi kwama-65. Phakathi kweli qela leminyaka, izinga leminyaka elishumi lokusinda libuhlwempu, lijikeleza malunga neepesenti ezihlanu. Ukunyanga kwamazinga kubantu abadala abaselula banokuphucula ngakumbi naphi na-25 ukuya kuma-70 ekhulwini ukufumana ukuxolelwa okupheleleyo emva kwe-chemotherapy.
Izifo
I-leukemia yiqela elineentlobo zamanomdla ezichaphazela iiscuko ezenziwe ngegazi kunye neeseli zegazi ngokwabo. Nangona isifo sisithintela iiseli zegazi ezimhlophe , ezinye iintlobo zesifo zihlasela ezinye iintlobo zeeseli.
Kwimeko ye-AML, igama elithi "acute" lisetyenziselwa ukuba umhlaza uphuthuka ngokukhawuleza, ngelixa "umloyidi" ubhekisela kumathambo emathambo kunye neentlobo ezithile zeeseli zegazi ezithatha umongo.
I-AML ikhula kwiseli egazini yegazi ebizwa ngokuba yi-myeloblast.
Le yileli iiseli, eziphantsi kweemeko eziqhelekileyo, eziza kukhula zibe ngamaseli egazi ezimhlophe njengegranulocyte okanye i- monocytes . Nangona kunjalo, kunye ne-AML, i-myeloblasts iya kuba "yongqeleka" kwiimeko zabo ezingapheliyo kodwa ziqhubeke ziphindaphinda zingahloliswanga.
Ngokungafani neeseli eziqhelekileyo ezinomdla othile, amangqamuzana omhlaza "ngokungafi" kwaye uya kuqhubeka nokuphinda angapheli.
Nge-AML, iiseli zegazi zomhlaza ekugqibeleni ziza kuhluthwa eziqhelekileyo kwaye ziphazamise nokuphuhliswa kweeseli zamhlophe zegazi ezimhlophe, iiseli ezibomvu zegazi (i-erythrocytes), kunye neeplatelets ( thrombocytes ).
I-AML ayifani nomzala wakhe we -lymphocytic leukemia (BONKE) echaphazela olunye uhlobo lweseli elimhlophe legazi elibizwa ngokuba yi- lymphocyte . Nangona i-AML ibandakanyeka kakhulu kubantu abadala, BONKE baxabana nabantwana phakathi kweminyaka emihlanu ukuya kwemihlanu.
Iimpawu zokuqala kunye neempawu
Iimpawu ze-AML zihambelana ngqo nokufuduka kweeseli zegazi eziqhelekileyo ngabadlavuza. Ukungabikho kweeseli eziqhelekileyo zegazi kunokushiya umntu osengozini ekukhuselweni kunye nezinye izifo apho umzimba unokuthintela khona.
Ngokomzekeliso, iiseli zegazi ezimhlophe ziphambili kumasosha omzimba. Amaseli egazi abomvu, ngokuchaseneyo, banomthwalo wokuthwala i-oksijeni kunye nokususa i-carbon dioxide kwiishukela, ngelixa iiplatelet ziphambili ekutyeni igazi.
Ukunciphisa kwanoma yiliphi la maseli kunokukhokelela ekuhlaselweni kweempawu, ngokuqhelekileyo kungekhona okuthe ngqo kwaye kunzima ukuxilonga. Imizekelo ibandakanya:
- Ukunqongophala kweeseli ezimhlophe zegazi kunokunyusa umngcipheko wezonyango ezingayi kuhamba. Ezi ziquka iimpawu ezinxulumene nokungabikho kwe-leukocytes (leukopenia) okanye i-neutrophils (i- neutropenia ).
- Ukunqongophala kweeseli ezibomvu zegazi kungakhokelela ekudleni kwegazi okuza kubonakalisa ngeempawu zokukhathala, ukunyuka, ukuphefumula, intloko, isisu, kunye nobuthathaka.
- Ukunqongophala kweeplatelet kunokukhokelela ekutheni i-thrombocytopenia kunye nokuphuhliswa kweentlobo zegazi, ukunyunyuza ngokweqile okanye ukuphuma kwegazi, okanye ukukhawuleka kwamanzi.
Iimpawu zeeNqanaba kamva
Njengoko eso sifo siyaqhubeka, ezinye, iimpawu ezingakumbi ziqala ukuphuhlisa. Ngenxa yokuba iiseli ze-leukemia zikhulu kuneeseli zegazi ezimhlophe eziqhelekileyo, ziyakwazi ukunamathela kwiinqanawa ezincinci zenkqubo yokujikeleza okanye ukuqokelela izitho ezahlukeneyo zomzimba.
Ngokuxhomekeka apho ukukhutshwa kwenzeka khona, umntu unokufumana:
- Ii-chloromas , iqoqo eqokelelweyo yeeseli ezinokukhula, zibe ngenye indlela, inqwaba enjenge-tumor ngaphandle komnatha wethambo, ukugqithiswa kwe-plaque, okanye ukuphuma kwegazi kunye nokuvuvukala kweentlobo
- I-Leukostasis , ingxamisekileyo yonyango apho ukukhutshwa kungakhokelela kwimpawu ezinjenge-stroke
- I-Sweet's syndrome , isifo esibuhlungu esikhankanyeni esibonakala kakhulu kwiingalo, intloko, imilenze kunye ne-trunk
- I-deep vein thrombosis (DVT) apho i-vein iya kuvinjelwa, ngokuqhelekileyo emlenzeni
- Ubumblism (PPE) , ukucinywa komthambo kwimpompo
- Ukubanjelwa kwesisu ngenxa yokuqokelela kweeseli kwipeni kunye nesibindi
- I-meningeal leukemia ebonakalisa iziphazamiso eziphambili ezifana neentloko, ukuhlanza, umbono obonakalayo, ukuxhatshazwa, ukuxhatshazwa kweengxaki, kunye nokugqithisa ubuso
Ngokuqhelekanga, i-AML inokuchaphazela iinjongo, i-lymph nodes, amehlo, okanye amathambo.
Izizathu kunye neengozi
Kukho imiba emingcipheko enxulumene ne-AML. Nangona kunjalo, ukuba neyodwa okanye eninzi kule miba ayithethi ukuba uya kufumana i-leukemia. Kuza kube namhlanje, asiyiqondi kakuhle ukuba kutheni ezinye iiseli ziza kutshatyalaliswa ngokukhawuleza xa abanye bengenalo.
Into esiyaziyo kukuba iidlers zibangelwa yimpazamo yokubhala i-genetic edlalwa ngamanye amaxesha xa iseli sahlula. Sibhekisela kule nto njengenguqu. Nangona ubuninzi bezitshintsho ezingaholeli kumhlaza, kukho amaxesha apho iphosakelo "liyakucima" into ebizwa ngokuthi i- tumor suppressor gene echaza ukuba ixesha elide lihlala phi. Ukuba oku kwenzekayo, iseli engavumelekanga ingaphinda iphinde iphendule ngaphandle kokulawula.
Kukho imiba emingcipheko enxulumene nalokhu:
- Ukutshaya
- Ukuchithwa kwemisebenzi kwiikhemikhali, ngakumbi kwi-benzene
- Ezinye iziyobisi zamachiza e-chemotherapy eziquka i- cyclophosphamide , mechlorethamine, procarbazine, i-chlorambucil, i-melphalan, i-busulfan, i-carmustine, i-cisplatin kunye ne-carboplatin
- Ukunyuka kwamayeza omlilo, njengomdlavuza we-radiotherapy
- Ukuba neengxaki ezithile zegazi ezingapheliyo ezifana nesifo se-myeloproliferative (MPS) okanye i- myelodysplastic syndromes (MDS)
- Ukuba neengxaki ezithile ze-congenital ezifana ne- Down syndrome , i- Fanconi anemia , ne- neurofibromatosis uhlobo 1
Ngenxa yezizathu ezingaziwa, amadoda angama-67 ekhulwini amathuba okufumana i-AML kunabesifazane.
Ukuxilongwa
Ukuba i-AML iyakrokrelwa, ukuxilongwa ngokuqhelekileyo kuya kuqalisa ngokuhlolwa komzimba kunye nokuhlaziywa kwimbali yomntu kunye nentsapho yakhe. Ngethuba loviwo, ugqirha uya kuhlawula ngokukhawuleza iimpawu ezinjenge-bruising, ukuphaphaza, ukusulela, okanye ukungaqhelekanga kwamehlo, umlomo, isibindi, i-spleen, okanye i-lymph nodes. Inani elipheleleyo legazi (CBC) liya kwenziwa kwakhona ukuchonga naziphi na izinto ezingaqhelekanga ekubunjweni kwegazi.
Ngokusekelwe kwezi ziphumo, ugqirha unokuyalela iindidi zeemvavanyo ukuqinisekisa ukuxilongwa. Ezi ziquka:
- I-bone yomnkantso ekufunwa kuwo iiselula zomnatha zethambo zifakwe ngokufaka inaliti ende emathanjeni, ngokuqhelekileyo ejikeleze umlenze
- I-bone yomnkantsha we-Bone apho inaliti enkulu ifakwe ngaphakathi kwithambo ukuze ikhuphe amaseli
- Ukugqitywa kwe-Lumbar (intonga yomgca) apho inaliti encinci ifakwa phakathi kwamathambo o umqolo womgcini wokukhupha ukukhupha i- cerebrospinal fluid (CSF )
- Ukujonga iimvavanyo ezifana ne-X-ray, ultrasound, okanye i- computed tomography (CT )
- I-blood smear egazini apho igazi lihlolwe phantsi kwe-microscope, ngokuqhelekileyo ngeedayi ezingabonakali kuphela iiseli ze-leukemia kodwa zinceda ukuhlula phakathi kwe-AML kunye NONKE
- I-cytometry ehambayo apho iiprotheni ezikhuselayo, ezibizwa ngokuba ngama-AML antibodies, zifakwa kwigazi okanye iSampuli ye-CSF ukuqinisekisa ubungqina bee-cells ze-AML
- I-Cytogenetics apho iiseli ze-leukemia "zakhula" ebhodini kwaye zihlolwe phantsi kwe-microscope ye-electron ukuchonga utshintsho oluthile ngamaphetheni abo
Ukucwangcisa
Isiteji sogqirha sisenziwa ukuze kuqinisekiswe ukuba umhlaza usasazeke kangakanani. Oku, kunceda ugqirha ukuba acwangcise ikhondo elifanelekileyo lokonyango ukuze umntu angagqithwanga okanye angagqithwanga. Isiteji sinceda ukuqikelela ukuba umntu unokuphila ixesha elingakanani emva kwonyango.
Ngenxa yokuba ii-AML azibandakanyi ukubunjwa kwesifo esibi esibukwe kwezinye iintlobo zesifo somhlaza, asikwazi ukujongwa nge- TNM ye- classic (i-tumor / lymph node / malignancy ).
Kukho iindlela ezimbini ezahlukileyo ezisetyenziswayo kwi-AML yesigaba: udidi lweFrench-American-British (FAB) lwe-AML kunye nokwahlula kwe-World Health Organisation (WHO) ye-AML.
Uhlobo lweFAB
Ulwahlulo lweFransi-American-British (FAB) lwaphuhliswa kuma-1970 kunye nezigaba zesifo esekelwe kwimeko kunye nokukhula kweseli echaphazelekayo.
Isizathu sokwenza isilula silula: I-AML iya kulandelelana iphethini apho i-myeloblasts engapheliyo yimizimba yokuqala echaphazelekayo. Njengoko esi sifo siyaqhubeka, siya kuqala ukuphazamisa i-myeloblasts kwizigaba ezilandelayo zokukhula komzimba kwaye emva koko kuqhutywe phambili kumaseli egazi amhlophe (njengama-monocyte kunye ne-eosinophils) ngaphambi kokufudukela kumaseli obomvu (i-erythrocyte) kwaye ekugqibeleni i-megakaryoblasts (iiseliti ze-platelet ezingamanzi).
Le nkqubela iya kunika i-pathologist ulwazi olufunekayo ukuze ukwazi ukuba umhlaza unomdla kangakanani.
Uhlu lwezithuba ze-FAB ukusuka kwi-M0 (nge-AML yokuqala) ukuya kwi-M7 (kwi-AML ephezulu) ngolu hlobo:
- I-M0: i-leukemia enesifo esingaxhamliyo
- I-M1: i-leyemia ye-myeloblastic enomzimba onomlinganiselo omncinci
- I-M2: i-leyemia ye-myeloblastic ye-acute
- I-M3: i-leukemia ye-promyelocytic
- I-M4: i-lemonemic leukemia
- I-M4 eos: i-myelomonocytic leukemia nge-eosinophilia
- I-M5: i-leocematic acute leukemia
- I-M6: i-leyemia ye-erythrocytic
- I-M7: i-leakemia ye-megakaryoblastic leukemia
WHO Classification
I-World Health Organization yavelisa iindlela ezintsha zokumisa i-AML ngo-2008. Ngokungafani ne-FAB nkqubo, udidi lwe-WHO luqwalasela ukutshintshwa kwe-chromosomal ethile efunyenweyo ngexesha lohlalutyo lwe-cytogenetic. Kwakhona ziimeko kwiimeko zonyango ezinokuphucula okanye ezimbi ngakumbi (ukuxela kwangaphambili) umntu ochaphazelekayo.
Inkqubo ye-WHO inamandla ngakumbi ekuhlolweni kwayo kwesi sifo kwaye ingaqhekeka ngokubanzi ngolu hlobo lulandelayo:
- I-AML eneemvelaphi ezingapheliyo zofuzo (intsingiselo ecacileyo, iinguqu eziphathekayo zezofuzo)
- I-AML kunye neenguqulelo ezinxulumene ne-myelodysplasia (ebonisa ukuba khona kwe-MDS, i-MDP, okanye ezinye iingxaki ze-myeloblastic)
- Iimpawu eziphathekayo ezinxulumene neyeza (ezibhekiselele kwi-chemotherapy ngaphambili okanye unyango lwe-radiation)
- I-Myeloid sarcoma (intsingiselo ye-AML ihamba nekloroma)
- Ukwanda kweMyeloid ehlobene ne-Down syndrome
- Blastic plasmacytoid i-dendritic cell neoplasm (uhlobo olunefuthe lomhlaza olululwe zizilonda zesikhumba)
- I-AML ayikwahlulelwanga ngenye indlela (ngokuqhelekileyo inkqubo ye-FAB yesigaba esixhenxe kunye nokwahlukaniswa kwezifo ezimbini ezongezelelweyo)
Unyango
Ukuba ufunyaniswe ne-AML, ifom kunye nobude bonyango kuya kukhululelwa ngokubanzi kwisigaba somhlaza kunye nempilo jikelele yomntu ngamnye.
Ukuthetha ngokuqhelekileyo, unyango luya kuqala nge-chemotherapy. Oku kungabandakanya izidakamizwa zesizukulwana esikhulileyo ezinokuchaphazela zombini iiseli zomhlaza kwaye ezingenayo umdlavuza kunye nezilwanyana ezitsha ezijoliswe kuzo ezitshatyalaliswayo kwintsholongwane yomhlaza kuphela.
I-standard ye-chemotherapy regimen ibizwa ngokuthi "7 + 3" kuba isichemotherapy ebizwa ngokuba yi- cytarabine inikezwa njenge-infravenous (IV) ukunyuswa kweentsuku ezisixhenxe zilandelwa iintsuku ezintathu ezilandelelanayo kwesinye isilwanyana esibizwa ngokuba yi- anthracycline . Ukufikelela kuma-70 ekhulwini labantu abane-AML baya kufumana ukuxolelwa ngokulandela "u-7 + 3" unyango.
Xa kuthethwa oko, inani elincinci leetyukemia luza kuhlala lilandela i-chemotherapy, ekhokelela ekuphindaphinda kwiimeko ezininzi. Ukuze ugweme oku, oogqirha baya kunika unyango oluqhubekayo olusekelwe kwiziphumo zonyango emva kwonyango kunye nesimo sempilo.
Kubantu abanesilathisi esihle sokuxilonga, unyango lunokuthi lubandakanye izifundo ezintathu ukuya kwezihlanu ze-chemotherapy ezinzulu, ezibizwa ngokuba yi-chemotherapy ehlanganisiweyo.
Kwabo basemngciphekweni omkhulu wokuphindaphinda, ezinye, unyango oluninzi luyafunekayo kubandakanywa ukutshintshwa kwe-cell stem ukuba umnikeli angafumaneka. Ngokuqhelekanga, utyando okanye unyango lwe-radiation lunganconywa.
Ngenxa yokuba i-AML chemotherapy idala ukukhokelela ekukhutshweni kwe-immune, izigulane ezisebekhulile zingenako ukunyamezela unyango kwaye kunokuthi zinikezwe i-chemo encinci okanye ukunyamekela .
Ukusinda
Imbono yomntu oye wafumana unyango lwe-AML iyahluka kakhulu ngokusekelwe kwinqanaba lomhlaza ngexesha lokuxilongwa. Kodwa, kukho ezinye iimeko ezinokuthi ziqikelele ukuba kukho umphumo. Phakathi kwabo:
- Abantu abafumene i-MDS kunye ne-MPD banexesha lokuphila ukusuka kwiinyanga ezithoba ukuya kwiminyaka eyi-11.8 kuxhomekeke kubukhulu beengxaki.
- Ezinye iinguqu ze-chromosomal ezichazwe yi-cytogenetics zingakhokelela kwiminyaka emihlanu yokusinda kwamazinga angaphantsi kwe-15 ukuya kuma-70 ekhulwini.
- Abantu abangaphezu kwama-60 abaye baphakamisa amanqanaba e- lactate dehydrogenase (ebonisa umonakalo omkhulu wesikhumba) ngokubanzi ziphumo ezimbi.
Ngokubanzi, izinga lokunyanga eliphakathi kwe-AML liphakathi kwama-20 ekhulwini kunye ne-45 ekhulwini. Amazinga okuxolelwa okuxhaswayo ahlala ephakamileyo kubantu abancinci abakwazi ukunyamezela unyango.
ILizwi
Ukuba uye wafumanisa ukuba u-AML, uza kujamelana nemingeni yomzwelo neyomzimba enokuba nzima ukuyinqoba. Musa ukuhamba yedwa. Amathuba akho okuphumelela aya kuphucula kakhulu xa ukwakha inethiwekhi yenkxaso eyenziwe ngabantu abathandekayo, abaqeqeshi bezempilo kunye nabanye abaye bahamba okanye bafumana unyango lomhlaza.
Nangona emva kokufumana unyango, ukwesaba ngokuphindaphindiweyo kunokuhlala ixesha elide kwiinyanga okanye okanye kwiminyaka. Ngenkxaso, ekugqibeleni uya kunqoba ezi nkxalabo kwaye ufunde ukubeka esweni impilo yakho ngokutyelela ngokugqithisa ugqirha. Ngokuqhelekileyo, ukuphindaphindiwe akuzange kwenzeke kwiminyaka embalwa, akunakwenzeka ukuba i-AML ibuye ibuye.
Nangona kungekho nto ongayithatha ukukhusela ukubuyela kuphinda, indlela yokuphila enempilweni inokuphucula kakhulu izinto zakho. Oku kubandakanya ukunikezela ngokutya okulungileyo, ukusebenzisa rhoqo, ukuyeka ukutshaya, nokufumana ukuphumla okuninzi ukuphepha uxinzelelo kunye nokukhathala.
Ekugqibeleni, kubalulekile ukuthatha izinto ngolunye usuku ngexesha kwaye ube nomntu onokukuphendukela ukuba ngaba ufuna ukuxhaswa.
> Imithombo:
> I-American Cancer Society. "Ukusinda kwiSatisiti zeMyelodysplastic Syndromes." EWashington, DC; hlaziywa ngoJanuwari 22, 2018.
> De Kouchenovsky, I. kunye no-Abdul Hay, M. "I-leukemia eqhelekileyo ye-leememia: uhlaziyo olubanzi kunye nohlaziyo lwe-2016." Igazi likaJ. J. 2016; 6; e441.
> Döhner, H .; Weisdorf, D .; kunye neBloomfield, C. "I-Acute Myeloid Leukemia." I-Engl J Med entsha . 2015; 373 (12): 1136-52. INGXELO: 10.1056 / NEJMra1406184.