Ukulinda, i-Chemotherapy, i-Monoclonal Antibodies, okanye i-Stem Cell Transplant for CLL
Ziziphi iipilisi ezingcono kwi-chronic lymphocytic leukemia (CLL)?
Ukuhlaziywa kwe-Lymphocytic Leukemia (CLL)
Ukuba uyazi kakuhle iimpawu kunye nemingcipheko ye-CLL , kwaye uye wangena kwi- diagnostic and staging ye-CLL mhlawumbi ukulungele ukuthatha inyathelo elilandelayo. Emva kwakho konke, uvile ezininzi malunga neyeza ezahlukeneyo ezifumanekayo ngomhlaza.
Ngokudabukisayo, ngeli xesha akukho nonyango ebonwa ukuba yonyango lwe-lymphocytic leukemia (CLL) engapheliyo. Kodwa nangona kungekho unyango, abanye abantu banokuphila iminyaka kunye namashumi eminyaka ngesifo. Ngexesha langoku, unyango lujoliswe ekuboneleleni izigulane ngokukhululeka kwiimpawu zabo, nethemba lokuqinisekisa umgangatho omhle wobomi kunye nokuxolelwa ixesha elide.
Jonga kwaye ulinde
Izigulane ezingenayo nayiphi na impawu ze-CLL, ezifana ne-sweat ebusuku, imfiva, ukulahleka kwesisindo, i-anemia (inani elibomvu lentsholongwane yegazi,) i- thrombocytopenia (ukubala okuphantsi kweplatelet) okanye ukusulelwa rhoqo rhoqo akunakuncedwa kunyango. Unyango kulona nqanaba kwisifo akusayi kukwandisa ubomi bakho, kwaye akuyi kunciphisa ukuqhubela phambili kwe-leukemia yakho. Ngako oko, indlela yokulinda "ilindile" idla ngokuthathwa. Kwimiba yokulindela, uya kulandelwa ngumzimba wegazi okanye u-oncologist kwaye uya kufuneka ube nomsebenzi wegazi uze ubonwe ngumphathi wakho kwiinyanga ezintandathu ukuya kwezi-12.
Phakathi kokutyelela, kuya kufuneka uhlawule ingqalelo imiqondiso yokuba umhlaza wakho unokuqhubeka. U nga phawula:
- Ukuvuvukala kwii- lymph nodes zakho
- Ukukhathazeka kwesisu okanye intlungu
- Iimpawu ze- anemia ezifana nolusu olumnyama kunye nokuziva ukhathele kakhulu
- Ukusulela rhoqo okanye usulelo olusayi kuhamba
- Iingxaki zokuhlamba okanye ukululaza lula
Izigulane ezininzi zihlala zibukele kwaye zilinde iminyaka ngaphambi kokuba zifune unyango kwi-CLL yazo . Kungaba nzima ukuba ufunde ukuba unomdlavuza, ngoko "ulinde ukuba ube nzima kakhulu" ngaphambi kokuba uphathwe. Unokuvakalelwa ukuba ufuna nje ukulwa nalo leyemia kwaye uhambe nayo!
Nangona kunokuba nzima ukuba ube nomonde, kubalulekile ukuba uqonde ukuba ulindi kwaye ulinde ngumgangatho xa i-CLL ingabonakali nayiphi na impawu. Uphando kweli nqanaba alibonanga naliphi na inzuzo yokuqala unyango kuqala.
Chemotherapy
Kwiminyaka emininzi, i- chemotherapy yomlomo kunye neLeukeran (i-chlorambucil) yayingumgangatho wonyango lwe-CLL xa umhlaza waqala ukuqhubeka. Ngelixa ezininzi izigulane zenza kakuhle kule nyango, ayizange inikezele ngokuphendula ngokupheleleyo (CR) kakhulu. Le mihla, i-chlorambucil isetyenziswe kuphela kwizigulane ezinezinye iinkxalabo zempilo ezizikhusela ukuba zithole imithi ephezulu, eyingozi kakhulu.
Ngoku kutshanje, i-Fludara (i-fludarabine) i-chemotherapy iye yaboniswa ukuba isebenze ekuphatheni ukungathotywanga kunye ne-CLL kwakhona. Kuye kwaphucula iRR kunye nokuqhubeka kokusasazeka (PFS) xa kuthelekiswa ne-chlorambucil, kodwa kusengabonakali inzuzo ekuqhubekekeni kokuhlala (OS) xa isetyenziswe yodwa.
Esinye isilwanyana esivela kwintsapho enye, i-Nipent (i-pentostatin,) isetyenzisiwe njengenxalenye yonyango lwe-CLL.
Ukuphucula kwangempela kwi-CLL yonyango kwenzeka xa i- Cytoxan (cyclophosphamide) yongezwa ngokudibanisa ne-fludarabine therapy. Ukusebenzisa le regimen ("FC" okanye "Flu / Cy"), impendulo yonyango yonyuka njengoko kuboniswe yi-CR, PFS, kunye ne-OS. Ngoxa ukudibanisa ezi ziibini izidakamizwa kubangele ukwanda kwesoxube, akubonakali kubangela izinga eliphezulu lokusuleleka.
Antioclonal Antibodies
Iziphumo kwi-CLL yonyango ziye zaphuculiswa ngokukongezwa kwe-antioclonal antibody.
Ama-antibodies aseMonoclonal ngokuqinisekileyo axhomekeke kwiintsholongwane ezihlasela umhlaza. Nangona ukhuseleko lomzimba luyaqaphela iiprotheni ezingaqhelekanga kwindawo yebhakteria okanye intsholongwane, le mithi "iyaqonda" amanqaku angabonakaliyo kummandla weeseli zomhlaza. Ukongezwa kwe-antioclonal antibody Rituxan (rituximab) kwi-regimen ("FCR" protocol) inike abantu abantu nge-CLL izinga lokuphendula eli-90% kunye ne-96% kunye ne-CR ye-50% kwisibhengezo se-70%.
Olunye ulwaphulo-mzimba lwe-monoclonal, i-Campath (alemtuzumab) ivunyiwe yi-US Food and Drug Administration (FDA) yokusetyenziswa kwonyango lwe-CLL. Ijoliswe kwi-cell antigen "marker" ngaphandle kwe-rituximab, kwaye ingasetyenziselwa ngokwayo okanye inxulumene ne-chemotherapy.
Utshintsho lweStem Cell
Kwimeko yezinye iintlobo zeengcingo zegazi, uphando oluninzi luye lwenziwe ukuthelekisa iziphumo zokusinda kwezigulane ezithobela i-chemotherapy, ngokuchasene ne- stem cell transplant . Ukususela kwiminyaka yobudala yesigulane se-CLL esandul 'ukufumana isithuba seminyaka engama-65 ukuya kweyama-70 ubudala, ngokuqhelekileyo imdala kakhulu ukuba ithathwa njengomgqatswa wokufakelwa, ezi ntlobo zophando azizange zenziwe kule ndawo.
Ukuba uthe, i-40% yezigulane ze-CLL zingaphantsi kweminyaka engama-60 kwaye i-12% ingaphantsi kweminyaka engama-50. Ukutshintshwa kwe-stem cell kunokunika ithuba lokunyanga kwizigulane ezincinci ze-CLL ezixhamlekileyo.
I-Allogeneic stem cell transplant (ukufakelwa ngokusebenzisa iiseli ezixhamlayo zeseli) isebenzisa iqondo eliphezulu kakhulu le-chemotherapy ukunyanga i-leukemia kunye nama-stem cells anikezelayo ukuba ahlaziye isistim somzimba wesigulane. Inzuzo kwi-allogeneic stem cell transplant iwukuthi ngelixa linokuba yinto enobuthi, ingabangela "umphumo we-graft-versus-leukemia". Oko kukuthi, iiseli ezixhamliweyo ezixhasayo ziyaqaphela ukuba iiseli ze-leukemia zingavamile kwaye zihlasela.
Nangona ezi zixhobo zithuthuka ngokuphawulekayo, zikhona ezinye iingxaki ezinkulu kwi-15 ukuya ku-25% yezigulane, enye isalathisi nesifo sesigodlo apho izicubu zinikelo zivuma ukuba izigulane zinezisele zangezinye zangaphandle kwaye ziqala ukuhlaselwa.
Ngenxa yemiphumo emibi ye-allogeneic stem cell transplant, ayibonakaliswa ukuphucula iziphumo kwizigulane ezigugile.
Okwangokunje, uphando ukufumana indima ye- non-obliablative , okanye " imizuzu " yokutshintsha kwi-CLL iyaqhubeka. Ukuguqulwa okungekho-myeloablative kuxhomekeke ngaphantsi kwityhefu ye-chemotherapy kunye nokunye kwi-"graft-versus-leukemia" impembelelo yokuphatha umhlaza. Olu hlobo lonyango lunokunika ukhetho lwonyango kubantu abadala abaya kuba nako ukunyamezela ukufakelwa kwe-allogeneic standard.
Izigulane ze-Autologous stem cell ekunyangeni kwe-CLL ziye zabonisa iziphumo ezibi kwaye izinga eliphezulu lokugula kwakhona, ngamanye amaxesha emva kweminyaka emva kokutshintshwa. Nangona iyancipha ukutywala, ukufakelwa kwe-autologous akusebenzi kakuhle ekunakekeleni i-CLL ngaphandle kweyonyango engabalulekanga . Ngenxa yoko, ukufakelwa kwe-autologous akuyikonyanzelwanga kwizigulane ze-CLL.
Utyando lweyeza
Kwizigulane nge-CLL, ukusetyenziswa kwonyango lwe-radiation kuncinci ekuboneleleni ngoncedo lwempawu. Ingasetyenziselwa ukuphatha indawo ye-lymph nodes evuvuzayo engabangela ukuphazamiseka okanye ukuphazamisa ukuhamba okanye umsebenzi wezitho eziseduze.
Splenectomy
Kuba izigulane ezifumana ipeni ekhulisiweyo ngenxa yokuqokelelwa kweeseli ze-CLL, u- splenectomy , okanye ukukhishwa kwepenjini, kungakunceda ekuqaleni kuncede ukuphucula ukubala kwegazi kunye nokunciphisa ukungahambi kakuhle. Njengoko unyango lwe-radiation, u-splenectomy isetyenziselwa ukulawula iimpawu zesifo kwaye akuboneli unyango lwe-leukemia.
Ukuyifumanisa
Ngelo xesha, ngelixa unyango lwe-CLL lunakho ukubonelela izigulane ngeempawu zokuphucula kunye nokulawulwa kwe-leukemia, ayikwazi ukubonelela unyango, kwaye inkambo yesifo iyahlukahluka phakathi kwabantu abahlukeneyo. Nangona kunjalo, ukuqonda kwethu olu hlobo olulodwa lwe-leukemia lukhula rhoqo. Ukusetyenziswa, umzekelo, ukuguqulwa kwe-stem cell kubantu abano-CLL bathuthukile ngokukhawuleza ngexesha eliphakathi kuka-2006 no-2016. Izifundo zophando ziya kuqhubela phambili kwaye zingabonelela ngeendlela zokulawula ixesha elide okanye unyango lwe-CLL.
Imithombo
I-Chanan-Khan, A. "Iingonyango ezintsha ze-Lymphocytic Leukemia engapheliyo" Iingxelo ze-Oncology 2007; 9: 353-360.
I-Dreger, P. Ithemba nge-High-Risk Chronic Lymphocytic Leukemia Ukubuyela emva kweSallogeneic Stem-Cell Transplantation. Umbhalo we-Clinical Oncology . 2015. 2014.60.3282.
Lin, T., Byrd, J. "I-Lymphocytic Leukemia kunye ne-Leukemias echaphazelekayo echaphazelekayo" e-Chang, A., Hayes, D. Pass, H. et al. eds. (2006) I- Oncology: Indlela eSebenzisiweyo -Sekelwe kwi- Springer: eNew York. iphe. 1210- 1228.
Hillman, R., Ault, K. (2002) I- Hematology kwi-Clinical Practice 3rd ed. McGraw-Hill: eNew York.
National Cancer Institute. Ukwelashwa kwe-Lymphocytic Leukemia Treatment (PDQ) - kwizonyango zempilo. Ukuhlaziywa 01/29/16. http://www.cancer.gov/types/leukemia/hp/cll-treatment-pdq
Le Dieu, R., noGribben, J., "Ukutshintshwa kwe-Lymphocytic Leukemia engapheliyo" I- Hematology yangoku i-Repignance Reports 2007; 2: 56-63
I-Zent, C., Kay, N. "I-Lymphocytic Leukemia engapheliyo: i-Biology kunye neNyango yangoku . 9: 345-352.