Impembelelo kunye noTyango lwe-Post-Transplant Non-Hodgkin's Lymphoma
Umngcipheko wokuphuhlisa i- lymphoma ukwanda ngokukhawuleza emva kokufakelwa kwesigxina somzimba ngokomzekelo, ukuguquka kweentso, ukufakelwa kwesibindi, ukuguquka kwentliziyo okanye ukuhamba kwemiphunga. Ezi lymphomas zibizwa ngokuba yi-"post-transplant disorders" okanye i-PTLDs.
Ziyayimfuneko kangakanani i-Lymphoma emva kokutshintshwa komzimba?
I-PTLD ifaka iindidi ezahlukahlukeneyo zeemeko ezinomzimba olulandelayo emva kwesigxina esiqinileyo okanye i-hematopoietic stem cell transplantation (HSCT) kwaye inokuthi ifike kwi-10 ekhulwini yabantu abadala emva kokutshintshwa.
Uluhlu lwe-1 ukuya kwi-20 ekhulwini luye lwasetyenziselwa ukuqikelela isiganeko esipheleleyo se-post-transplant LPD.
Kutheni i-Lymphomas ivela emva kokutsalwa komzimba?
I-post-transplant lymphomas ihlala isondelelwanyo kwintsholongwane yi-Epstein Barr Virus (EBV) . Usulelo lwe-Epstein Barr Virus lubangela ukuguqulwa kwee-cell (uhlobo lwe-lymphocyte okanye iseli legazi elimhlophe) eliba ngumhlaza. Kwiimeko eziqhelekileyo ezinye iiseli zamasosha omzimba ziyakwazi ukujongana nosuleleko lwe-EBV, kodwa kubantu abachaphazelekayo, ukunyuka kwamachiza okukhusela isistim somzimba kufuneka kulawulwe. Akukho nto yokulawula isifo, amathuba okuphuhlisa i-lymphomas.
Ziziphi izinto eziKwandisa ingozi yeL-Plasma emva kokutshiza?
Izinto ezibini eziphambili ezibeka amathuba okufumana i-lymphoma zi:
- Kufuneka unyango olunjani lwe-immunosuppressive - Ingakumbi ukunyuswa kwe-immunosuppression, ngaphezulu kwamathuba okusuleleka ku-EBV.
- Isimo se-EBV serology yommkeli wokutshintshwa - Ukuba umntu uphethwe ngu-EBV ngaphambili (unembali yokuba ne-mono) amathuba ukuba umzimba ukhumbule intsholongwane kwaye igazi sele linamaphrotheni akhethekileyo abizwa ngokuba ngama-antibodies ukuchonga nokubulala intsholongwane. Oku kungahlolwa ngokuthatha isampuli yegazi.
I-Post-Transplant Lymphomas Behave?
Ngokomyinge, ukuba i-PTLD iya kwenzeka, ixesha eliqhelekileyo lokwenza njalo malunga neenyanga ezi-6 emva kokutshintshwa kwezigulane eziqinileyo zokuguqula izigulana kunye neenyanga ezi-2-3 kwi-HSCT abafumanayo, kodwa kuye kwabikwa kungekudala ngeveki enye kunye ekupheleni kweminyaka eyi-10 emva kokufakelwa.
I-post-transplant lymphomas zihlala zihluke kwii -lymphomas eziqhelekileyo ezingekho kwiHodgkin . Iiseli zomhlaza zeli lymphoma zingumxube weendlela ezahlukeneyo kunye nobukhulu. Ngelixa ezininzi izigulane zibandakanyeka kakhulu kuma-lymph nodes, ezinye izitho zithinteka ngokuqhelekileyo-into ebizwa ngokuba yi-'exranodal ' . Ezi ziquka ubuchopho, imiphunga kunye namathumbu. Iqumrhu elifakelwayo lingabandakanyeka.
I-Post-Transplant Lymphoma isingathwa njani?
Xa kunokwenzeka, unyango lwe-immunosuppressive kufuneka luncitshiswe okanye luyeke. Kulabo abanesifo esincinci kunye neendawo, ukuhlinzwa okanye i-radiation ingazama. Ukuba akunjalo, umgca wokuqala wonyango ngokuqhelekileyo u-Rituxan (rituximab) , umntu olwa-monoclonal antibody ojolise ngqo kwiiseli ze-lymphoma. Kuphela xa le nto ihluleka ukukhwela i-chemotherapy. I-Chemotherapy ichithwa kude kube yinto efunekayo njengokuba abantu abathile abangenayo i-immunosuppressed chemotherapy banokunyusa ukwanda kwengozi yezifo .
Kulabo bahlakulela i-lymphomas emva kokutshintsha komongo we-bone, ukuxilongwa kwe-leukocyte abaxhasi banokuphumelela kakhulu.
Ziziphi iziphumo kunye ne-Post-Transplant Lymphomas?
Ngokubanzi, i-PTLD yimbangela ebalulekileyo yokugula nokufa, ngokudlulileyo kwimivuzo yokufa yabantu abaye bafikelela kuma-40-70 ekhulwini kwizigulane ezinezigulana eziqinile kunye ne-90 esecaleni kwizigulana ezilandelayo kwi-HSCT. I-non-Hodgkin lymphomas ezenzeka emva kokuguquka komzimba zinomphumo oswelekileyo kunezinye i-NHL. Olunye upapasho olushicilelwe luye lwaba malunga no-60-80% ekugqibeleni lugxothwa kwi-lymphoma yabo. Nangona kunjalo, ukusetyenziswa kweRituxan kuye kwatshintsha izinga lokusinda, kwaye abanye abantu bahamba kakuhle kakhulu kwaye banokuphiliswa.
Ukubandakanyeka kwamanye amalungu, ingakumbi ingqondo, ine-prognosis.
Imithombo:
Yena, G., Wang, C., Tan, H., no S. Yena. I-Rituximab emva kwe-autologous stem cell transplantation yandisa impilo yezilwanyana ze-B-cell lymphoma: uhlalutyo lwe-meta kunye nokuphononongwa ngokufanelekileyo. Inkqubo yokuTywala . 2015. 47 (2): 517-22.
Katabathina, V., Menias, C., Pickhardt, P., uLubner, M., noS S. Prasad. Iingxaki zonyango lokungena kwi-Immunosuppressive kwi-Organic Organ Transplantation. Iikliniki zeRadioology zaseNyakatho Melika . 2016. 54 (2): 303-19.
> Metser U, Lo G. FDG-PET / CT kwisisu esisemva kokutshiza isifo se-lymphoproliferative. Br J Radiol . 2016; 89 (1057): 20150844.
Petrara, M., Giunco, S., Serraino, D., Dolcetti, R., no-A. De Rossi. I-post-transplant disorders: Ukusukela kwi-epidemiology ukuya kwi-pathogenesis. Iileta Zomhlaza . 2015. 369 (1): 37-44.