I-Myeloma kunye ne-myeloma eninzi ngamagama ahlukeneyo ngomhlaza ofanayo. Igama eliqela likhethiweyo kwaye libhekisela kwiimvumi ezininzi ezikhula kumathambo abantu abaneli sifo.
I-Myeloma, i- leukemia, kunye ne-lymphoma ziintlobo ezintathu eziphambili zeengxaki zegazi okanye i-hematologic malignancy. Kwezi zintathu, i-myeloma yinto encinane. Amathuba okuphuhlisa i-myeloma ngokwanda kwaye abaninzi abantu abafunyaniswa ukuba bangama-60 okanye ngaphezulu. Nangona kungenzeka kubantu abadala, abantu abangaphantsi kwepesenti kwimiba engaphantsi kweminyaka engama-35.
Iyini i-Myeloma?
I-Myeloma ngumhlaza oqala emlonyeni wethambo . Abantu abadala abasemgangathweni, umongo wesifuba iindawo eziphilayo ezipakishwe kwiindawo eziphakathi kwamathambo athile. Kulapho, ihlala iyenza kwaye ikhuphe iiseli zegazi ezibomvu kunye neeseli ezimhlophe zegazi kuzo zonke iintlobo, ukuqinisekisa ukuba unokubonelela ngegazi lakho.
Nangona kunjalo, i-myeloma ngumhlaza ngokukodwa kwiseli ye- plasma -uhlobo oluthile olukhethekileyo lwegazi elimhlophe. Umsebenzi oyintloko weeseli ze-plasma ukwenza i-antibodies, iiprotheni ezincinci ezithengisa abahlaseli belizwe langaphandle ngokutshabalaliswa komzimba.
Inani eliphilileyo lamaseli e-plasma lifihla lonke iipotifoliyo zamanqindi ahlukeneyo ukuhlasela enye intsholongwane. Kwi-myeloma, kukho 'i-clone' yeeseli zeplasma ezixakekayo-iikopi ezininzi zeefesili enye yeplasma emnzini wethambo zivelisa iprotheni efanayo ( iprotheni yamonoclonal okanye i-protein ) engavamile. Ikhonkco elibi lamaseli e-plasma alindele ukuba intsholongwane ihlasele; ivelisa i-protein rhoqo kunye nokugqithiseleyo.
Ngokuchanekileyo indlela iseli elisempilweni yeplasma eliba ngumhlaza lisaziwa ngokupheleleyo, kodwa izazinzulu zifumana umhlaba. Okubalulekileyo, ngoku kuyaqondakala ukuba i-myeloma ingowentsapho yezifo ezahlukahlukeneyo zeplasma. Abantu abaninzi abanesifo esithile seplasma zezifo zesigxina ekugqibeleni bahlakulela i-myeloma eninzi.
Iimpawu
Akunjalo wonke umntu onomculo wam i-myeloma unempawu ekuqaleni, ngoko ukubamba i-myeloma ekuqaleni kwenkqubo yayo kunzima. Iimpawu zokubheka ziquka ezi zilandelayo:
- Intlungu yesifo, ikakhulukazi emqolo okanye esifubeni
- Ukukhathala
- Ukulahlekelwa kwesisindo esingenziyo
- Ukusulela rhoqo
- Ukuxubha, ukuzithemba, kunye / okanye ukungabikho kokutya
- Uziva unxaniwe kakhulu
- Ukudideka okanye inkohlakalo yengqondo
- Ubungqina okanye ubuthathaka kwimilenze
Ngokuqhelekileyo iimpawu ze-myeloma zidibene nemiphumo ethile yegciwane elibi kunye / okanye i-antibody-proteins ezivelisayo. Umzekelo:
- Njengoko iiseli ezingaqhelekanga ngaphakathi kwamathambo ziyakha, iintlungu zethambo, ubuthathaka bamathambo kunye neziqhekeza ziyakwenzeka, ezinokubangelwa ngumonakalo wemisipha.
- Xa amangqamuzana e-myeloma aqala ukukhupha iiseli zegazi, abantu banokuhlakulela ubuncinane bee cell cell. Inani elincitshisiweyo yeeseli ezibomvu zegazi, okanye i-anemia , inokufaka isandla kwimpawu zobuthathaka kunye nesondlo. Ukunqongophala kweeseli ezimhlophe zegazi kunokukwenza ukuba usuleleke ngakumbi. Ukunqongophala kweplatelet kunokukhokelela kwiingxaki zokuphaphaka kwingozi eziza kuba zibi kakhulu.
- Amaseli e-Myeloma angakalisa ezinye iiseli ukuba aphule ithambo, akhulule i-calcium efikelela kumazinga aphezulu egazini. Eyaziwa ngokuba yi-hypercalcemia, lo buninzi kwi-calcium yegazi iza kunye neempawu zayo, kubandakanywa ukoma okwedlulele okanye ukucola ngokugqithiseleyo, ukudideka, ukuxhalaba okukhulu, intlungu yesisu, kunye nokulahleka kwesidlo.
- Maxa wambi iiseli ze-myeloma zivelisa iiproteni ezinobungozi kwiintso kunye neentsholongwane. Oku kunokuvelisa izifo zengqondo okanye, xa kuthe kwintlungu echaphazelekayo, ukugubha, ukubetha okanye ubuthathaka. Ukuxubha kunye neentlungu ezandleni, iingalo, iinyawo kunye nemilenze zibizwa ngokuba yi-peripheral neuropathy.
- Ukwakhiwa kwiprotheni ye-myeloma nako kunokubangela ukwanda kwegazi-phantse ukongeza umgubo ogqithiseleyo kwi-batter panter. Oku kwandisa kuthiwa yi-hyperviscosity. Inganciphisa ukuhamba kwegazi ukuya kwingqondo kwaye ibangele ukudideka, utyumbe, kunye nezinye iimpawu.
Ngaba ikhona i-Myeloma yangaphambili?
Ukuxilongwa kwangaphambili kwe-myeloma kuyinselele njengoko iimpawu zingenakuvela kwiinqanaba eziphambili. Ngamanye amaxesha, kukho izibonakaliso ezingacacanga okokuqala zibangelwa ezinye izifo. Nangona kunjalo, izazinzulu ziye zafumanisa intsapho yezifo ezahlukahlukeneyo zeplasma, ezinye zazo ekugqibeleni zingathuthuka kwi-myeloma, njengalezi zilandelayo:
- I-Monoclonal Gammopathy yokuBaluleka okungapheliyo (MGUS)
- I-Plasmacytoma, okanye iplasmacytoma yodwa.
MGUS
Xa unayo iikopi ezininzi ze-antibody efanayo, oku kwaziwa ngokuba yi-gammopathy ye-monoclonal okanye i-MG. Abantu abane-myeloma banokuba ne-MG, kodwa akusiyo yonke into ene-MG ine-myeloma. Enyanisweni, kukho uluhlu olude lwezifo ezinxulumene nobukho be-MG kwaye ezininzi zazo azikho umdlavuza.
Xa umntu ephethe iMG kodwa akukho zikhokelo malunga noko kubangela oko, kwaziwa ngokuba yi-MG yokubaluleka okungagqithwanga okanye iMGUS. Akunabo bonke abane-MGUS baya kuqhubeka nokuphuhlisa i-myeloma, kodwa abanye banokuthi, kutheni iliso lonyaka ludingekile.
Nangona iimeko ezibuhlungu, i-MGUS inomngcipheko wokuba i-myeloma kwisilinganiso sama-1.5 ekhulwini ngonyaka. Iingxaki zikhuphuka ngeenombolo eziphezulu zamaseli e-plasma engavamile kwintsipho yethambo kwaye kunye namazinga aphezulu eprotheni egazini. I-MGUS ikwajongwa rhoqo kodwa ingaphathwa.
Plasmacytoma
Ngamanye amaxesha kukho ubungqina bodwa besikhomba esisodwa se plasma. Xa kwenzeka oko, kuthiwa yi-plasmacytoma okanye iplasmacytoma ekhethiweyo yethambo, kunokuba i-myeloma.
I-plasmacytoma yodwa ingakhula ngaphandle komnatha wethambo kwelinye iqumrhu. Kule meko, kuthiwa yi-extramedullary plasmacytoma. Abantu abaninzi abane-plasmacytoma yedwa baya kuqhubeka nokuphuhlisa i-myeloma, ukujonga ngokukhawuleza iimpawu ze-myeloma kubalulekile.
Yintoni eyenzekayo eMyeloma?
Cinga ngomongo wakho wethambo njengebhola lebhola lebhola lebhola kunye nabalandeli. Umtshini ngamnye uyiseli kwaye kukho iintlobo ezahlukeneyo zeeseli. Kule nqanaba, iiseli ze-plasma zibalandeli abanikezwe ifulegi ukuba batyhusele ngexesha lokubonisa. Yaye nganye iplasma cell / fan iseflegi ehlukeneyo, emele i-antibody ekhethekileyo eyenzayo.
Ngomnkantso onomsoco, ezinye iintlobo zeeseli zininzi kwiiseli ze-plasma. Ngoko, kwinqanaba lethu, abaninzi abalandeli abanalo iiflegi ezinemibala. Sekunjalo, kukho abalandeli abaneleyo kunye namaflegi ebalawuli ukuze bagcwalise le midlalo malunga nomthunzi wonk 'umbala wonke-ulwahlulo oluthambileyo lwee-antibodies.
Khawucinge nje ukuba iselenki esisodwa se-plasma ephethe igrafti egugu iguqule kwaye ilawula ukuzibandakanya, ibe ngamafomu amabini afanayo, ngalinye liphethe ifulegi ezimnyama. Emva koko ezimbini ziba ezine, ezine zibe zisibhozo, njalo njalo-zonke ziphethe iiflegi ezimhlophe. Ekugqibeleni, kuneendlela ezininzi zegrigi ezingaphezulu kwezinto ezilindelekileyo. Iiflegi ezimpunga zimela iikopi ezininzi zeprotheni efanayo-iprotheni yamonoclonal okanye iprotheni ye-M - kuba ivela kwi-clone enye engxaki. Isixa esininzi seprotheni e-monoclonal egazini okanye emcimbini yinto enokufunyanwa kwiimvavanyo zebhabhi.
Khawuthethe ukuba enye iseli kwi-clone ebulalayo iphakama ukuthenga isiselo, kodwa iphinda ibuyele kwicandelo elingalunganga lokuhlala, iqhubeke ikwazi ukuzibandakanya. I-clone iqala kwicandelo elitsha, kwaye kwakhona ezimbini zibe ezine, ezine zibe zisibhozo, njalo njalo.
Ezi clones zee-plasma ezinamahloni ezinokuthi zingathatha ukuthatha inkundla. Baxhamla ngaphandle kwemigca kunye nezicwangciso zokuhlala eziqhelekileyo zibe ngamalungu eemori eziphilileyo, njengalezo ezenza ukubonelelwa kwakho kweeseli ezibomvu, iiseli ezimhlophe, iiplatelets, kunye nezinye iiseli ze-plasma ezinamaflegi ambala. Ngoko, njengoko inani lamagqabi egijimi landa, inani lezinto eziqhelekileyo, iifolgigi ezimibalabala ziyakwazi ukunciphisa.
Kwaye ama-clones awonakalisayo anokuchaphazela namanye amaseli esondele kwisebe. Iimpawu zeeklassi zePlasma zinokukhupha izithunywa zeekhemikhali ezenza ukuba "abalandeli" abasondeleyo baziphathe ngendlela engafanelekanga. Ezinye zazo (i-osteoclasts) ziya kuqala ukugxotha kwisitimu se-stadium ( resorption yamathambo ), ukukhulula amafu othuli (calcium) esasazeka kwibala lemidlalo kunye nangaphezulu (igazi).
Iintlobo
Xa i-myeloma ikhula, inokuvela kwaye ibonakale ngokuhlukileyo kubantu abahlukeneyo. Ezinye zeemigqaliselo ezisetyenziselwa ukubeka i-myeloma ziquka:
- I-Myeloma ye-Asymptomatic
- Smoldering Myeloma
- Symptomatic okanye Active Myeloma
- Umzila woKhanya eMyeloma
- I-Myeloma
- I-Myelomas yeentlobo ze-genetic ezihlukileyo
Isymptomatic vs. Smoldering vs. Active / Symptomatic Myeloma
Kwabanye abantu, kukho "phakathi" kwesigaba sesifo-imeko phakathi kweMGUS kunye ne-myeloma esebenzayo, oko kukuthi. Xa oko kwenzeka, kubizwa ngokuthi i-myeloma engummangaliso kwaye, kwiimeko ezinje, kukho impawu embalwa yezifo ezisebenzayo okanye i-myeloma igxininiswe.
Xa ndibetha i-myeloma, umongo wethambo uzaliswe ngamaseli e-plasma. Iipesenti ezili-10 okanye ngaphezulu zamaseli e-marrow zisuka kwi-clel ye-myeloma kunye / okanye ii-protein zamanqanaba zibe zikhulu kune-30 g / L. Nangona kunjalo, ekutshiseni i-myeloma, akukho nciphisa i-anemia, ayikho i-kidney failure, ayikho inqanaba eliphezulu le-calcium egazini, kwaye akukho ndawo ephosakeleyo yethanga. Ukutshiza i-myeloma ngokuqhelekileyo kubonwa ngaphandle kokuphathwa; Nangona kunjalo, abaphandi bajonga ngeenzuzo zokuncedisa unyango kwezinye iimeko.
I-Symptomatic okanye esebenzayo i-myeloma kufuneka iphathwe. Zikhona ii-proteins egazini okanye kumchamo kunye nenani elandisiweyo lamaseli e-plasma emnzini wethambo. Amabala amancinci angabonakala kwiindawo zethambo, athathaka ithambo, abangela intlungu, kwaye ukwandisa umngcipheko weentlobo. Kwaye, ezo zinto ezingekho kwiinkcazo zokutshiza i-myeloma zivela phezulu zingase ziphumelele kwi-myeloma esebenzayo.
Iiprotheni Zinceda Ukubeka i-Myeloma
Uhlobo lweeprotheni iiseliyo ze-myeloma zivelisa kwakhona lunceda ukuba luhlobo luni lwe-myeloma. Ama-antibodies ayenamaprotheni amakhulu anamaqela ahlukeneyo okanye amathanga. Iimpahla ezinzima, okanye iintambo ezinzima, kunye namacandelo amancinane, okanye iintambo zokukhanya, zonke ziyahlangana ukuze zenze i-antibody eyodwa.
Ngokubizwa nge-antibody okanye i-immunoglobulin, iinqununu ezinzima zicacisa ukuba yeyiphi incwadi elandelayo emva kwe-immunoglobulin (Ig). Ngoko, umzekelo, inxalenye eyimfuneko kakhulu efunyenwe kwiiprotheni ze-myeloma M yi-IgG, elandisa malunga nama-60 ukuya kuma-70 ekhulwini lamatyala e-myeloma. Okulandelayo yi-IgA. Ngokuqhelekileyo, i-IgD okanye i-IgE ingabandakanyeka.
Kwezinye iimeko, iiseli ze-myeloma zingavelisa kuphela izikhuselo ezingaphelelanga okanye zingabhalisa kuphela iintambo zokukhanya. Ezi zibizwa ngokuba yi- Bence-Jones amaprotheni kwaye zincinci kangangokuthi zidla ngokusuka ezintsheni emcini. Phantse iipesenti ezingama-20 zazo zonke iziganeko ze-myeloma zidibanisa kuphela iintambo zokukhanya.
Phantsi kwepesenti enye yazo zonke iziganeko ze-myeloma azifihli iiprotheni ezaneleyo okanye ii-proteins ezikhanyayo. Kule meko, iimvavanyo ezininzi zentsholongwane zisetyenzisiweyo okanye iimpawu ze-myeloma kunye nokufunyanwa kwamaseli e-plasma engavumelekile kumnxeba obangela ukuxilongwa.
Iintlobo zeeGenestiki
Kukho iintlobo ezahlukeneyo zezofuzo ezinxulumene ne-myeloma. Ulandelelwano lwe-DNA luye lwafundiswa ukuze kuthiwa, ukuba, ukuba enye yezinto eziyimfuyo ingachaphazela okanye iqikelele ukuba isifo sakho sisabela njani kunyango . Abaphandi banethemba lokuthi ukuprofetwa kwezofuzo kuya kuqhubeka kukunceda ekuqhubekeni kwindlela yokwelashwa kwe-myeloma.
Izizathu
Kwiimeko ezininzi, izazinzulu azizi kakuhle ukuba i-myeloma iqala njani . Amaxabiso ahluke ngohlanga-abaseMerika-baseMelika abangaphezu kweCaucasian-baseMelika kunye neCaucasian-amaMelika amakhulu kunama-Asiya aseMerika-kodwa izizathu aziwa. Utshintsho oluthile lwezofuzo kwiiseli ze-plasma luye lwachongwa, kodwa yintoni ebangela ukuba utshintsho lusekuqaleni aluhlali lucacile.
Izidalwa zeGenesis zifakwe kwi-DNA, ehlanganiswe kuma-23 amabini ama-chromosomes. Kwezinye iiseli ze-myeloma zabantu, inxalenye ye-chromosome inombolo ye-13 ayikho, iyaziwa njengokususwa. Ezi zicelo zibonakala zenza i-myeloma inganyangekiyo.
Kwingama-50 ekhulwini labantu abane-myeloma, i-clone ebulalayo inomdla we-chromosome kunye nento ebizwa ngokuba yi-translocation-inxenye yecromosome enye ishintshile kunye nenxalenye yenye i-chromosome kumaseli e-myeloma. Xa izilungiso ezinjalo ziguqula izakhi zofuzo eziphambili, ziyakhuthaza ukubola.
Abaphandi bakholelwa ukuba ukungaqhelekanga kwamanye amaseli kwintolongo yethambo kungabamba indima e-myeloma. Ngokomzekelo, amaseli athile omzimba abizwa ngokuba ngamaseli e- dendritic angenza izibonakaliso zamakhemikhali ezibangela ukuba iiselm zeeplasma eziphilileyo zikhule. Ngoko, ukubonakaliswa ngokugqithiseleyo ngamaseli e-dendritic kunokufaka isandla ekuphuhliseni i-myeloma.
Ukuxilongwa
Ukuba iimpawu zibonisa i-myeloma, iimvavanyo zelabhu egazini kunye / okanye umchamo, ukucatshulwa kwamathambo, kunye ne-bone marrow biopsy zivame ukwenza.
Uvavanyo lweGazi
- Gcwalisa i-Blood Count (CBC): Oku kubandakanya ukubalwa ngokuzenzekelayo kwamaseli eentlobo ezahlukahlukeneyo ukuqinisekisa ukuba ngaba iinombolo zakho zingena kwibala eliqhelekileyo okanye elingavamile. Xa iiseli ze-myeloma zisasaza emlonyeni wethambo, ezinye zee-cell count counts ziya kuba ziphantsi. Ubalo obomvu besibalo segazi kukufumana okuqhelekileyo.
- I-Immunoglobulins (Ig) Isiqinisekiso: I-quantification yeG igqitywe ukujonga ukuba yiyiphi na, xa ikhona, kwiintlobo ezi-5 ezahlukeneyo ze-antibodies, zisezingeni eliphezulu-IgA, IgD, IgE, IgG, ne-IgM. Kwi-myeloma, enye yezinto ezinokuthi iphakamileyo kwaye abanye bangaphantsi kuneqhelekileyo. Ezinye iipateni zinokwenzeka.
- I-SPEP ne-UPEP: Oku kubhekisela kwi-serum protein electrophoresis kunye ne-urine protein electrophoresis. Ezi mvavanyo ziyakwazi ukuchonga ukuba kukho iprotein ye-protein okanye i-spike echaphazelekayo.
- Amakhonkco okuHlahla okuMahla: Olu vavanyo lusetyenziswa inani lamaketanga alula egazini. Oku kunokwenziwa, umzekelo, kwisigulane kunye ne-myeloma ongekho m protini efunyanwa yi-SPEP.
Uvavanyo lweMarrow Bone kunye nee-Biopsies
Abantu abane-myeloma banama-plasma amaninzi amaninzi ematyeni abo. Ngoko, i- marrow bone and aspiration yenzelwe ukuvavanya iibali kwaye ufumane iisampuli. Kungenziwa kwinqanaba legqirha okanye esibhedlele. Iimvavanyo ze-Biopsy zivavanywa ngumhlaza wezilwanyana kwaye ziqhubeke nokuhlolwa kovavanyo lweebhoratri.
Ukuhlolwa kweGenesis yeeCells Cancerous
Iimvavanyo ze-Genetic zisoloko zenziwa kwiiseli ezingaqhelekanga njengenxalenye yokuxilongwa nokuvavanywa kwe-myeloma. Uhlalutyo lwe-Cytogenic lubhekisela kwimvavanyo ehlola utshintsho kuma-chromosomes yamaseli e-myeloma.
Ukutshintshwa kwezinto ezithile kunye nokulungiswa kwemvelo kwakhona kunceda oogqirha baxelele ukuba ukuziphatha kakubi kungaziphatha njani. Iimvavanyo ezahlukeneyo ziyafumaneka kwaye zisetyenziselwa ukuvavanya umhlaza womntu xa izityalo zifumaneka.
I-Amyloid Biopsy
Amanqanaba aphakamileyo ama-proteins engaqhelekanga abeka izigulane zesoeloma engozini yokuphuhlisa i-amyloidosis. I-Amyloid yinto enokuyakha kuyo nayiphi na isisu kunye ne-biopsy inceda ukuxilonga esi sifo. Ngokuqhelekileyo, le ngxaki iquka ukusebenzisa inaliti ukuze isuse ezinye izifo zesisu.
Imizobo kunye nokuTyekisa
Amaseli aseMyeloma ayaziwa ngokukwazi kwabo ukwenza i-lytic lesions emathanjeni. Basenokufumana ezinye iiseli ezibizwa ngokuthi i-osteoclasts ukutshabalalisa amathambo okanye kubangele amabala athile kwiindawo eziphathekayo zethambo.
Ngokuqhelekileyo uchungechunge lwe-x-ray equka amaninzi amathambo. Xa lolu hlobo lokucinga luyenziwa, lubizwa ngokuba luphando lwethambo okanye uphando lwee-skeletal. Ezinye iintlobo zengcamango zingakunceda kwiimeko ezithile, ezifana nokufumana i-plasmacytomas engabonakali kwi-ray-ray.
Nini ukubona iDokotela
Cinga ukwenza ukuqesha kunye nodokotela wakho ukuba unayo nayiphi na imiqondiso okanye iimpawu eziqhubekayo ezikukhathazayo. Iimpawu ze-myeloma zinokuthi zingacacanga.
Ukuba uye wafumanisa ukuba unesi-MGUS okanye i-plasmacytoma yedwa, kubalulekile ukuba wena kunye nogqirha wakho nihlale ninamehlo kwizinto ezifana nalezi zifo zeseli ye-plasma zingaqhubela phambili kwi-myeloma. Njalo ubuze ugqirha wakho nawuphi na umbuzo onokufumana ngawo malunga nemeko ethile.
ILizwi
Ukuba wena okanye othandekayo usandul 'ufumane i-myeloma, kuyinto eqhelekileyo ukuziva udidekile, unomsindo, unxunguphekile okanye konke oku ngasentla. Ukuxilongwa komhlaza kukutshintsha ubomi kwiindlela ezininzi . Kunganceda ukuva amanye amabali abantu. Iindibano zocweyo zokufunda, iingqungquthela, kunye neendlela zokuzonwabisa zentlalo ziindlela ezihle kakhulu zokudibanisa nabanye abangaba neengxaki zakho okanye amava afanayo kunye nokuqonda.
> Imithombo:
> Hengeveld PJ, uKersten MJ. I-cell-activating factor in the pathophysiology ye-myeloma ezininzi: ithagethi yeyeza? Journal Cancer Journal. 2015; 5 (2): e282-.
> Sonneveld P, Broijl A. Ukunyangwa kwe-myeloma ephindaphindiweyo kunye ne-refractory. Haematologica. 2016; 101 (4): 396-406.
> Palumbo A, Anderson K. I-myeloma yamaninzi. N Engl J Med. 2011; 364 (11): 1046-1060.