I-leukemia, umhlaza weeseli ezenza igazi, uvame ukucingwa njengemeko echaphazela abantwana kunye nentsha-eneneni, ngumdla wesiqhelo obuninzi kakhulu. Nangona kunjalo, i-leukemia inokuchaphazela abantu abadala abadala kunye nabantu abakwinqanaba elingama-60, ngokukodwa.
Nangona unyango lwabantu abadala abadala lunokuba nzima kakhulu, namhlanje kuninzi inani elincinci lokukhetha-nokuba uneminyaka eyaneleyo yokukhumbula i-Eisenhower ne-JFK.
Amachiza amatsha amachiza aphumayo anokunceda ukulwa nesifo, nangona xa umzimba wakho ungeke uthathe umonakalo onobungozi we-chemotherapy enamandla. Oku kwathiwa, nangamaxesha anamhlanje, i-leukemia yintsikelelo enokubangela ininzi.
I-Leukemia Iintlobo kwi-Older Adult
I-lymphocytic leukemia (CLL) engapheliyo iyona leyemia eqhelekileyo kubantu abadala, abaneminyaka yobudala yokuxilongwa malunga neminyaka engama-71. I-lemonem ye-leememia (AML) eqhelekileyo ibonisa isibini esondeleyo kubantu abadala, eneminyaka yobudala ekuxilongweni kweminyaka engama-67; kwaye ngaphezu kwama-60 ekhulwini kwezigulane ezandul 'ukufumana i-AML zingaphezu kwama-60. Ngaloo ndlela, i-CLL ne-AML zibhekiselwe kakhulu apha, nangona kunjalo, abadala abadala bangakhula ezinye iindidi ezimbini ze-leukemia, ngokunjalo. Umdala ongaphezu kweminyaka engama-70 ngumngcipheko we-adult acute lymphoblastic leukemia (YONKE), ebizwa ngokuba yi-adult lymphocytic leukemia. Kwaye malunga ne-lemonemia engapheliyo (CML), malunga neepesenti ezingama-50 zezigulane ezine-CML zineminyaka engama-66 nangaphezulu.
Abantu abadala abakwazi ukufumana i-Leukemia
I-CLL kunye ne-AML yimiba eqhelekileyo ye-leukemia ukuvela kamva ebomini. Kula mabini, i-AML yisifo esiphuthuma ngokukhawuleza. Uqikelelo lweentlondi ezimbini (onke amaqela eminyaka) ngo-2016 zilandelayo:
- Amatyala amatsha angama-18 960 kunye nokufa kwabangu-4,660 abavela kwi-CLL
- 19,950 amatyala amatsha kunye nokufa kwabangu-10,430 be-AML.
I-CLL kunye ne-AML zizifo ezahlukileyo kakhulu, ezibonisa ukungafani okuphawulekayo phakathi kwama-leukemia acute kunye angapheliyo, ngokubanzi. Zonke i-leukemia ziqala xa iiseli zomncuba wethambo-umzimbeni wakho womzimba ekwenzeni iiseli ezintsha zegazi-ziqala ukuvelisa iiseli zegazi ezimhlophe ezingavamile. Amaseli esitshixo emntsheni wethambo ngokuqhelekileyo anika onke amangqamuzana egazi lakho ngokuqhubekayo, okwenza iiseli ezintsha zithathe indawo yamandulo. I-leukemia echaphazelekayo iqukethe amangqamuzana angama-blood forming kwaye ihamba phambili ngokukhawuleza ngokukhawuleza. I-leukemia engapheliyo ibandakanya iiseli ezenza igazi ezithe zavuthwa ngakumbi, kodwa i-leukemia engapheliyo kwaye ihlala ingapheliyo, ithambekele ekuphuculeni kancinci, ngaphezu kweenyanga kunye neminyaka.
CLL
I-CLL ngumhlaza weeseli ezimhlophe zegazi kwiintsapho ze-B-lymphocyte. I-B-lymphocytes, okanye iiseli ze-B, ziyi-lymphocytes ezinokuqalisa ukusebenza kwaye zikhokelela kwimveliso ye-antibody. Olunye uhlobo lwe-lymphocyte yi-T-cell, efana ne-infantry's 'infantry', okanye amaseli ejoni.
I-CLL ayinakudala iimpawu kuqala, kwaye umntu akayi kukwazi ukuba unayo i-CLL ekuqaleni. Enyanisweni, ngokukhawuleza, abantu bayafunyanwa emva kokuvavanywa kwegazi rhoqo. Xa i-CLL ibangela iimpawu, ezinye zezona ziqhelekileyo zi: ziziva zidinwe kwaye zibuthathaka; okanye zine-lymph nodes ezivuvukileyo entanyeni, phantsi kweengalo okanye kwi-groin; okanye ukugula ukugula ngokulula ngaphezu kwesigqirha; okanye unemfiva, okanye ukukhupha okukhulu ngexesha lokuhlwa; okanye ukulahlekelwa ubunzima ngaphandle kokuzama.
Kwi-CLL, amangqamuzana omhlaza afunyaniswa kakhulu kwigazi, umongo weethambo, kunye ne-lymph nodes. Imeko ehambelana nayo, ebizwa ngokuba yi-lymphocytic leukemia, okanye i-SLL, ngumhlaza oqala kwi-B cell cell cell, njengeCLL, nangona kunjalo, umntu onoxilongo akayiyo inani eliphezulu lamaseli egazi ezimhlophe kwigazi labo.
Ukuxilongwa kwe-CLL kudinga ukuhlolwa kwegazi, kwaye inani leeseli ze-B egazini lakho kufuneka lizimisele. I-CLL ifunyaniswa ngokuba khona kwama-5,000 angama-b-cell angavumelekanga nge ml yegazi, kunye neeseli ze-B kufuneka zibe "ikopi" okanye iifayile zesalathisi esifanayo somzali. Oku kubizwa ngokuba yi-monoclonality.
Iiseli ze-CLL nazo zifuna ukuvavanywa ukuze zibone oko ziphezulu. Ba nokuba nenani leepakethi zeprotheni okanye amanqaku. Iilabhoratori zibhekisela kula manqaku eeprotheni usebenzisa iileta zeCD ezilandelwa ngumbhalo. Kwi-CLL, iiseli zinokuba neempawu ezibizwa ngokuba yiCD5, i-CD19, ne-CD23 ebusweni; abanye banokuba neCD20, kodwa akukho nanye eneCD10. Kwamanye amaxesha, kufuneka ufumane ezinye iimvavanyo zenziwe kwongezwa kwiimvavanyo zegazi, ezifana ne-lymph node biopsy okanye i-bone marrow biopsy-nangona kunjalo, akusiyo imeko eqhelekileyo yokuxilongwa kwe-CLL.
CLL vs. MBL
Uphononongo lubonisa ukuba abantu aba-3 ukuya kuma-5 ekhulwini abantu abangaphezu kweminyaka engama-40 ubudala, xa bavavanywa ngeemvavanyo ezibucayi, babonisa inani le-clonal labantu be-lymphocyte, njengaku-CLL. Oku kufunyenwe kukhokelela ekudaleni ukuxilongwa kwe-MBL, ebonwa ngumbuso wangaphambili kwi-CLL.
Ukuba unamaqela angama-5 000 angama-B e-monoclonal, akukho lymph node yokwandiswa kwaye akukho nanye imiqondiso ye-CLL, unokuthi ufumaneke nge-B-lymphocytosis ye-monoclonal (MBL). Oku kuqhelekileyo kubantu abadala, kwaye akusengomdlavuza. Bambalwa kakhulu abantu abane BML baya phambili ukuphuhlisa i-CLL; nangona kunjalo kukho loo nto, kwaye ngoko kulinda kulindelwe.
Nangona unokuxilongwa kwe-CLL, isigqibo sokunyanga singasisigqibo esiphezulu. Kwixesha elidlulileyo, oogqirha baxelele izigulane nge-CLL ukuba "ixesha elindeyo lokulinda" kufuneka lilandele ukuxilongwa de isifo siphumelele. Nangona oko kusenokuba kunjalo kwiimeko ezininzi, kukho ukuqonda okunyukayo ukuba amacala ahlukeneyo e-CLL angaziphatha ngokungafaniyo, kwaye ezinye iimeko ze-CLL zingabiza unyango oluthe xaxa.
Icandelo locwangciso oya kugqirha wena kunye nogqirha wakho kukuqinisekisa ukuba unyango lwe-CLL yakho luqale njani. Isigqibo senziwe ngokusekelwe kwiimpawu ze-CLL, iziphumo ezivela kwiimvavanyo zebhabhi kunye nokuhlolwa kweesiteji. Kwi-CLL, inkqubo yesiteji seRai isetyenziswa, ukususela kwiSigaba I ukuya kwiNqanaba IV. Kukho ne-Binet yesitatimende sesiteji se-CLL esichaza izigaba A, B, no-C, kodwa akunakuncedo ekunqumeni ngexesha lokuqalisa unyango.
Oogqirha bahlula iinqanaba zeRai zibe ngamaqela aphantsi, aphakathi, kunye nengozi aphezulu xa bekhetha iindlela zokonyango.
- Isigaba 0 sithathwa njengengozi ephantsi.
- Amanyathelo I no-II athathwa njengengozi ephakathi.
- Izigaba III ne-IV zibhekwa njengengozi enkulu.
Kuba abantu abane-CLL ye-RAI izigaba 0, mna no-II, kunokwenzeka ukuba unyango alufanelekanga ngokukhawuleza. Nangona kunjalo, kumntu osesikweni sokuqala kwesifo kunye ne-CLL esebenzayo-ngokomzekelo kunye nobukho beempawu ze-CLL ezifana nokukhathala okanye imfiva, ukukhupha ebusuku okanye ukulahlekelwa kwindleko engenakuncedo-unyango lukwaziswa.
Ezinye izinto kunye nesigaba ngamanye amaxesha ziqwalaselwa xa zikhangela iindlela zokonyango. Iziganeko ezinxulumene nezihlandlo ezincinci zokuphila zibizwa ngokuba yizinto ezichasayo zokuxela, ngelixa izinto ezinxulumene nokuhlala ixesha elide zizinto ezilungileyo zokuxela.
Eminye imiba enxulumene neephene zeengcambu ze-leukemia kunye neempawu ze-surface zisetyenzisiwe: ZAP-70, i-CD38, kunye nemfuyo eguquguqukayo ye-IGHV ukunceda ukwahlula iimeko ze-CLL kumaqela amabini, ikhula ngokukhawuleza kwaye ikhula ngokukhawuleza. Abantu abanomdla okhula ngokukhawuleza we-CLL bathambekele ekubeni baphile ixesha elide kwaye banokwazi ukulibazisa unyango ixesha elide.
Ukufumana unyango lwe-CLL ngokubanzi luwela kwiindidi ezibanzi zonyango ezifana ne-chemotherapy, unyango olujoliswe kuyo, imithi-immunotherapy, i-immunomodulators, kunye ne-steroids. Ayikho yonke imveliso efanelekileyo kubo bonke abantu abane-CLL. Uninzi oogqirha bafunda malunga neentlobo ezahlukeneyo ze-CLL, iindlela ezithe ngqo zonyango zifanelekile kwiimeko ezithile ze-CLL kodwa kungekhona abanye.
Ezinye iindlela zonyango ziphando kwaye ziya kufumaneka kuphela xa ungena kwisilingo seklinikhi. Ngokusekelwe kwizilingo zeklinikhi, xa sele unyango luzimisele ukukhuseleka kwaye lusebenza ngokufanelekileyo kwi-CLL, isizaziso siyavunywa yi-FDA kwaye siyafumaneka ngokubanzi.
Ubudala kunye nempilo jikelele kubaluleke kakhulu xa kuthathwa isigqibo malunga nonyango. Ngokomzekelo, ezinye zonyango zokuqala ze-CLL zinokumiselwa ukuba zifaneleke ngakumbi kubantu abancinci nabanempilo abane-CLL; ezinye izibonelelo zonyango zokuqala okanye iirimimitha zingabonwa ngcono kulabo asebekhulile okanye kwimpilo embi.
Unonophelo oluxhasayo luncedo olungayi kunyanga umhlaza kodwa lujolise ukwenza ubomi kunye ne-CLL bube bhetele ngakumbi kuwe. Unonophelo loxhasayo luquka izinto ezifana negontsho, ukuxilongwa, imishanguzo yokukhusela, kunye nokuncediswa nokunakekelwa ngononophelo xa kukho oogqirha abaninzi abachaphazelekayo.
Abantu abakhulileyo abane-AML
Ngokutsho kwe-American Cancer Society, i-leukemia enkulu ye-myeloid ngokuqhelekileyo isifo sabantu abadala kwaye ayiqhelekanga ngaphambi kweminyaka engama-45. Umyinge wesigidi se-AML uneminyaka engama-67.
Iimpawu ze-AML zihlala zihambelana nomntu osezantsi wegazi. Xa iiseli ze-leukemia zithatha phezu komnatha wethambo, zixhamla ngaphandle kweeseli eziqhelekileyo ezenza igazi, okubangelwa kukuntuleka kwegazi lakho. Ukunqongophala kweeseli ezibomvu zegazi kubangela ukuba i-anemia kunye neempawu ezinjengebuthathaka kunye nokukhathala ngokweqile. Ukunqongophala kweeseli ezimhlophe zegazi kuholele kwi-neutropenia, ezinokuba nezibonakaliso ezinjengomkhuhlane kunye nosulelo. Ukunqongophala kweeplatelet kukhokelela ekutheni i-thrombocytopenia kunye neempawu ezifana nokukhupha okungavamile okanye ukutyumla . Kwaye ukuhlanganiswa kwezi zimpawu ziqhelekileyo.
Ekuxilongweni kwe-AML, kukho ukungafanelanga kwiimvavanyo zegazi; nangona kunjalo, ngokungafani nokuxilongwa kwe-CLL, ukufunwa komongo we-bone / biopsy kudla ukuba kuhlolwe kwaye kuhlolwe i-AML. Amaninzi amaninzi ahlukeneyo ase-AML ngoku ayaziwa ukuba akhoyo.
Emva kokuxilongwa kwe-AML, kunye neqela lakho lononophelo lwempilo, uhlakulela uluvo lweenjongo zonyango, kunye nemiphumo emibi yonyango. Phantse kwisiqingatha sezigulane ze-AML ezidala ziya kuxolelwa emva kokunyanga kokuqala, ngokutsho kweMerika Cancer Society. Abantu abafezekisa ukuxolelwa ngokupheleleyo banomgangatho ophuculweyo wobomi xa kuthelekiswa nazo zigulane ezifumana unyango olusisigxina, mhlawumbi ngenxa yezibhedlele ezimbalwa, ukuxilongwa kunye neyeza-antibiotics. Abasindileyo bexesha elide be-AML bamelwa kuwo onke amaqela; nangona kunjalo, ukubuyela emva kokunyanga okokuqala kunjalo. Ngokuqhelekileyo, izigulane ezine-AML zikhuthazwa ukuba zibhalise kwizilingo zekliniki ukuze zisebenzise izixhobo zonyango kunye neenjongo zokuphucula iziphumo zazo.
Kwizigulane ezithe zikhulile okanye ngokuqhelekileyo zigula kakhulu, okanye zineempembelelo zomzimba, ngamanye amaxesha unonophelo oluxhasayo kunye / okanye i-chemotherapy engaphantsi ekhethiweyo. Unonophelo loxhasayo lubandakanya ukumpontshelwa igazi, i-antibiotics kunye namanye amayeza anceda impilo yomntu kodwa angayigxothi umhlaza.
> Imithombo:
> I-American Society of Hematology. Unyango lwezigulane ezisebekhulile ezine-leukemia ezinzulu.
> Chiorazzi N, Rai K, Ferrarini M. Chronic Lymhocytic Leukemia. N Engl J Med. 2005; 352: 804-15.
> Izikhokelo zeNCCN. I-Lymphocytic Leukemia. Version 1. 2016.