Isifo se-Graft-versus-host

Isifo esibizwa ngokuthi yi-Graft-versus-host (GVHD) siyinkinga esongela impilo engenzeka ngemuva kokufakwa kwesinye se-stem cell noma umnkantsha wethambo.

I-GVHD kungenzeka ngemuva komnkantsha wethambo, noma i-stem cell, ukufakelwa lapho othile ethola izicubu zomnkantsha noma amaseli kumnikeli. Lolu hlobo lokufakelwa lubizwa nge-allogeneic. Amaseli amasha, atshalwe kabusha abheka umzimba womamukeli njengowangaphandle. Uma lokhu kwenzeka, amaseli ahlasela umzimba womamukeli.

I-GVHD ayenzeki lapho abantu bethola amaseli abo. Lolu hlobo lokufakelwa lubizwa ngokuthi yi-autologous.

Ngaphambi kokufakelwa, izicubu namaseli avela kubanikeli abangahle bahlolwe ukuze kubonakale ukuthi kufana kangakanani nomamukeli. I-GVHD mancane amathuba okuthi yenzeke, noma izimpawu zizoba mncane, lapho umdlalo ususondele. Ithuba le-GVHD yile:

• Cishe ama-35% kuye kuma-45% lapho umnikeli nomamukeli behlobene
• Cishe ama-60% kuye kuma-80% lapho umnikeli nomamukeli bengahlobene

Kunezinhlobo ezimbili ze-GVHD: ezinzima futhi ezingapheli. Izimpawu kuzo zombili i-GVHD ebukhali nengapheli kusuka ebumnandini kuya kokubi.

I-Acute GVHD ivame ukwenzeka zingakapheli izinsuku noma ngemuva kwezinyanga eziyisithupha ngemuva kokufakelwa kabusha. Amasosha omzimba, isikhumba, isibindi namathumbu kuthinteka kakhulu. Izimpawu ezivamile ezijwayelekile zifaka:

• Ubuhlungu besisu noma amajaqamba, isicanucanu, ukuhlanza, nohudo
• I-jaundice (umbala ophuzi wesikhumba noma wamehlo) noma ezinye izinkinga zesibindi
• Ukuqhuma kwesikhumba, ukulunywa, ukubomvu ezindaweni zesikhumba
• Ingozi eyengeziwe yokutheleleka

I-GVHD engapheli ivame ukuqala ngaphezu kwezinyanga ezintathu ngemuva kokufakelwa, futhi ingahlala impilo yonke. Izimpawu ezingamahlalakhona zingafaka:

• Amehlo omile, ukushisa okushisayo, noma ukushintsha kombono
• Umlomo owomile, amabala amhlophe ngaphakathi komlomo, nokuzwela kokudla okubabayo
• Ukukhathala, ubuthakathaka bemisipha, nobuhlungu obungapheli
• Ubuhlungu obuhlangene noma ukuqina
• Ukuqhuma kwesikhumba ngezindawo eziphakanyisiwe, ezinombala, kanye nokuqina kwesikhumba noma ukuqina
• Ukuphefumula okuncane ngenxa yokulimala kwamaphaphu
• Ukoma kwesitho sangasese sowesifazane
• Ukwehla kwesisindo
• Ukwehla kwe-bile okuvela esibindini
• Izinwele ezi-brittle nokumpunga ngaphambi kwesikhathi
• Ukulimala kwezindlala zomjuluko
• I-Cytopenia (yehla ngenani lamaseli egazi avuthiwe)
• I-Pericarditis (ukuvuvukala kulwelwesi oluzungeze inhliziyo; kubangela ubuhlungu besifuba)

Ukuhlolwa okuningana kwelebhu nemifanekiso kungenziwa ukuthola nokuqapha izinkinga ezibangelwa yi-GVHD. Lokhu kungafaka:

• Isisu se-X-ray
• I-CT scan isisu nesifuba se-CT
• Ukuhlolwa kokusebenza kwesibindi
• Ukuskena kwe-PET
• I-MRI
• I-capsule endoscopy
• I-biopsy yesibindi

I-biopsy yesikhumba, ulwelwesi lwamafinyila emlonyeni, ingasiza futhi ukuqinisekisa ukuxilongwa.

Ngemuva kokufakelwa kabusha, umamukeli uvame ukuthatha imithi, njenge-prednisone (i-steroid), ecindezela amasosha omzimba. Lokhu kusiza ukunciphisa amathuba (noma ukuqina) kwe-GVHD.

Uzoqhubeka nokuthatha imithi kuze kube yilapho umhlinzeki wakho wezokunakekelwa kwezempilo ecabanga ukuthi ingozi ye-GVHD iphansi. Eminingi yale mithi inemiphumela engemihle, okubandakanya ukulimala kwezinso nesibindi. Uzoba nokuhlolwa okuvamile ukubheka lezi zinkinga.

I-Outlook incike ebukhali be-GVHD. Abantu abathola izicubu zomnkantsha kanye namangqamuzana omnkantsha asondelene ngokuvamile benza kangcono.

Ezinye izimo ze-GVHD zingalimaza isibindi, amaphaphu, umgudu wokugaya ukudla, noma ezinye izitho zomzimba. Kukhona nengozi yokutheleleka okunzima.

Izimo eziningi ze-GVHD ebukhali noma engalapheki zingelashwa ngempumelelo. Kepha lokhu akuqinisekisi ukuthi ukufakelwa uqobo kuzophumelela ekwelapheni isifo sokuqala.

Uma uke wafakelwa umnkantsha wethambo, shayela umhlinzeki wakho khona manjalo uma uba nezimpawu ze-GVHD noma ezinye izimpawu ezingavamile.

I-GVHD; Ukufakelwa komnkantsha wethambo - isifo se-graft-versus-host; Ukufakelwa kwe-stem cell - isifo se-graft-versus-host; Ukufakelwa kabusha kwe-Allogeneic - GVHD

• Ukufakelwa komnkantsha wethambo - ukukhipha

• Amasosha omzimba

UMbhishobhi MR, uKeating A. Ukufakelwa kabusha kwe-stem cell. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 168.

Ngingu-A A, Pavletic SZ. Ukufakelwa kabusha kwe-stem cell ye-hematopoietic. Ku: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, abahleli. I-Abeloff’s Clinical Oncology. Umhlaka 6. IPhiladelphia, PA: Elsevier; 2020: isahluko 28.

UReddy P, uFerrara JLM. Izimpendulo ze-Graft-versus-host kanye nezimpendulo ze-graft-versus-leukemia. Ku: Hoffman R, Benz EJ, Silberstein LE, et al, ama-eds. I-Hematology: Izimiso Eziyisisekelo Nokuzijwayeza. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2018: isahluko 108.