Ukufakelwa komnkantsha wethambo

Ukufakelwa komnkantsha wethambo kuyinqubo yokushintsha umongo wethambo owonakele noma owonakalisiwe ngamaseli we-bone marrow stem.

Umnkantsha wamathambo yizicubu ezithambile, ezinamafutha ngaphakathi kwamathambo akho. Umnkantsha wethambo ukhiqiza amangqamuzana egazi. Ama-stem cell amangqamuzana angavuthiwe emnkantsheni wethambo okhulisa wonke amaseli akho ehlukene egazi.

Ngaphambi kokufakelwa kabusha, i-chemotherapy, i-radiation, noma kokubili kunganikezwa. Lokhu kungenziwa ngezindlela ezimbili:

• Ukwelashwa kwe-Ablative (myeloablative) - I-chemotherapy ephezulu, i-radiation, noma kokubili kunikezwa ukubulala noma yimaphi amangqamuzana omdlavuza. Lokhu kubulala nawo wonke umnkantsha onempilo osele, futhi kuvumela ama-stem cells amasha ukuba akhule emnkantsheni wethambo.
• Ukwehla kwamandla okwelashwa, okubizwa nangokuthi ukufakelwa okuncane - Imithamo engezansi yokwelashwa ngamakhemikhali nemisebe inikezwa ngaphambi kokufakelwa kabusha. Lokhu kuvumela abantu asebekhulile, nalabo abanezinye izinkinga zezempilo ukuthi bafakelwe.

Kunezinhlobo ezintathu zokufakelwa komnkantsha wethambo:

• Ukufakelwa kabusha komnkantsha we-Autologous - Igama elithi auto lisho ukuzimela. Amaseli esiqu ayasuswa kuwe ngaphambi kokuthola ukwelashwa ngamakhemikhali aphezulu noma ukwelashwa ngemisebe. Amaseli esiqu agcinwa efrijini. Ngemuva kokwelapha i-chemotherapy ephezulu noma ukwelashwa ngemisebe, amaseli akho eziqu abuyiselwa emzimbeni wakho ukwenza amangqamuzana egazi ajwayelekile. Lokhu kubizwa ngokuthi ukufakelwa kabusha kokutakula.
• Ukufakelwa komnkantsha we-allogeneic - Igama elithi allo lisho okunye. Ama-stem cell ayasuswa komunye umuntu, obizwa ngomnikeli. Izikhathi eziningi, izakhi zofuzo zomnikeli kufanele okungenani zifane nezakhi zakho zofuzo. Ukuhlolwa okukhethekile kuyenziwa ukubona ukuthi umnikeli ungumdlalo ofanele yini kuwe. Umfowethu noma udadewethu kungenzeka abe ngumdlalo omuhle. Kwesinye isikhathi abazali, izingane, nezinye izihlobo bangumdlalo omuhle. Abanikeli abangahlobene nawe, okwamanje abafanayo, bangatholakala kubhaliso lomnkantsha kazwelonke.
• Ukufakelwa kwegazi ngentambo yombilical - Lolu uhlobo lokufakelwa kabusha kwe-allogeneic. Ama-stem cell ayasuswa enkabeni yomntwana osanda kuzalwa ngemuva nje kokuzalwa. Amaseli esiqu afriziwe futhi agcinwa aze adingeke ukufakelwa kabusha. Amaseli we-umbilical cord egazi akavuthiwe ngakho-ke asikho isidingo esincane sokufaniswa okulungile. Ngenxa yenani elincane lamaseli eziqu, ukubalwa kwegazi kuthatha isikhathi eside ukubuyisa.

Ukufakelwa kwe-stem cell kuvame ukwenziwa ngemuva kokuphela kwamakhemikhali nokwelashwa ngemisebe. Amaseli esiqu ahanjiswa egazini lakho, imvamisa ngebhubhu ebizwa nge-central venous catheter. Le nqubo iyefana nokumpontshelwa igazi. Amaseli esiqu ahamba egazini angene emnkantsheni wethambo. Izikhathi eziningi, akukho ukuhlinzwa okudingekayo.

Amaseli we-donor stem angaqoqwa ngezindlela ezimbili:

• Ukuvuna umnkantsha - Lokhu kuhlinzwa okuncane kwenziwa ngaphansi kwe-anesthesia ejwayelekile. Lokhu kusho ukuthi umnikeli uzobe elele futhi engenazinhlungu ngesikhathi senqubo. Umnkantsha wamathambo ususwa ngemuva kwawo womabili amathambo enqulu. Inani lomnkantsha osusiwe lincike kusisindo somuntu owamukelayo.
• Leukapheresis - Okokuqala, umnikeli unikezwa izinsuku ezimbalwa zokudutshulwa ukusiza amangqamuzana okunqanda ukusuka emnkantsheni wethambo aye egazini. Ngesikhathi se-leukapheresis, igazi liyasuswa kulowo onikelayo ngomugqa we-IV. Ingxenye yamaseli amhlophe egazi aqukethe ama-stem cells ahlukaniswa emshinini bese esuswa ukuze anikezwe umamukeli kamuva. Amaseli abomvu abuyiselwa kumnikeli.

Ukufakelwa komnkantsha ithatha indawo yomnkantsha ongasebenzi kahle noma oshonelwe (obhujisiwe) ngamakhemikhali noma ngemisebe. Odokotela bakholelwa ukuthi kumdlavuza omningi, amangqamuzana amhlophe egazi omnikeli angahlasela noma yimaphi amangqamuzana omdlavuza asele, afana nalapho amangqamuzana amhlophe ehlasela amabhaktheriya noma amagciwane lapho elwa nesifo.

Umhlinzeki wakho wezokunakekelwa kwempilo angancoma ukufakelwa umnkantsha wethambo uma une:

• Amanye umdlavuza, njenge-leukemia, i-lymphoma, i-myelodysplasia, noma i-myeloma eminingi.
• Isifo esithinta ukukhiqizwa kwamangqamuzana omnkantsha, njenge-aplastic anemia, i-congenital neutropenia, izifo ezinzima zesistimu yomzimba, i-sickle cell anemia, noma i-thalassemia.

Ukufakelwa komnkantsha wethambo kungadala lezi zimpawu ezilandelayo:

• Ubuhlungu besifuba
• Yehlisa umfutho wegazi
• Imfiva, amakhaza, ukugeleza
• Ukunambitheka okumnandi emlonyeni
• Ubuhlungu bekhanda
• Isifuba
• Isicanucanu
• Ubuhlungu
• Ukuphelelwa umoya

Izinkinga ezingenzeka zokufakelwa komnkantsha wethambo zixhomeke ezintweni eziningi, kufaka phakathi:

• Iminyaka yakho
• Impilo yakho iyonke
• Ubuhle bomdlalo obuphiwe ngumnikeli wakho
• Uhlobo lokufakelwa komnkantsha wamathambo owutholile (igazi le-autologous, allogeneic, noma umbilical cord)

Izinkinga zingafaka:

• Ukushoda kwegazi
• Ukopha emaphashini, emathunjini, ebuchosheni nakwezinye izindawo zomzimba
• Isifo senkwethu
• Ukuvala emithanjeni emincane yesibindi
• Ukulimala kwezinso, isibindi, amaphaphu, nenhliziyo
• Ukukhula okubambezelekile ezinganeni ezithola ukufakelwa umnkantsha wethambo
• Ukunqamuka kokuqala
• Ukwehluleka kokuxhunyelelwa, okusho ukuthi amaseli amasha awahlali emzimbeni bese eqala ukukhiqiza ama-stem cells
• Isifo se-Graft-versus-host (GVHD), isimo lapho amaseli anikelayo ehlasela umzimba wakho
• Ukutheleleka, okungaba kubi kakhulu
• Ukuvuvukala nobuhlungu emlonyeni, emphinjeni, emqaleni nasesiswini, okubizwa nge-mucositis
• Ubuhlungu
• Izinkinga zesisu, kubandakanya uhudo, isicanucanu nokuhlanza

Umhlinzeki wakho uzobuza ngomlando wakho wezokwelapha futhi enze ukuhlolwa komzimba. Uzoba nokuhlolwa okuningi ngaphambi kokuqala ukwelashwa.

Ngaphambi kokufakelwa kabusha, uzoba namashubhu ayi-1 noma ama-2, abizwa ngokuthi ama-catheters ama-venous central, afakwa emthanjeni wegazi entanyeni noma ezandleni zakho. Le tube ikuvumela ukuthi uthole ukwelashwa, uketshezi, futhi kwesinye isikhathi ukondleka. Iphinde isetshenziselwe ukudweba igazi.

Umhlinzeki wakho cishe uzoxoxa ngengcindezi engokomzwelo yokufakelwa umnkantsha wethambo. Ungahle uthande ukuhlangana nomeluleki. Kubalulekile ukuthi ukhulume nomndeni wakho nezingane ukuze ubasize baqonde okufanele bakulindele.

Uzodinga ukwenza izinhlelo zokukusiza ulungiselele inqubo futhi uphathe imisebenzi ngemuva kokufakelwa kwakho:

• Gcwalisa isiqondiso sokunakekelwa kusengaphambili
• Hlela ikhefu lezempilo emsebenzini
• Nakekela izitatimende zebhange noma ezezimali
• Hlela ukunakekelwa kwezilwane ezifuywayo
• Hlela umuntu ozosiza ngemisebenzi yasendlini
• Qinisekisa ukufakwa komshuwalense wezempilo
• Khokha izikweletu
• Hlela ukunakekelwa kwezingane zakho
• Zitholele indlu noma uzitholele umndeni wakho eduze kwesibhedlela, uma kudingeka

Ukufakelwa komnkantsha wethambo kuvame ukwenziwa esibhedlela noma esikhungweni sezokwelapha esikhethekile kulokho kulashwa. Isikhathi esiningi, uhlala endaweni ekhethekile yokufakelwa umnkantsha wethambo enkabeni. Lokhu ukunciphisa amathuba akho okuthola ukutheleleka.

Ngokuya ngokwelashwa nokuthi kwenziwa kuphi, konke noma ingxenye yokufakelwa kwe-autologous noma i-allogeneic kungenziwa njengesiguli esingalaliswayo. Lokhu kusho ukuthi akudingeki uhlale esibhedlela ubusuku bonke.

Ukuhlala kwakho isikhathi eside esibhedlela kuncike kulokhu:

• Noma ngabe uthuthukise noma yiziphi izinkinga ezihlobene nokufakelwa
• Uhlobo lokufakelwa kabusha
• Izinqubo zesikhungo sakho sezokwelapha

Ngenkathi usesibhedlela:

• Ithimba lezokunakekelwa kwezempilo lizobhekisisa ukubalwa kwegazi lakho kanye nezimpawu ezibalulekile.
• Uzothola imishanguzo yokuvikela i-GVHD futhi uvikele noma welaphe izifo, kufaka phakathi ama-antibiotics, ama-antifungal, nemithi elwa namagciwane.
• Cishe uzodinga ukumpontshelwa igazi okuningi.
• Uzondliwa ngomthambo (IV) uze ukwazi ukudla ngomlomo, futhi imiphumela emibi yesisu nezilonda zomlomo sezihambile.

Ngemuva kokuphuma esibhedlela, qiniseka ukuthi ulandela imiyalo yokuthi ungazinakekela kanjani ekhaya.

Wenza kahle kangakanani ngemuva kokufakelwa kabusha kuncike ku:

• Uhlobo lokufakelwa komnkantsha wethambo
• Amaseli omnikeli afana kanjani kahle nawe
• Unhloboni yomdlavuza noma ukugula onakho
• Iminyaka yakho nempilo yonke
• Uhlobo nesilinganiso se-chemotherapy noma i-radiation therapy owawunaso ngaphambi kokufakelwa kwakho
• Noma iziphi izinkinga ongahle ube nazo

Ukufakelwa komnkantsha kungakuphulukisa ngokuphelele ukugula kwakho. Uma ukufakelwa kabusha kuyimpumelelo, ungabuyela emuva emisebenzini yakho ejwayelekile ngokushesha lapho uzizwa usanele. Imvamisa kuthatha unyaka owodwa ukuthola kabusha ngokugcwele, kuya ngokuthi yiziphi izinkinga ezenzekayo.

Izinkinga noma ukwehluleka ukufakelwa umnkantsha wethambo kungaholela ekufeni.

Ukufakelwa kabusha - umnkantsha wethambo; Ukufakelwa kwe-stem cell; Ukufakelwa kabusha kwe-stem cell ye-hematopoietic; Ukunciphisa ukufakelwa okungekho emthethweni okuncishisiwe; Ukufakelwa okuncane; Ukufakelwa komnkantsha we-Allogenic; Ukufakelwa kabusha komnkantsha we-Autologous; Ukufakelwa kwegazi lentambo yombilical; I-aplastic anemia - ukufakelwa umnkantsha wethambo; I-leukemia - ukufakelwa umnkantsha wethambo; I-Lymphoma - ukufakelwa umnkantsha wethambo; Ukufakelwa komnkantsha we-myeloma amaningi

• Ukopha ngesikhathi sokwelashwa komdlavuza
• Ukufakelwa komnkantsha wethambo - ukukhipha
• I-catheter ye-venous emaphakathi - ushintsho lokugqoka
• Ipayipi le-venous emaphakathi - ukugeleza
• Ukuphuza amanzi ngokuphepha ngesikhathi sokwelashwa komdlavuza
• Umlomo owomile ngesikhathi sokwelashwa komdlavuza
• Ukudla ama-calories amaningi lapho ugula - abantu abadala
• Ukudla ama-calories amaningi lapho ugula - izingane
• I-Oral mucositis - ukuzinakekela
• I-catheter emaphakathi efakwe ngaphesheya - ukufutha
• Ukudla okuphephile ngesikhathi sokwelashwa komdlavuza

• Ukufiswa komnkantsha wethambo
• Izakhi ezakhiwe zegazi
• Umnkantsha wamathambo kusuka enqulwini
• Ukufakelwa komnkantsha wethambo - uchungechunge

Iwebhusayithi yeAmerican Society of Clinical Oncology. Kuyini ukufakelwa umnkantsha (stem cell transplant)? www.cancer.net/navigating-cancer-care/how-cancer-treated/bone-marrowstem-cell-transplantation/what-bone-marrow-transplant-stem-cell-transplant. Kubuyekezwe u-Agasti 2018. Kufinyelelwe ngoFebhuwari 13, 2020.

IHeslop HE. Ukubuka konke nokukhethwa komnikeli we-hematopoietic stem cell transplantation. Ku: Hoffman R, Benz EJ, Silberstein LE, et al, ama-eds. I-Hematology: Izimiso Eziyisisekelo Nokuzijwayeza. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2018: isahluko 103.

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.