Ingabe Sisondele Ekwelapheni I-Leukemia Engamahlalakhona YeLymphocytic?

-Delile

• I-Immunotherapy iletha ukuthethelelwa okude
• Ukwelashwa kwe-CAR T-cell
• Izidakamizwa ezintsha ezihlosiwe
• Ukufakelwa kwe-stem cell
• Ukudla okudlela endlini

I-lymphocytic leukemia engapheli (CLL)

I-lymphocytic leukemia (CLL) engapheli ngumdlavuza wamasosha omzimba. Luhlobo lwe-non-Hodgkin lymphoma oluqala ekutheleleni komzimba ukulwa namaseli amhlophe egazi, abizwa ngama-B cells. Lo mdlavuza ukhiqiza amangqamuzana amaningi egazi amhlophe angajwayelekile emnkantsheni wegazi kanye negazi elingakwazi ukulwa nokutheleleka.

Ngoba i-CLL ingumdlavuza okhula kancane, abanye abantu ngeke badinge ukuqala ukwelashwa iminyaka eminingi. Kubantu abanomdlavuza osakazekayo, izindlela zokwelashwa zingabasiza ukuthi bafinyelele esikhathini eside lapho kungekho sibonakaliso somdlavuza emzimbeni wabo. Lokhu kubizwa ngokuthi yi-remission. Kuze kube manje, asikho isidakamizwa noma olunye ukwelashwa esikwazile ukwelapha i-CLL.

Inselelo eyodwa ukuthi inani elincane lamangqamuzana omdlavuza avame ukuhlala emzimbeni ngemuva kokwelashwa. Lokhu kubizwa ngokuthi yisifo esincane esisele (MRD). Ukwelashwa okwelapha i-CLL kuzofanele kusule wonke amangqamuzana omdlavuza futhi kuvimbele umdlavuza ukuthi ungaphinde ubuye noma ubuyele emuva.

Ukuhlanganiswa okusha kwe-chemotherapy kanye ne-immunotherapy sekuvele kusize abantu abane-CLL ukuthi baphile isikhathi eside ekuxolelweni. Ithemba ukuthi eyodwa noma ngaphezulu yemithi emisha ekwakhiweni inganikeza ikhambi abacwaningi nabantu abane-CLL abebenethemba lokulithola.

I-Immunotherapy iletha ukuthethelelwa okude

Ngaphambi kweminyaka embalwa edlule, abantu abane-CLL babengenazo izinketho zokwelashwa ngaphandle kwamakhemikhali. Ngemuva kwalokho, ukwelashwa okusha okufana ne-immunotherapy kanye nokwelashwa okuhlosiwe kwaqala ukuguqula umbono futhi kwandise kakhulu izikhathi zokusinda kubantu abanalo mdlavuza.

I-Immunotherapy yimithi esiza amasosha omzimba wakho ukuthola nokubulala amangqamuzana omdlavuza. Abaphenyi bebelokhu bezama inhlanganisela entsha ye-chemotherapy kanye ne-immunotherapy esebenza kangcono kunokwelapha okunye kuphela.

Ezinye zalezi zinhlanganisela - njengeCCR - zisiza abantu ukuthi baphile ngaphandle kwezifo isikhathi eside kakhulu kunakuqala. I-FCR iyinhlanganisela yemithi yokwelapha ngamakhemikhali i-fludarabine (Fludara) ne-cyclophosphamide (i-Cytoxan), kanye ne-monoclonal antibody rituximab (Rituxan).

Kuze kube manje, kubonakala kusebenza kangcono kubantu abasha, abanempilo enokuguquka kwezakhi zofuzo ze-IGHV. Kubantu abangama-300 abane-CLL nokuguquka kwezakhi zofuzo, abangaphezu kwengxenye basinda iminyaka engu-13 bengenazifo ku-FCR.

Ukwelashwa kwe-CAR T-cell

Ukwelashwa kwe-CAR T-cell luhlobo olukhethekile lokwelashwa kwamagciwane okusebenzisa amaseli akho omzimba aguquliwe ukulwa nomdlavuza.

Okokuqala, amaseli omzimba abizwa ngama-T cell aqoqwa egazini lakho. Lawo maseli we-T aguqulwa ngokwezakhi zofuzo ebhodini ukukhiqiza ama-chimeric antigen receptors (ama-CAR) - ama-receptors akhethekile abopha amaprotheni ebusweni bamangqamuzana omdlavuza.

Lapho amangqamuzana e-T aguquliwe abuyiselwa emzimbeni wakho, afuna futhi aqede amangqamuzana omdlavuza.

Njengamanje, ukwelashwa kwe-CAR T-cell kuvunyelwe ezinye izinhlobo ezimbalwa ze-non-Hodgkin lymphoma, kepha hhayi i-CLL. Le ndlela yokwelashwa ifundelwa ukubona ukuthi ingaveza yini ukukhishwa okude noma ikhambi le-CLL.

Izidakamizwa ezintsha ezihlosiwe

Izidakamizwa ezihlosiwe njenge-idelalisib (Zydelig), ibrutinib (Imbruvica), ne-venetoclax (Venclexta) zilandela izinto ezisiza amangqamuzana omdlavuza ukuba akhule futhi aphile. Noma le mishanguzo ingeke iselule lesi sifo, ingasiza abantu ukuthi baphile isikhathi eside kakhulu ekuxolelweni.

Ukufakelwa kwe-stem cell

Ukufakelwa kabusha kwe-allogenic stem cell njengamanje kuwukuphela kokwelapha okunikeza ukuthi kungenzeka kube ikhambi le-CLL. Ngalokhu kwelashwa, uthola imithamo ephezulu kakhulu yokwelashwa ngamakhemikhali ukubulala amangqamuzana omdlavuza amaningi ngangokunokwenzeka.

I-Chemo ibuye ibhubhise amaseli enempilo akha igazi emnkantsheni wakho wethambo. Ngemuva kwalokho, uthola ukufakelwa kwamaseli ama-stem kusuka kumnikeli onempilo ukugcwalisa amaseli abhujisiwe.

Inkinga yokufakelwa kwe-stem cell yingozi. Amaseli abanikeli angahlasela amaseli akho aphilile. Lesi yisimo esibi esibizwa ngokuthi yi-graft-versus-host disease.

Ukufakelwa futhi kwandisa ingozi yokutheleleka. Futhi, ayisebenzi kuwo wonke umuntu one-CLL. Ukufakwa kwama-stem cell kuthuthukisa ukusinda okungenazifo isikhathi eside kubantu abangamaphesenti angama-40 abawatholayo.

Ukudla okudlela endlini

Kusukela manje, alukho umuthi ongalapha i-CLL. Okuseduze kakhulu ekwelapheni ukufakelwa kwe-stem cell, okuyingozi futhi okusiza kuphela abanye abantu ukuba baphile isikhathi eside.

Ukwelashwa okusha entuthukweni kungashintsha ikusasa kubantu abane-CLL. Ama-immunotherapies neminye imishanguzo emisha isivele isandisa ukusinda. Esikhathini esizayo esiseduze, izinhlanganisela ezintsha zemithi zingasiza abantu ukuthi baphile isikhathi eside.

Ithemba ukuthi ngelinye ilanga, imishanguzo izosebenza ngendlela yokuthi abantu bazokwazi ukuyeka ukuphuza imishanguzo yabo baphile impilo ephelele, engenawo umdlavuza. Uma lokho kwenzeka, abacwaningi ekugcineni bazokwazi ukusho ukuthi bayiphulukisile i-CLL.