Ukwelashwa Kwamanje Nokuqhamuka Kwe-CLL

-Delile

• Ukubuka konke
• Ukwelashwa kwe-CLL enobungozi obuphansi
• Ukwelashwa kwe-CLL ephakathi noma engcupheni enkulu
• I-Chemotherapy ne-immunotherapy
• Izindlela zokwelashwa ezihlosiwe
• Ukumpontshelwa igazi
• Imisebe
• Ukufakwa kwesitina kanye nomnkantsha wethambo
• Ukwelashwa okuphumelelayo
• Ukuhlanganiswa kwezidakamizwa
• Ukwelashwa kwe-CAR T-cell
• Ezinye izidakamizwa eziphenywayo
• Ukuthatha

Ukubuka konke

I-chronic lymphocytic leukemia (CLL) umdlavuza okhula kancane wamasosha omzimba. Ngoba ikhula kancane, abantu abaningi abane-CLL ngeke badinge ukuqala ukwelashwa iminyaka eminingi ngemuva kokutholakala kwabo.

Lapho umdlavuza uqala ukukhula, kunezindlela eziningi zokwelashwa ezitholakalayo ezingasiza abantu ukuthi bathole ukuxolelwa. Lokhu kusho ukuthi abantu bangathola isikhathi eside lapho kungekho sibonakaliso somdlavuza emzimbeni wabo.

Inketho yokwelashwa ozoyithola incike ezicini ezahlukahlukene. Lokhu kufaka ukuthi i-CLL yakho iyisifo noma cha, isigaba se-CLL esuselwa kwimiphumela yokuhlolwa kwegazi nokuhlolwa komzimba, nobudala bakho nempilo yonke.

Ngenkathi lungekho ikhambi le-CLL okwamanje, impumelelo emkhakheni iseduze.

Ukwelashwa kwe-CLL enobungozi obuphansi

Odokotela bajwayele ukubeka i-CLL besebenzisa uhlelo olubizwa ngeRai system. I-CLL enobungozi obuphansi ichaza abantu abawela "esigabeni 0" ngaphansi kohlelo lweRai.

Esigabeni 0, ama-lymph node, ubende, nesibindi akwandiswa. Ukubalwa kwamaseli abomvu egazi namaplatelet nakho kuseduze kokujwayelekile.

Uma une-CLL enobungozi obuncane, udokotela wakho (imvamisa udokotela wezifo zegazi noma i-oncologist) cishe uzokweluleka ukuthi "linda ubuke" izimpawu. Le ndlela ibizwa nangokuthi ukubhekwa okusebenzayo.

Umuntu onengozi engaphansi kwe-CLL kungenzeka angadingi ukwelashwa okuqhubekayo iminyaka eminingi. Abanye abantu abasoze badinga ukwelashwa. Usazodinga ukubona udokotela ukuze azihlole njalo futhi ahlolwe ilebhu.

Ukwelashwa kwe-CLL ephakathi noma engcupheni enkulu

ICLL esezingeni eliphakathi ichaza abantu abanesigaba 1 kuya esigabeni 2 CLL, ngokohlelo lweRai. Abantu abanesigaba 1 noma 2 CLL bakhulise ama-lymph node futhi kungenzeka babe nobende obukhulisiwe nesibindi, kepha eduze kwesibalo segazi elibomvu elijwayelekile nokubalwa kweplatelet.

I-CLL enobungozi obukhulu ichaza iziguli ezinesigaba 3 noma umdlavuza wesigaba 4. Lokhu kusho ukuthi ungaba nesipelula esandisiwe, isibindi noma ama-lymph node. Ukubalwa kwamaseli abomvu abomvu nakho kuvamile. Esigabeni esiphezulu kakhulu, ukubalwa kwama-platelet nakho kuzoba phansi.

Uma une-CLL ephakathi noma engcupheni enkulu, udokotela wakho kungenzeka ancoma ukuthi uqale ukwelashwa khona manjalo.

I-Chemotherapy ne-immunotherapy

Esikhathini esedlule, ukwelashwa okujwayelekile kwe-CLL kufaka phakathi inhlanganisela yamakhemikhali kanye nama-immunotherapy agents, njenge:

• i-fludarabine ne-cyclophosphamide (FC)
• I-FC kanye ne-antibody immunotherapy eyaziwa njenge-rituximab (Rituxan) yabantu abangaphansi kweminyaka engama-65
• i-bendamustine (iTreanda) kanye ne-rituximab yabantu abadala kunama-65
• i-chemotherapy ihlangene namanye ama-immunotherapies, njenge-alemtuzumab (Campath), obinutuzumab (Gazyva), ne-ofatumumab (Arzerra). Lezi zinketho zingasetshenziswa uma umjikelezo wokuqala wokwelashwa ungasebenzi.

Izindlela zokwelashwa ezihlosiwe

Eminyakeni embalwa edlule, ukuqonda kangcono i-biology ye-CLL kuye kwaholela ekwelashweni okuqondiswe kakhulu. Le mithi ibizwa ngokuthi yimithi eqondisiwe ngoba iqondiswe kumaprotheni athile asiza amangqamuzana e-CLL ukuba akhule.

Izibonelo zezidakamizwa ezihlosiwe ze-CLL zifaka:

• ibrutinib (Imbruvica): ihlose i-enzyme eyaziwa njenge-Bruton's tyrosine kinase, noma i-BTK, ebaluleke kakhulu ekusindeni kwe-CLL cell
• venetoclax (Venclexta): ihlose iphrotheni ye-BCL2, iphrotheni ebonwa ku-CLL
• i-idelalisib (i-Zydelig): ivimba iprotheni ye-kinase eyaziwa njenge-PI3K futhi isetshenziselwa i-CLL ebuyile
• i-duvelisib (iCopiktra): ibuye ihlose i-PI3K, kepha isetshenziswa kuphela ngemuva kokuthi ezinye izindlela zokwelashwa zehluleke
• i-acalabrutinib (i-Calquence): enye i-BTK inhibitor evunyelwe ngasekupheleni kwe-2019 ye-CLL
• venetoclax (Venclexta) ngokuhlangana ne-obinutuzumab (Gazyva)

Ukumpontshelwa igazi

Ungadinga ukuthola ukumpontshelwa igazi ngemithambo (IV) ukukhulisa ukubalwa kwamaseli egazi.

Imisebe

Ukwelashwa ngemisebe kusebenzisa izinhlayiya zamandla aphezulu noma amagagasi ukusiza ukubulala amangqamuzana omdlavuza nokunciphisa ama-lymph node akhulisiwe abuhlungu. Ukwelashwa ngemisebe kuyaqabukela kusetshenziswe ekwelashweni kwe-CLL.

Ukufakwa kwesitina kanye nomnkantsha wethambo

Udokotela wakho angancoma ukufakelwa kwe-stem cell uma umdlavuza wakho ungaphenduli kwezinye izindlela zokwelashwa. Ukufakelwa kwe-stem cell kukuvumela ukuthi uthole amanani aphakeme we-chemotherapy ukubulala amangqamuzana omdlavuza amaningi.

Ukweqiwa okuphezulu kwe-chemotherapy kungadala umonakalo emnkantsheni wakho wethambo. Ukushintsha la maseli, uzodinga ukuthola amaseli ama-stem angeziwe noma umnkantsha wethambo kusuka kumnikeli onempilo.

Ukwelashwa okuphumelelayo

Izindlela eziningi zisaphenywa zokwelapha abantu abane-CLL. Ezinye zisanda kuvunywa yi-Food and Drug Administration (FDA).

Ukuhlanganiswa kwezidakamizwa

NgoMeyi 2019, i-FDA ivume i-venetoclax (Venclexta) ihlangene ne-obinutuzumab (Gazyva) yokwelapha abantu abane-CLL ebingakalashwa ngaphambilini njengenketho engenamakhemikhali.

Ngo-Agasti 2019, abacwaningi bashicilela imiphumela yocwaningo lomtholampilo weSigaba III ekhombisa ukuthi inhlanganisela ye-rituximab ne-ibrutinib (Imbruvica) igcina abantu bengenazo izifo isikhathi eside kunaleso samanje sokunakekelwa.

Lezi zinhlanganisela zenza kube lula ukuthi abantu bakwazi ukukwenza ngaphandle kwe-chemotherapy ngokuphelele ngokuzayo. Imithi yokwelashwa engeyona eye-chemotherapy ibalulekile kulabo abangakwazi ukubekezelela imiphumela emibi ehlobene ne-chemotherapy.

Ukwelashwa kwe-CAR T-cell

Enye yezinketho ezethembisayo zokwelashwa zesikhathi esizayo ze-CLL ukwelashwa kwe-CAR T-cell. I-CAR T, emele ukwelashwa kwe-chimeric antigen receptor T-cell, isebenzisa amaseli omzimba omuntu ukulwa nomdlavuza.

Le nqubo ifaka phakathi ukukhipha nokuguqula amaseli omzimba womuntu ukuze abone kangcono futhi abhubhise amangqamuzana omdlavuza. Amaseli abese ebuyiselwa emzimbeni ukuze ande futhi alwe nomdlavuza.

Ukwelashwa kwe-CAR T-cell kuyathembisa, kepha kunezingozi. Ingozi eyodwa yisimo esibizwa nge-cytokine release syndrome. Le yimpendulo yokuvuvukala ebangelwa ama-CAR T-cell afakiwe. Abanye abantu bangathola ukusabela okunzima okungaholela ekufeni uma kungenakwelashwa ngokushesha.

Ezinye izidakamizwa eziphenywayo

Ezinye izidakamizwa ezibhekiswe njengamanje ezihlolisiswa ekuhlolweni kwemitholampilo ye-CLL zifaka:

• I-zanubrutinib (BGB-3111)
• i-entospletinib (GS-9973)
• tirabrutinib (ONO-4059 noma i-GS-4059)
• i-umbralisib (TGR-1202)
• I-cirmtuzumab (UC-961)
• i-ublituximab (TG-1101)
• i-pembrolizumab (Keytruda)
• i-nivolumab (Opdivo)

Lapho nje izivivinyo zokwelashwa seziqediwe, eminye yale mithi ingavunyelwa ukwelapha i-CLL. Khuluma nodokotela wakho ngokujoyina isilingo somtholampilo, ikakhulukazi uma izinketho zokwelashwa zamanje zingakusebenzeli.

Izilingo zomtholampilo zihlola ukusebenza kwemithi emisha kanye nokuhlanganiswa kwemithi esivele ivunyelwe. Lezi zindlela zokwelashwa ezintsha zingakusebenzela kangcono kunalezo ezitholakalayo njengamanje. Okwamanje kunamakhulu ezivivinyo zomtholampilo eziqhubekayo ze-CLL.

Ukuthatha

Abantu abaningi abatholakala ukuthi bane-CLL empeleni ngeke badinge ukuqala ukwelashwa khona manjalo. Lapho lesi sifo siqala ukuthuthuka, unezinketho eziningi zokwelashwa ezitholakalayo. Kukhona nohlu olubanzi lwezivivinyo zomtholampilo ongakhetha kuzo eziphenya izindlela ezintsha zokwelapha kanye nezinhlanganisela zokwelapha.