I-Acute Myeloid Leukemia (AML): kuyini, izimpawu nokwelashwa

-Delile

• Izimpawu eziyinhloko
• Ukuxilongwa nokuhlukaniswa
• Yelashwa kanjani
• 1. Ukwelashwa ngamakhemikhali
• 2. I-Radiotherapy
• 3. Ukufakelwa umnkantsha wethambo
• 4. Ukwelashwa okuhlosiwe kanye nokwelashwa komzimba
• 5. Ukwelashwa kofuzo lwe-Car T-Cell

I-Acute myeloid leukemia, eyaziwa nangokuthi i-AML, uhlobo lomdlavuza oluthinta amangqamuzana egazi futhi luqala emnkantsheni wethambo, okuyilungu elibhekele ukukhiqizwa kwamangqamuzana egazi. Lolu hlobo lomdlavuza lunethuba elikhulu lokwelashwa lapho lutholakala esigabeni sokuqala, lapho ingekho imastastasis futhi idala izimpawu ezifana nokwehla kwesisindo nokuvuvukala kwezilimi nesisu, ngokwesibonelo.

I-acute myeloid leukemia yanda ngokushesha okukhulu futhi ingenzeka kubantu bayo yonke iminyaka, noma kunjalo ivame kakhulu kubantu abadala, njengoba amangqamuzana omdlavuza ehlangana emnkantsheni wethambo futhi adedelwa angene egazini, lapho athunyelwa kwezinye izitho., Njengesibindi , ubende noma uhlelo oluphakathi lwezinzwa, lapho ziqhubeka zikhula futhi zikhula khona.

Ukwelashwa kwe-acute myeloid leukemia kungenziwa esibhedlela somdlavuza futhi kuba namandla kakhulu ezinyangeni ezimbili zokuqala, futhi okungenani unyaka owodwa wokwelashwa uyadingeka ukuze lesi sifo silapheke.

Izimpawu eziyinhloko

Izimpawu ezivame kakhulu ze-acute myeloid leukemia zifaka:

• I-anemia, ebonakala ngokuncipha kwenani le-hemoglobin;
• Ukuzwa ubuthakathaka nokugula okuvamile;
• I-Pallor nekhanda elibangelwa i-anemia;
• Ukopha njalo okubonakala ukopha ngamakhala okulula nokuya esikhathini;
• Ukutholakala kwemivimbo emikhulu ngisho nangemivimbo emincane;
• Ukwehla kwesifiso sokudla nokuncipha ngaphandle kwesizathu esisobala;
• Izilimi ezivuvukele nezibuhlungu, ikakhulukazi entanyeni nasemgodini;
• Ukutheleleka njalo;
• Ubuhlungu emathanjeni nasemalungeni;
• Imfiva;
• Ukuphefumula kanye nokukhwehlela;
• Umjuluko wasebusuku wehaba, okumanzisa izingubo zakho;
• Ukungakhululeki esiswini okubangelwa ukuvuvukala kwesibindi nobende.

I-Acute myeloid leukemia wuhlobo lomdlavuza wegazi ovame ukuthinta abantu abadala futhi ukuxilongwa kwawo kungenziwa ngemuva kokuhlolwa kwegazi, ukubhoboza i-lumbar kanye ne-bone marrow biopsy.

Ukuxilongwa nokuhlukaniswa

Ukuxilongwa kwe-acute myeloid leukemia kusekelwe ezincwadini ezethulwe ngumuntu kanye nemiphumela yezivivinyo, ezinjengokubalwa kwegazi, ukuhlaziywa komnkantsha kanye nokuhlolwa kwamangqamuzana kanye nokuzivikela komzimba. Ngokubala kwegazi, kungenzeka ukubona ukwehla kwenani lamaseli amhlophe egazi, ubukhona bokujikeleza kwamaseli amhlophe angavuthiwe kanye nenani eliphansi lamaseli abomvu nama-platelets. Ukuqinisekisa ukuxilongwa, kubalulekile ukuthi kwenziwe i-myelogram, lapho yenziwa khona ngokubhoboza nokuqoqa isampula lomnkantsha, elihlaziywa elabhoratri. Qonda ukuthi i-myelogram yenziwa kanjani.

Ukuhlonza uhlobo lwe-acute myeloid leukemia, kubalulekile ukuthi kwenziwe ukuhlolwa kwamangqamuzana kanye ne-immunohistochemical ukuthola izici zamaseli atholakala egazini okuyisici sesifo, lolu lwazi lubalulekile ukucacisa ukubikezelwa kwalesi sifo kanye udokotela ukukhombisa ukwelashwa okufanele kakhulu.

Lapho uhlobo lwe-AML selutholakele, udokotela anganquma ukubikezela futhi abeke amathuba okwelashwa. I-AML ingahlukaniswa ngama-subtypes athile, okuyi:

Yelashwa kanjani

Ukwelashwa kwe-acute myeloid leukemia (AML) kudinga ukukhonjiswa yi-oncologist noma i-hematologist futhi kungenziwa ngamasu amaningi, njenge-chemotherapy, imithi noma ukufakelwa umnkantsha wethambo:

1. Ukwelashwa ngamakhemikhali

Ukwelashwa kwe-acute myeloid leukemia kuqala ngohlobo lwe-chemotherapy olubizwa nge-induction, oluhlose ukuthethelelwa komdlavuza, lokhu kusho ukunciphisa amaseli agulayo aze angatholakali ekuhlolweni kwegazi noma ku-myelogram, okuwukuhlolwa kwegazi eliqoqiwe ngqo kusuka emnkantsheni wethambo.

Lolu hlobo lokwelashwa lukhonjiswa yi-hematologist, lwenziwa emtholampilo wabangalaliswa esibhedlela futhi lwenziwa ngokusebenzisa imishanguzo ngqo emthanjeni, ngokusebenzisa ipayipi elibekwe ohlangothini lwesokunene sesifuba olubizwa nge-port-a-cath noma ngokungena emthanjeni wengalo.

Ezimweni eziningi ze-acute myeloid leukemia, udokotela uncoma ukuthi umuntu athole isethi yemithi ehlukahlukene, ebizwa ngokuthi izivumelwano, ezisuselwa kakhulu ekusetshenzisweni kwemithi efana ne-cytarabine ne-idarubicin, isibonelo. Lezi zinqubo zenziwa ngezigaba, nezinsuku zokwelashwa okunamandla nezinsuku ezimbalwa zokuphumula, ezivumela umzimba womuntu ukuthi ululame, futhi nenani lezikhathi okufanele zenziwe kuncike ebukhali be-AML.

Eminye yemithi ejwayelekile yokwelapha lolu hlobo lwe-leukemia, kungaba:

Udokotela futhi angancoma ukusetshenziswa kwama-corticosteroids, njenge-prednisone noma i-dexamethasone, njengengxenye yenqubo yokwelashwa ye-acute myeloid leukemia. Olunye ucwaningo luyenziwa ukuze kusetshenziswe imishanguzo emisha efana ne-capecitabine, lomustine ne-guadecitabine ukwelapha lesi sifo.

Ngaphezu kwalokho, ngemuva kokuxolelwa kwalesi sifo ngamakhemikhali, udokotela angakhombisa izinhlobo ezintsha zokwelashwa, ezibizwa ngokuthi ukuhlanganiswa, okusebenzela ukuqinisekisa ukuthi amangqamuzana omdlavuza asusiwe wonke emzimbeni. Lokhu kuhlanganiswa kungenziwa ngokusebenzisa i-chemotherapy ephezulu kanye nokufakelwa komnkantsha wamathambo.

Ukwelashwa kwe-acute myeloid leukemia nge-chemotherapy kunciphisa inani lamaseli amhlophe egazini, okungamaseli omzimba okuvikela, futhi umuntu unamasosha omzimba aphansi, okwenza ukuthi angenwe kalula yizifo. Ngakho-ke, kwezinye izimo, umuntu udinga ukungeniswa esibhedlela ngesikhathi sokwelashwa futhi udinga ukusebenzisa ama-antibiotic, ama-antivirals kanye nama-antifungals ukuvimbela ukuvela kwezifo. Futhi nokho, kujwayelekile ukuthi ezinye izimpawu zivele, njengokulahleka kwezinwele, ukuvuvukala komzimba nesikhumba esinamabala. Funda ngeminye imiphumela emibi ye-chemotherapy.

2. I-Radiotherapy

I-Radiotherapy wuhlobo lokwelashwa olusebenzisa umshini okhipha imisebe emzimbeni ukubulala amangqamuzana omdlavuza, noma kunjalo, le ndlela yokwelapha ayisetshenziselwa kabanzi i-acute myeloid leukemia futhi isetshenziswa kuphela ezimweni lapho isifo sesisabalalele kwezinye izitho, njenge ubuchopho nama-testis, okufanele kusetshenziswe ngaphambi kokufakwa komnkantsha wethambo noma ukuqeda izinhlungu endaweni yethambo ehlaselwe yi-leukemia.

Ngaphambi kokuqala amaseshini e-radiotherapy, udokotela wenza uhlelo, ebheka izithombe ze-computed tomography ukuze indawo ngqo lapho imisebe kufanele ifinyelelwe khona emzimbeni ichazwe bese kuthi, ukumakwa kwenziwa esikhumbeni, ngepeni elithile, ukukhombisa isikhundla esifanele emshinini we-radiotherapy nokuthi zonke izikhathi zihlale zisendaweni emakiwe.

Njenge-chemotherapy, lolu hlobo lwezokwelapha lungaholela nasemiphumeleni emibi, njengokukhathala, ukungathandi ukudla, isicanucanu, umphimbo obuhlungu nokuguquka kwesikhumba okufana nokushiswa yilanga. Funda kabanzi ngokunakekelwa okufanele kuthathwe ngesikhathi se-radiotherapy.

3. Ukufakelwa umnkantsha wethambo

Ukufakelwa komnkantsha wethambo wuhlobo lokumpontshelwa igazi okwenziwa ngamaseli we-hematopoietic stem athathwe ngqo emnkantsheni wethambo lomnikeli ohambisanayo, kungaba ngokuhlinzwa kwegazi kusuka enqulwini noma nge-apheresis, okuwumshini ohlukanisa amangqamuzana egazi nge ipayipi lomthambo emthanjeni.

Lolu hlobo lokufakelwa luvame ukwenziwa ngemuva kokuba kwenziwe imithamo ephezulu yokwelashwa ngamakhemikhali noma ngemisebe ye-radiotherapy futhi kuphela ngemuva kokuthi amangqamuzana omdlavuza engatholakali ezivivinyweni. Kunezinhlobo eziningana zokufakelwa, njenge-autologous kanye ne-allogeneic, futhi inkomba yenziwa ngudokotela wezifo zegazi ngokuya ngezimpawu ze-acute myeloid leukemia yomuntu. Bona okuningi mayelana nokuthi ukufakelwa umnkantsha wethambo kwenziwa kanjani nezinhlobo ezahlukene.

4. Ukwelashwa okuhlosiwe kanye nokwelashwa komzimba

Ukwelashwa okuhlosiwe uhlobo lokwelashwa olusebenzisa imishanguzo ehlasela amangqamuzana aphethwe yi-leukemia ngezinguquko ezithile zofuzo, okudala imiphumela emibi embalwa kunekhemotherapy. Eminye yale mithi esetshenzisiwe yile:

• Ama-inhibitors e-FLT3: kuboniswe kubantu abane-acute myeloid leukemia ngokuguquka kwesakhi sofuzoI-FLT3 kanti eminye yale mithi i-midostaurin ne-gilteritinib, ayikavunyelwa ukusetshenziswa eBrazil;
• Ama-HDI inhibitors: kunconywe ngudokotela ukuthi isetshenziswe kubantu abane-leukemia nge-gene mutationIDH1 nomaIDH2, lokho kuvimbela ukuvuthwa okufanele kwamangqamuzana egazi. Ama-HDI inhibitors, njenge-enasidenib ne-ivosidenib, angasiza amangqamuzana e-leukemia avuthwe abe amaseli egazi ajwayelekile.

Ngaphezu kwalokho, ezinye izidakamizwa ezisebenza kuzakhi zofuzo ezithile ziyasetshenziswa njengama-inhibitors ohlobo lwe-BCL-2, njenge-venetoclax, ngokwesibonelo. Kodwa-ke, eminye imishanguzo yesimanje esekwe ekusizeni amasosha omzimba ukulwa namaseli we-leukemia, aziwa nge-immunotherapy, nawo anconywa kakhulu ngabadokotela begazi.

Ama-antibody e-monoclonal yimithi ye-immunotherapy eyenziwe njengamaprotheni wesistimu yomzimba esebenza ngokuzihlanganisa nodonga lwamaseli e-AML bese ewachitha. Imithi ye-gemtuzumab lolu hlobo lwemithi olunconywa kakhulu odokotela ukwelapha lolu hlobo lwe-leukemia.

5. Ukwelashwa kofuzo lwe-Car T-Cell

Ukwelashwa kwe-Gene usebenzisa inqubo yeCar T-Cell kuyindlela yokwelashwa kubantu abane-acute myeloid leukemia equkethe ukususa amaseli kumasosha omzimba, aziwa ngokuthi ama-T cell, emzimbeni womuntu bese ewathumela elebhu. Egumbini lokucwaninga, lawa maseli ayalungiswa futhi izinto ezibizwa ngama-CAR ziyethulwa ukuze zikwazi ukuhlasela amangqamuzana omdlavuza.

Ngemuva kokwelashwa elabhorethri, amangqamuzana e-T afakwa kumuntu one-leukemia ukuze, aguqulwe, abulale amangqamuzana agula ngumdlavuza. Lolu hlobo lwezokwelapha lusacwaningwa futhi alutholakali yi-SUS. Bheka okuningi mayelana nokuthi ukwelashwa kweCar T-Cell kwenziwa kanjani nokuthi yini engalashwa.

Bona futhi ividiyo yokuthi ungayiqeda kanjani imiphumela yokwelashwa komdlavuza: