Ukutsalwa komongo wethambo

Ukufakelwa komongo wethambo yinkqubo yokutshintsha umongo wethambo owonakeleyo okanye owonakalisiweyo ngeeseli zomongo wethambo.

Umongo wethambo sisithambo esithambileyo esinamafutha ngaphakathi kwamathambo akho. Umongo wethambo uvelisa iiseli zegazi. Iiseli zesinti ziiseli ezingakhuliyo kumongo wethambo obangela ukuba zonke iiseli zakho zegazi zahluke.

Ngaphambi kokufakelwa, i-chemotherapy, i-radiation, okanye zombini inokunikwa. Oku kunokwenziwa ngeendlela ezimbini:

• Unyango lwe-Ablative (myeloablative )- I-high-dose chemotherapy, i-radiation, okanye zombini zinikezelwa ukubulala nayiphi na iiseli zomhlaza. Oku kubulala wonke umongo wethambo oseleyo, kwaye ivumela iiseli ezintsha zokukhula kumongo wethambo.
• Unyango oluncitshisiweyo lokuqina, lukwabizwa ngokuba kukufakelwa okuncinci - Iidosi ezisezantsi zekhemotherapy kunye nemitha zinikezelwa ngaphambi kokufakelwa. Oku kuvumela abantu abadala, kwaye abo banezinye iingxaki zempilo ukuba bafakelwe.

Zintathu iintlobo zokufakelwa komongo wethambo:

• Ukufakelwa komongo wethambo u-Autologous Igama elithi auto lithetha ukuzimela. Iiseli zeziqu ziyasuswa kuwe ngaphambi kokuba ufumane unyango lweedosi ephezulu okanye unyango ngemitha. Iiseli zeziqu zigcinwe kwisikhenkcezisi. Emva konyango lweedosi ephezulu okanye unyango ngemitha, iiseli zakho ezibunjiweyo zibuyiselwa emzimbeni wakho ukwenza iiseli eziqhelekileyo zegazi. Oku kubizwa ngokuba kukuhlangulwa ngokutsha.
• Utshintsho lomongo wethambo allogeneic Igama elithi allo lithetha enye. Iiseli zeziqu ziyasuswa komnye umntu, obizwa ngokuba ngumnikeli. Amaxesha amaninzi, ufuzo lomnikeli kufuneka ngokuyinxenye ludibanise nemfuza yakho. Kwenziwa iimvavanyo ezizodwa ukujonga ukuba ngaba umnikeli ngumdlalo ofanelekileyo kuwe. Umzalwana okanye udade kunokwenzeka ukuba abe ngumdlalo ofanelekileyo. Ngamanye amaxesha abazali, abantwana kunye nezinye izalamane ziyimidlalo efanelekileyo. Abanikeli abangazalaniyo nawe, kodwa besadibana, banokufunyanwa kubhaliso lomongo wethambo kuzwelonke.
• Intambo yokufakelwa kwegazi embilical - Olu luhlobo lokufakelwa kwe-allogeneic. Iiseli zeziqu ziyasuswa kwimbambo yomntwana olusandul 'ukuzalwa kanye emva kokuzalwa. Iiseli zeziqu zifriziwe kwaye zigcinwa de zifuneke ukufakelwa. Iiseli zegazi ze-Umbilical zegazi azikhuli kakhulu ngenxa yoko akukho sidingo sincinci sokudibana ngokugqibeleleyo. Ngenxa yenani elincinci leeseli zeziqu, ukubalwa kwegazi kuthatha ixesha elide ukufumana kwakhona.

Ukufakelwa kwe-stem cell kudla ngokwenziwa emva kokuba i-chemotherapy kunye ne-radiation igqityiwe. Iiseli zeziqu zinikezelwa kwigazi lakho, zihlala zityhubhu ebizwa ngokuba yicatheter esembindini yemithambo. Inkqubo iyafana nokufumana igazi. Iiseli zeziqu zihamba ngegazi ukuya kumongo wethambo. Amaxesha amaninzi, akukho tyando lufunekayo.

Iiseli zeziqu zabanikeli zinokuqokelelwa ngeendlela ezimbini:

• Ukuvunwa komongo wethambo - Olu tyando luncinci lwenziwa phantsi kweanesthesia ngokubanzi. Oku kuthetha ukuba umnikeli uya kuba elele kwaye engenazintlungu ngexesha lenkqubo. Umongo wethambo uyasuswa ngasemva kwawo omabini amathambo esinqe. Ubungakanani bomongo osuswe buxhomekeke kubunzima bomntu owamkelayo.
• Leukapheresis - Okokuqala, umnikeli unikwa iintsuku ezininzi zokudubula ukuze ancede ukuhambisa iiseli zisuka kumongo wethambo uye egazini. Ngexesha leukapheresis, igazi liyasuswa kulowo unikeleyo ngokusebenzisa umgca we-IV. Inxalenye yeeseli ezimhlophe zegazi eziqulethe iiseli zeziqu emva koko zahlulwa kumatshini zisuswe ukuze kamva zinikwe ummkeli. Iiseli ezibomvu zegazi zibuyiselwa kumnikeli.

Ukufakelwa komongo wethambo kuthathe indawo yomongo wethambo ongasebenzi kakuhle okanye otshabalalisiweyo (otshisiweyo) yichemotherapy okanye yimitha. Oogqirha bakholelwa ukuba kumhlaza omninzi, iiseli ezimhlophe zegazi lomnikeli zinokuhlasela naziphi na iiseli zomhlaza ezisele, ezifanayo naxa iiseli ezimhlophe zihlasela iintsholongwane okanye intsholongwane xa kusilwa usulelo.

Umboneleli wakho wezempilo unokucebisa ukufakelwa komongo wethambo ukuba unayo:

• Eminye imihlaza, njenge-leukemia, i-lymphoma, i-myelodysplasia, okanye i-myeloma eninzi.
• Isifo esichaphazela ukuveliswa kweeseli zomongo wethambo, ezinje nge-aplastic anemia, i-congenital neutropenia, izifo ezomeleleyo zomzimba, i-sickle cell anemia, okanye i-thalassemia.

Ukufakelwa komongo wethambo kunokubangela ezi mpawu zilandelayo:

• Iintlungu zesifuba
• Yehla kuxinzelelo lwegazi
• Umkhuhlane, ukubanda, ukugungxula
• Incasa emnandi emlonyeni
• Intloko ebuhlungu
• Imihlathi
• Isicaphucaphu
• Intlungu
• Ukuqhawukelwa ngumphefumlo

Iingxaki ezinokwenzeka zokutsalwa komongo wethambo zixhomekeka kwizinto ezininzi, kubandakanya:

• Iminyaka yakho
• Impilo yakho iyonke
• Wawulunge kangakanani umdlalo owawunikelwe ngumnikeli wakho
• Uhlobo lokufakelwa komongo wethambo olufumene (i-autologous, allogeneic, okanye umbilical cord yegazi)

Iingxaki zinokubandakanya:

• Ukunqongophala kwegazi
• Ukopha kwimiphunga, emathunjini, kwingqondo nakwezinye iindawo zomzimba
• Iimpawu
• Ukuvala emithanjeni encinci yesibindi
• Umonakalo kwizintso, isibindi, imiphunga kunye nentliziyo
• Ukukhula okulibazisekileyo kubantwana abafumana ukufakelwa umongo wethambo
• Ukuyeka ukuya exesheni kwangoko
• Ukungaphumeleli kwegrafti, oko kuthetha ukuba iiseli ezintsha azihlali emzimbeni kwaye ziqale ukuvelisa iiseli zeziqu
• Isifo se-Graft-versus-host host (GVHD), imeko apho iiseli ezinikelayo zihlasela umzimba wakho
• Usulelo, olunokuba lubi kakhulu
• Ukuvuvukala kunye nokukrakra emlonyeni, emqaleni, kwi-esophagus, nakwisisu, esibizwa ngokuba yi-mucositis
• Intlungu
• Iingxaki zesisu, kubandakanya urhudo, isicaphucaphu kunye nokugabha

Umboneleli wakho uya kubuza malunga nembali yakho yezonyango kwaye enze uvavanyo lomzimba. Uya kuba neemvavanyo ezininzi ngaphambi kokuba unyango luqale.

Ngaphambi kokufakelwa, uya kuba neetyhubhu ezi-1 okanye ezi-2, ezibizwa ngokuba yi-central venous catheters, ezifakwe kwisitya segazi entanyeni okanye kwiingalo zakho. Le tyhubhu ikuvumela ukuba ufumane unyango, ulwelo, kwaye ngamanye amaxesha isondlo. Isetyenziselwa ukutsala igazi.

Umboneleli wakho uya kuthi axoxe ngoxinzelelo lweemvakalelo zokufakelwa ngomongo wethambo. Unokufuna ukudibana nomcebisi. Kubalulekile ukuba uthethe nosapho kunye nabantwana bakho ukubanceda baqonde ukuba balindele ntoni na.

Uya kudinga ukwenza izicwangciso zokukunceda ulungiselele inkqubo kunye nokusingatha imisebenzi emva kokufakelwa kwakho:

• Gcwalisa isikhokelo sokhathalelo kwangaphambili
• Lungiselela ikhefu lonyango emsebenzini
• Khathalela iingxelo zebhanki okanye ezezimali
• Hlela ukhathalelo lwezilwanyana zasekhaya
• Lungiselela umntu oza kuncedisa kwimisebenzi yasekhaya
• Qinisekisa i-inshurensi yezempilo
• Hlawula amatyala
• Lungiselela ukhathalelo lwabantwana bakho
• Zifunele indlu okanye usapho lwakho kufutshane nesibhedlele, xa kufuneka njalo

Ukufakelwa komongo wethambo kuhlala kwenziwa esibhedlele okanye kwiziko lonyango eligxile kunyango olunje. Uninzi lwexesha, uhlala kwiyunithi yokufakelwa umongo okhethekileyo embindini. Oku kukunciphisa amathuba akho okufumana usulelo.

Kuxhomekeke kunyango kunye nalapho lwenziwe khona, konke okanye inxenye yokufakelwa kwe-autologous okanye i-allogeneic kungenziwa njengesigulana esingaphandle. Oku kuthetha ukuba akukho mfuneko yokuba uhlale esibhedlele ubusuku bonke.

Uhlala ixesha elingakanani esibhedlele kuxhomekeke:

• Nokuba uphuhlise naziphi na iingxaki ezinxulumene nokufakelwa
• Uhlobo lofakelo
• Iinkqubo zeziko lakho lonyango

Ngelixa usesibhedlele:

• Iqela lokhathalelo lwempilo liya kujonga ngokusondeleyo ubalo lwegazi kunye neempawu ezibalulekileyo.
• Uya kufumana amayeza okuthintela i-GVHD kunye nokuthintela okanye ukunyanga usulelo, kubandakanya i-antibiotics, i-antifungals, kunye neyeza lokulwa neentsholongwane.
• Ngokuqinisekileyo uya kufuna utofelo-gazi oluninzi.
• Uya kutyiswa ngomthambo (IV) de ube unokutya ngomlomo, kwaye iziphumo ebezingalindelekanga zesisu kunye nezilonda zomlomo zimkile.

Emva kokuba uphumile esibhedlele, qiniseka ukuba ulandela imiyalelo yendlela yokuzikhathalela ekhaya.

Wenza kakuhle kangakanani emva kokufakelwa kwakhona kuxhomekeke:

• Uhlobo lokutsalwa komongo wethambo
• Iiseli zomnikeli zihambelana njani nezakho
• Luhlobo luni lomhlaza okanye ukugula onako
• Ubudala bakho kunye nempilo yonke
• Uhlobo kunye nomyinge we-chemotherapy okanye unyango lwe-radiation owawunalo ngaphambi kokufakelwa kwakho
• Naziphi na iingxaki onokuba nazo

Ukufakelwa komongo wethambo kunokunyanga isigulo sakho ngokupheleleyo okanye ngokuyinxenye. Ukuba ukufakelwa kuyimpumelelo, ungabuyela kuninzi lwemisebenzi yakho yesiqhelo kwakamsinya nje ukuba uziva ngokwaneleyo. Ngokwesiqhelo kuthabatha unyaka ukuya ku-1 ukubuyela kwimeko yesiqhelo ngokupheleleyo, kuxhomekeka ekubeni zeziphi iingxaki ezikhoyo.

Iingxaki okanye ukusilela kokufakelwa komongo wethambo kungakhokelela ekufeni.

Ukutshintshwa - umongo wethambo; Ukufakelwa kweseli; Ukufakelwa kweseli ye-hematopoietic stem; Ukuncitshiswa kobunzulu bokubethelelwa okungafunekiyo; Ukufakelwa okuncinci; Ukufakelwa komongo wethambo u-Allogenic; Ukufakelwa komongo wethambo u-Autologous; Ukufakelwa kwegazi lomtya we-umbilical; I-aplastic anemia - ukufakelwa komongo wethambo; I-leukemia - ukufakelwa komongo wethambo; I-Lymphoma - ukufakelwa komongo wethambo; Ukuphindaphinda umongo wethambo

• Ukopha ngexesha lonyango lomhlaza
• Ukutsalwa komongo wethambo - ukukhupha
• I-catheter esembindini yemithambo-yokunxiba utshintsho
• Central catheter venous - ukugungxula
• Ukusela amanzi ngokukhuselekileyo ngexesha lonyango lomhlaza
• Umlomo owomileyo ngexesha lonyango lomhlaza
• Ukutya iikhalori ezongezelelweyo xa ugula - abantu abadala
• Ukutya iikhalori ezongezelelweyo xa ugula - abantwana
• I-Oral mucositis - ukuzikhathalela
• Ukufakwa ngokuthe gca kwe-catheter esembindini - ukugungxula
• Ukutya okukhuselekileyo ngexesha lonyango lomhlaza

• Umnqweno wethambo
• Izinto ezenziwe ngegazi
• Umongo wethambo esinqeni
• Ukufakelwa komongo wethambo-uthotho

Umbutho waseMelika wewebhusayithi yeClinic Oncology. Yintoni ukufakelwa umongo wethambo? www.cancer.net/navigating-cancer-care/how-cancer-treated/bone-marrowstem-cell-transplantation/what-bone-marrow-transplant-stem-cell-transplant. Ukuhlaziywa kuka-Agasti 2018. Ifikeleleke ngoFebruwari 13, 2020.

IHeslop HE. Isishwankathelo kunye nokukhethwa komnikeli we-hematopoietic stem cell transplant. Ku: Hoffman R, Benz EJ, Silberstein LE, et al, ii-eds. I-Hematology: Imigaqo esisiseko kunye nokuziqhelanisa. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2018: isahl. 103.

Ndingu-A, uPavletic SZ. Ukufakelwa kweseli ye-hematopoietic stem. Ku: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, ii-eds. I-Oncology yeklinikhi yase-Abeloff. Umhla wesi-6. IPhiladelphia, PA: Elsevier; 2020: isahluko 28.