Unyango lwangoku kunye nolwenzeko lwe-CLL

Umxholo

• Ushwankathelo
• Unyango lwe-CLL esemngciphekweni
• Unyango lwe-CLL ephakathi- okanye ephezulu yomngcipheko
• I-Chemotherapy kunye ne-immunotherapy
• Unyango ekujoliswe kulo
• Utofelo-gazi
• Imitha
• Ukutshintshwa kweseli kunye nomongo wethambo
• Unyango lonyango
• Indibaniselwano yeziyobisi
• Unyango lwe-CAR T-cell
• Amanye amachiza aphantsi kophando
• Ukuthatha

Ushwankathelo

I-lymphocytic leukemia (CLL) engapheliyo ngumhlaza okhula kancinci kwisistim somzimba. Ngenxa yokuba ikhula kancinci, abantu abaninzi abane-CLL abazukufuna ukuqala unyango iminyaka emininzi emva kokuxilongwa.

Nje ukuba umhlaza uqale ukukhula, zininzi iindlela zonyango ezikhoyo ezinokunceda abantu ukuba bafumane uxolelo. Oku kuthetha ukuba abantu banokuba namaxesha amade xa kungekho mqondiso womhlaza emzimbeni wabo.

Olona khetho lonyango oza kulifumana luxhomekeka kwizinto ezahlukeneyo. Oku kubandakanya ukuba ingaba i-CLL yakho ingumqondiso, inqanaba le-CLL esekwe kwiziphumo zovavanyo lwegazi kunye novavanyo lomzimba, kunye nobudala bakho kunye nempilo iyonke.

Ngelixa ingekho iyeza lokunyanga i-CLL okwangoku, impumelelo ebaleni ikufuphi.

Unyango lwe-CLL esemngciphekweni

Oogqirha bahlala bebeka i-CLL besebenzisa inkqubo ebizwa ngokuba yinkqubo yeRai. Umngcipheko ophantsi we-CLL uchaza abantu abawela "kwinqanaba 0" phantsi kwenkqubo yeRai.

Kwinqanaba le-0, i-lymph nodes, i-spleen, kunye nesibindi azikhuliswa. Iseli ebomvu yegazi kunye nokubalwa kweplatelet nako kufutshane nesiqhelo.

Ukuba unomngcipheko ophantsi we-CLL, ugqirha wakho (uhlala eyi-hematologist okanye i-oncologist) uya kukucebisa ukuba "ulinde kwaye ubukele" iimpawu. Le ndlela ikwabizwa ngokuba kukujonga okusebenzayo.

Umntu onomngcipheko ophantsi we-CLL usenokungafuneki ukuba aqhubeke nokunyanga iminyaka emininzi. Abanye abantu abanakuze bafune unyango. Kuya kufuneka uphinde ubonane nogqirha kuvavanyo rhoqo kunye novavanyo lwelebhu.

Unyango lwe-CLL ephakathi- okanye ephezulu yomngcipheko

Umngcipheko ophakathi we-CLL uchaza abantu abanenqanaba 1 ukuya kwinqanaba 2 CLL, ngokwenkqubo yeRai. Abantu abanenqanaba loku-1 okanye le-2 ye-CLL bandise ii-lymph node kwaye banokwandiswa kwepeni kunye nesibindi, kodwa kufutshane neeseli ezibomvu zegazi kunye nokubalwa kweplatelet.

Umngcipheko ophezulu we-CLL uchaza abaguli abanesigaba 3 okanye isigaba somhlaza wesi-4. Oku kuthetha ukuba unokwanda kwepleen, isibindi, okanye i-lymph nodes. Ukubalwa kweeseli ezibomvu ezisezantsi kuqhelekile. Kwinqanaba eliphezulu, ukubalwa kweplatelet kuya kuba sezantsi ngokunjalo.

Ukuba une-CLL ephakathi okanye enobungozi obukhulu, ugqirha wakho uya kuncoma ukuba uqale unyango kwangoko.

I-Chemotherapy kunye ne-immunotherapy

Kwixesha elidlulileyo, unyango oluqhelekileyo lwe-CLL lubandakanya indibaniselwano ye-chemotherapy kunye neearhente ze-immunotherapy, ezinje:

• fludarabine kunye necyclophosphamide (FC)
• I-FC kunye ne-antibody antibody eyaziwa ngokuba yi-rituximab (Rituxan) yabantu abangaphantsi kweminyaka engama-65
• bendamustine (iTreanda) kunye ne-rituximab yabantu abadala kunama-65
• ichemotherapy ngokudibeneyo nezinye ii-immunotherapies, ezinje nge-alemtuzumab (Campath), obinutuzumab (Gazyva), kunye ofatumumab (Arzerra). Olu khetho lunokusetyenziswa ukuba umjikelo wokuqala wonyango awusebenzi.

Unyango ekujoliswe kulo

Kule minyaka imbalwa idlulileyo, ukuqonda okungcono i-biology ye-CLL kukhokelele kwinani lezonyango ekujolise kuzo ngakumbi. La machiza abizwa ngokuba ziindlela ekujoliswe kuzo kuba zijolise kwiiproteni ezithile ezinceda iiseli ze-CLL zikhule.

Imizekelo yeziyobisi ekujoliswe kuzo ze-CLL zibandakanya:

• ibrutinib (Imbruvica): ijolise kwi-enzyme eyaziwa ngokuba yi-Bruton's tyrosine kinase, okanye i-BTK, ebaluleke kakhulu ekusindeni kweeseli ze-CLL
• venetoclax (Venclexta): ijolise kwiprotein ye-BCL2, iprotein ebonwa kwi-CLL
• idelalisib (Zydelig): iibhloko zeprotein kinase eyaziwa ngokuba yi-PI3K kwaye isetyenziselwa ukubuyela kwi-CLL
• duvelisib (Copiktra): ikwajolise kwi-PI3K, kodwa isetyenziswa kuphela emva kokuba olunye unyango lusilele
• I-acalabrutinib (iCalquence): enye i-BTK inhibitor evunyiweyo ngasekupheleni kwe-2019 ye-CLL
• venetoclax (Venclexta) ngokudibeneyo ne-obinutuzumab (Gazyva)

Utofelo-gazi

Kuya kufuneka ukuba ufumane utofelo-gazi (IV) lotofelo lwegazi ukonyusa ukubalwa kweeseli zegazi.

Imitha

Unyango lwe-radiation lusebenzisa amasuntswana amandla amakhulu okanye amaza ukunceda ukubulala iiseli zomhlaza kunye nokunciphisa i-lymph node ezandisiweyo. Unyango ngemitha kunqabile ukuba lusetyenziswe kunyango lwe-CLL.

Ukutshintshwa kweseli kunye nomongo wethambo

Ugqirha wakho unokucebisa ukufakelwa kweseli ukuba umhlaza wakho awuphenduli kolunye unyango. Ukufakelwa kweseli ye-stem kukuvumela ukuba ufumane iidosi eziphezulu ze-chemotherapy ukubulala iiseli zomhlaza ezingaphezulu.

Amayeza aphezulu e-chemotherapy anokubangela umonakalo kumnkantsha wethambo lakho. Ukutshintsha ezi seli, kuyakufuneka ufumane iiseli ezongeziweyo okanye umongo wethambo kumxhasi osempilweni.

Unyango lonyango

Inani elikhulu leendlela ziphantsi kophando ukunyanga abantu abane-CLL. Ezinye zisandula ukuvunywa nguLawulo lokutya kunye noLawulo lweziyobisi (FDA).

Indibaniselwano yeziyobisi

Ngo-Meyi ka-2019, i-FDA yamkele i-venetoclax (Venclexta) ngokudibanisa ne-obinutuzumab (Gazyva) yokunyanga abantu nge-CLL engazange inyangwe ngaphambili njenge-chemotherapy-free.

Nge-Agasti ka-2019, abaphandi bapapasha iziphumo ezivela kuvavanyo lweklinikhi yesiGaba sesi-III esibonisa ukuba indibaniselwano ye-rituximab kunye ne-ibrutinib (Imbruvica) igcina abantu bengenasifo ixesha elide kunendlela yokhathalelo yangoku.

Ezi ndibaniselwano zenza ukuba abantu babe nakho ukwenza ngaphandle kwekhemotherapy kwaphela kwixesha elizayo. Iirejimeni zonyango ezingezizo ezekhemikhali zibalulekile kwabo bangenako ukunyamezela iziphumo ebezingalindelekanga ezinobuzaza ezinxulumene nekhemotherapy.

Unyango lwe-CAR T-cell

Olunye lolona khetho luthembisayo kunyango lwe-CLL lonyango lwe-CAR T-cell. I-CAR T, emele unyango lwe-chimeric antigen receptor T-cell, isebenzisa iiseli zomzimba zomntu ukulwa nomhlaza.

Inkqubo ibandakanya ukukhupha kunye nokutshintsha iiseli zomzimba zomntu ukuqonda ngcono nokutshabalalisa iiseli zomhlaza. Iiseli ziye zibuyiselwe emzimbeni ukuze zande kwaye zilwe nomhlaza.

Unyango lwee-CAR T-cell luyathembisa, kodwa luneengozi. Umngcipheko omnye yimeko ebizwa ngokuba yi-cytokine release syndrome. Le yimpendulo yokuvuvukala ebangelwe kukufakwa kwe-CAR T-seli. Abanye abantu banokufumana iimpendulo ezinzima ezinokubangela ukufa xa benganyangwa ngokukhawuleza.

Amanye amachiza aphantsi kophando

Ezinye iziyobisi ekujoliswe kuzo ezivavanywa kuvavanyo lweklinikhi lwe-CLL zibandakanya:

• zanubrutinib (BGB-3111)
• i-entospletinib (GS-9973)
• tirabrutinib (ONO-4059 okanye GS-4059)
• Umbralisib (TGR-1202)
• Cirmtuzumab (UC-961)
• Ublituximab (TG-1101)
• ipembrolizumab (Keytruda)
• i-nivolumab (iOpdivo)

Nje ukuba kugqitywe uvavanyo lwezonyango, amanye ala machiza anokuvunywa kunyango lwe-CLL. Thetha nogqirha wakho malunga nokujoyina uvavanyo lweklinikhi, ngakumbi ukuba iindlela zonyango ezikhoyo ngoku azikusebenzeli.

Uvavanyo lwezonyango luvavanya ukusebenza kwamachiza amatsha kunye nokudityaniswa kwamachiza asele evunyiwe. Olu nyango lutsha lunokusebenzela bhetele kuwe kunolo lukhoyo ngoku. Okwangoku kukho amakhulu ezilingo zeklinikhi eziqhubekayo ze-CLL.

Ukuthatha

Uninzi lwabantu oluchongwe ukuba lune-CLL aluyi kufuna ukuba luqale unyango kwangoko. Emva kokuba isifo siqala ukuqhubela phambili, unokhetho oluninzi lonyango olufumanekayo. Kukho uluhlu olubanzi lwezilingo zeklinikhi onokukhetha kuzo eziphanda unyango olutsha kunye nonyango oludibeneyo.