I-Acute Myeloid Leukemia (AML): yintoni, iimpawu kunye nonyango

Umxholo

• Iimpawu eziphambili
• Ukuchonga kunye nokuhlelwa
• Unyango lwenziwa njani
• 1. Unyango ngamayeza
• 2. Unyango ngemitha
• 3. Ukufakelwa komongo wethambo
• 4. Unyango ekujoliswe kulo kunye nokunyanga komzimba
• 5. Unyango lwemfuza ye-T-Cell yemoto

I-Acute myeloid leukemia, ekwabizwa ngokuba yi-AML, luhlobo lomhlaza oluchaphazela iiseli zegazi kwaye luqala kumongo wethambo, nelilungu elijongene nokuveliswa kweeseli zegazi. Olu hlobo lomhlaza lunethuba elikhulu lokunyanga xa lufunyenwe kwinqanaba lalo lokuqala, xa ingekabikho i-metastasis kwaye ibangela iimpawu ezinje ngokuncipha komzimba kunye nokudumba kolwimi kunye nesisu, umzekelo.

I-Acute myeloid leukemia yanda ngokukhawuleza kwaye inokwenzeka kubantu bayo yonke iminyaka, nangona kunjalo ixhaphakile kubantu abadala, njengoko iiseli zomhlaza ziqokelelana kumongo wethambo kwaye zikhutshelwa kwigazi, apho zithunyelwa kwamanye amalungu. , i-spleen okanye i-central system ye-nervous, apho iqhubeka ikhula kwaye ikhula.

Unyango lwe-acute myeloid leukemia lunokwenziwa kwisibhedlele somhlaza kwaye lukhulu kakhulu kwiinyanga ezi-2 zokuqala, kwaye ubuncinci unyaka ongaphezulu kunyango luyafuneka ukuze sinyangeke esi sifo.

Iimpawu eziphambili

Iimpawu eziqhelekileyo ze-myeloid leukemia zibandakanya:

• I-anemia, ebonakala ngokuhla kwexabiso le-hemoglobin;
• Ukuziva ubuthathaka kunye ne-malaise ngokubanzi;
• Pallor kunye nentloko ebangelwa yi-anemia;
• Ukopha rhoqo okuphawulwa kukopha ngeempumlo ngokulula kunye nokunyuka kokuya exesheni;
• Ukuvela kwemivumbo emikhulu nkqu nakwimivimbo emincinci;
• Ukuphelelwa ngumdla wokutya kunye nokwehla kwesisindo ngaphandle kwesizathu;
• Ukudumba nolwimi olubuhlungu, ngakumbi entanyeni nasemiphakathini;
• Rhoqo usulelo;
• Iintlungu kumathambo kunye namalungu;
• Ifiva;
• Ukuphefumla kancinci kunye nokukhohlela;
• Ukubila okugqithisileyo ebusuku, okuthi kumanzise iimpahla zakho;
• Ukungahambi kakuhle esiswini okubangelwa kukudumba kwesibindi kunye nokudakumba.

I-Acute myeloid leukemia luhlobo lomhlaza wegazi oluchaphazeleka kakhulu kubantu abadala kwaye ukuxilongwa kwawo kunokwenziwa emva kovavanyo lwegazi, ukubhoboza i-lumbar kunye ne-bone marrow biopsy.

Ukuchonga kunye nokuhlelwa

Ukuxilongwa kwe-leukemia ye-myeloid etsolo kusekelwe kwiimpawu ezinikezelwe ngumntu kunye neziphumo zovavanyo, ezinje ngokubala kwegazi, uhlalutyo lomongo wethambo kunye novavanyo lweemolekyuli kunye ne-immunohistochemical. Ngokubala kwegazi, kunokwenzeka ukugcina ukuhla kwenani leeseli ezimhlophe zegazi, ubukho bokujikeleza kweeseli ezimhlophe zegazi ezingafakwanga kunye nenani elisezantsi leeseli ezibomvu zegazi kunye neeplatelets. Ukuqinisekisa ukuxilongwa, kubalulekile ukuba kwenziwe i-myelogram, apho yenziwa khona ngokuhluzwa kunye nokuqokelelwa kwesampulu yomongo wethambo, ehlalutywa elebhu. Qonda ukuba yenziwa njani i-myelogram.

Ukuchonga uhlobo lwe-acute myeloid leukemia, kubalulekile ukuba kwenziwe iimvavanyo zeemolekyuli kunye ne-immunohistochemical ukuchonga iimpawu zeeseli ezifumaneka egazini ezinophawu lwesifo, olu lwazi lubalulekile ekuchazeni isigulo. ugqirha ukubonisa olona nyango lufanelekileyo.

Nje ukuba kuchongwe uhlobo lwe-AML, ugqirha unokumisela isifo kunye nokuseka amathuba onyango. I-AML inokuhlelwa kwii-subtypes ezithile, ezi:

Unyango lwenziwa njani

Unyango lwe-acute myeloid leukemia (AML) kufuneka luboniswe yi-oncologist okanye i-hematologist kwaye lunokwenziwa ngeendlela ezininzi, ezinje nge-chemotherapy, amayeza okanye ukufakelwa umongo wethambo:

1. Unyango ngamayeza

Unyango lwe-acute myeloid leukemia luqala ngohlobo lwe-chemotherapy ekuthiwa kukungeniswa, olujolise ekuxolelweni komhlaza, oku kuthetha ukunciphisa iiseli ezigulayo zide zingafunyanwa kuvavanyo lwegazi okanye kwi-myelogram, eluvavanyo lwegazi eliqokelelweyo. ngqo kumongo wethambo.

Olu hlobo lonyango luboniswa ngugqirha wegazi, lwenziwa kwiklinikhi yezigulana ezingalaliswayo kwaye lwenziwa ngokufaka amayeza ngqo emthanjeni, ngokusebenzisa ipayinti ebekwe ngasekunene kwesifuba ekuthiwa yi-port-a-cath okanye ngokufikelela kumthambo wengalo.

Kwiimeko ezininzi ze-myeloid leukemia ebukhali, ugqirha ucebisa ukuba umntu afumane iseti yamayeza ahlukeneyo, abizwa ngokuba ziiprotocol, ikakhulu ezisekwe ekusetyenzisweni kwamayeza afana necytarabine kunye ne-idarubicin, umzekelo. Ezi protocols zenziwa ngokwezigaba, ngeentsuku zonyango olunamandla kunye neentsuku ezimbalwa zokuphumla, ezivumela umzimba womntu ukuba uphinde uchache, kunye nenani lamaxesha ekufuneka wenziwe lixhomekeke kubukhali be-AML.

Amanye amayeza aqhelekileyo ukunyanga olu hlobo lwe-leukemia, kunokuba:

Ugqirha unokucebisa ukuba kusetyenziswe ii-corticosteroids, ezinje nge-prednisone okanye i-dexamethasone, njengenxalenye yenkqubo yonyango lwe-acute myeloid leukemia. Olunye uphando luyenziwa ukuze amayeza amatsha anje nge-capecitabine, lomustine kunye ne-guadecitabine ayasetyenziswa ukunyanga esi sifo.

Ukongeza, emva kokuxolelwa kwesifo ngamayeza ngamayeza, ugqirha angabonisa iintlobo ezintsha zonyango, ezibizwa ngokuba kukuqinisa, ezisebenza ukuqinisekisa ukuba iiseli zomhlaza zisuswe zonke emzimbeni. Oku kudityaniswa kunokwenziwa ngeedosi ephezulu yonyango kunye nokufakwa komongo wethambo.

Unyango lwe-acute myeloid leukemia nge-chemotherapy linciphisa inani leeseli ezimhlophe egazini, eziziiseli zokhuselo lomzimba, kwaye umntu une-immune system esezantsi, nto leyo ibenza ukuba basuleleke lula zizifo. Ke ngoko, kwezinye iimeko, umntu kufuneka angeniswe esibhedlele ngexesha lonyango kwaye kufuneka asebenzise ii-antibiotics, ii-antivirals kunye ne-antifungals ukuthintela usulelo olungazukuvela. Kwaye ngoku, kuqhelekile ukuba ezinye iimpawu zivele, njengokulahleka kweenwele, ukudumba komzimba kunye nolusu olunamabala. Funda ngezinye iziphumo zechemotherapy.

2. Unyango ngemitha

I-Radiotherapy luhlobo lonyango olusebenzisa umatshini okhupha imitha emzimbeni ukubulala iiseli zomhlaza, nangona kunjalo, olu nyango alusetyenziswanga ngokubanzi kwi-leukemia ye-myeloid kwaye isetyenziswa kuphela kwiimeko apho isifo sinwenwele kwamanye amalungu, Ingqondo kunye ne-testis, kufuneka isetyenziswe ngaphambi kokufakelwa komongo wethambo okanye ukunciphisa iintlungu kwindawo yethambo ehlaselwe yi-leukemia.

Ngaphambi kokuqala iiseshoni ze-radiotherapy, ugqirha wenza isicwangciso, ekhangela imifanekiso ye-tomography ekhompyuter ukuze indawo echanekileyo apho imitha kufuneka ifikelelwe emzimbeni ichazwe emva koko, ukumakishwa kwenziwa kulusu, ngepeni ethile, ukubonisa isikhundla esifanelekileyo kumatshini we-radiotherapy kwaye zonke iiseshoni zihlala kwindawo ephawuliweyo.

Njenge chemotherapy, olu hlobo lonyango lunokubangela iziphumo ebezingalindelekanga, ezinjengokudinwa, ukungabinamdla wokutya, isicaphucaphu, umqala obuhlungu kunye notshintsho kolusu olufana nokutshiswa lilanga. Funda ngakumbi malunga nokhathalelo ekufuneka luthathiwe ngexesha le-radiotherapy.

3. Ukufakelwa komongo wethambo

Ukufakelwa komongo wethambo luhlobo lotofelo-gazi olwenziwe ngeeseli ze-hematopoietic stem ezithathwe ngokuthe ngqo kumongo wethambo lomnikeli ohambelanayo, nokuba kungenxa yotyando lwegazi lokunyanga ukusuka esinqeni okanye ngeapheresis, ongumatshini ohlukanisa iiseli zegazi ngokusebenzisa ipayinti ethanjeni.

Olu hlobo lokufakelwa luhlala lwenziwa emva kokuba kwenziwe idosi ephezulu ye-chemotherapy okanye ye-radiotherapy iziyobisi kwaye emva kokuba iiseli zomhlaza zingafumaneki kwiimviwo. Kukho iintlobo ezahlukeneyo zokufakelwa, ezifana ne-autologous kunye ne-allogeneic, kwaye isibonakaliso senziwa yi-hematologist ngokweempawu ze-leukemia ye-myeloid. Bona ngakumbi malunga nendlela okwenziwa ngayo ukutsalwa komongo wethambo kunye neendidi ezahlukeneyo.

4. Unyango ekujoliswe kulo kunye nokunyanga komzimba

Unyango ekujoliswe kulo luhlobo lonyango olusebenzisa amachiza ahlasela iiseli ezigulayo ezineleukemia ngotshintsho oluthile lwemfuza, ezibangela iziphumo ebezingalindelekanga ezimbalwa kunechemotherapy. Amanye ala mayeza asetyenziswayo zezi:

• I-FLT3 inhibitors: kubonisiwe kubantu abane-leukemia ebukhali kunye ne-geneI-FLT3 kwaye amanye ala machiza yi-midostaurin kunye ne-gilteritinib, engekavunywa ukuba isetyenziswe eBrazil;
• I-HDI inhibitors: kucetyiswa ngugqirha ukuba isetyenziswe kubantu abane-leukemia ngokutshintsha kwemfuzaIDH1 okanyeIDH2, ezithintela ukukhula okufanelekileyo kweeseli zegazi. Ii-HDI inhibitors, ezinjenge-enasidenib kunye ne-ivosidenib, zinokunceda iiseli ze-leukemia zikhule ziye kwiiseli zegazi eziqhelekileyo.

Ukongeza, amanye amachiza asebenza kwimfuza ethile ayasetyenziswa njenge-inhibitors ye-BCL-2 gene, enje nge-venetoclax, umzekelo. Nangona kunjalo, amanye amayeza ala maxesha asekwe ekuncedeni amajoni omzimba ukulwa iiseli ze-leukemia, ezaziwa njenge-immunotherapy, zikwacetyiswa kakhulu zii-hematologists.

Iintsholongwane zeMonoclonal ngamachiza e-immunotherapy amachiza enziwe njengeeproteni zomzimba ezisebenza ngokuzibandakanya eludongeni lweeseli ze-AML zize zizitshabalalise. Iyeza le-gemtuzumab lolu hlobo lwamayeza lukhuthazwa kakhulu ngoogqirha ukunyanga olu hlobo lwegazi.

5. Unyango lwemfuza ye-T-Cell yemoto

Unyango lwe-Gene usebenzisa ubuchwephesha beCar T-Cell lukhetho lonyango kubantu abane-leukemia ebukhali ene-myeloid equka ukususa iiseli kumajoni omzimba, abizwa ngokuba ziiseli ze-T, emzimbeni womntu emva koko azithumele elebhu. Kwilabhoratri, ezi seli ziguqulwa kwaye izinto ezibizwa ngokuba zii-CARs zaziswa ukuze zikwazi ukuhlasela iiseli zomhlaza.

Emva kokunyangwa kwilabhoratri, iiseli ze-T zitshintshwa emntwini one-leukemia ukuze, zilungiswe, zitshabalalise iiseli ezinomhlaza. Olu hlobo lonyango lisafundwa kwaye alufumaneki kwi-SUS. Jonga ngakumbi malunga nokuba lwenziwa njani unyango lweCar T-Cell kwaye yintoni enokuthi inyangwe.

Jonga kwakhona ividiyo malunga nendlela yokunciphisa iziphumo zonyango lomhlaza: