Leukemia, kenza yemasero eropa-forming, inowanzofungidzirwa sechiitiko chinokanganisa vana nevechiri kuyaruka-chaizvoizvo, ndiyo inowanzosangana nekenza yevana. Zvisinei, houkemia inobatawo vanhu vakawanda vakwegura uye vanhu vari muzana remakore makumi matanhatu, kunyanya.
Kunyange zvazvo kurapwa kwevakuru vakwegura kunogona kunge kwakaoma, nhasi kune nhamba inowedzera yezvasarudzo-kunyange kana iwe wakwegura zvakakwana kuti uyeuke Eisenhower uye JFK.
Makirasi matsva emishonga ari kubuda anokwanisa kubatsira hondo yehondo, kunyange kana muviri wako usingakwanisi kutora zvakashata kukuvara kwemakemikirini yakasimba. Izvozvo zvakati, kunyange munguva dzemazuva ano, chirwere chinokonzerwa neukemia chinotyisa kune vavengi vakawanda.
Leukemia Mitauro muVakuru Vakuru
Chronic lymphocytic leukemia (CLL) ndiyo inonyanya kuwanika neukemia kune vanhu vakuru, uye inopera makore ekufungidzirwa kwemakore anenge 71. Chirwere chinonzi myeloid leukemia (AML) chinowedzera chikamu chechipiri kune vanhu vakuru, nezera rinosvika makore makumi matanhatu nemakumi matanhatu; uye vanopfuura 60 muzana yevachangobva kuongororwa varwere vane AML vanopfuura makumi matanhatu. Sezvo zvakadaro, CLL ne AML zvinoshandiswa zvakanyanyisa pano, asi, vakwegura vakuru vanogona kukudziridza mamwe mapoka maviri eukemia, zvakare. Zera rakakura kudarika makore makumi manomwe ndeyengozi yevanhu vakuru acute lymphoblastic leukemia (ALL), iyo inonziwo "adult lymphocytic leukemia". Uye kana iri isingaperi myelogenous leukemia (CML), inenge 50 kubva muzana yevarwere vane CML vane makore makumi mana nemakumi matanhatu.
Vanhu Vakwegura Vanoonekwa Neukemia
CLL uye AML ndiyo inowanzosiyana nemarudzi eukemia kuti aone gare gare muupenyu. Pakati pezviviri, AML ndiyo chirwere chinokurumidza kufambira mberi. Inofungidzira zvinyorwa zviviri (mazera ose emakore) muna 2016 zvinotevera:
- 18 960 mitsva mitsva uye rufu rwe 4 660 kubva kuCLL
- 19 950 mitsva itsva uye rufu 10,430 kubva ku AML.
CLL uye AML zvirwere zvakasiyana kwazvo, zvichiratidza kusiyana kukuru pakati peAacute uye chronic leukemias, kazhinji. Zvose zvinonzi leukemias dzinotanga apo masero emapfupa emuti-fekitari yemuviri wako pakuita masero matsva eropa-anotanga kubudisa masero masero eropa. Masero emasero mumapfupa emapfupa anowanzosimudzira masero ako ose nguva dzose, achiita masero matsva kuti atsive zvakare. Izvozvo zvinokonzerwa neukemia zvinosanganisira masero eropa-kuita masero uye inotanga kufambira mberi nokukurumidza. Kurwara kweukwepa inokonzerwa neropa-kuumba masero ayo anenge akakura zvakanyanya, asi achiri kusina kuchena, uye anorwara eukemukari anowedzera kukura zvishoma nezvishoma, kupfuura kwemwedzi nemakore.
CLL
CLL inomukenza wemasero machena muB-lymphocyte mhuri. I-B-lymphocytes, kana B-masero, ndiyo lymphocytes inogona kushandiswa uye inotungamirira mukugadzirwa kweanoripi. Imwe mhando ye lymphocytes ndiyo T-seli, iyo yakafanana nemasikirwo emasitadhi e 'infantry,' kana masero emasoja.
CLL haiwanzokonzera zviratidzo pakutanga, uye munhu haazoziva kuti ane CLL pakutanga. Muzvokwadi, kazhinji, vanhu vanorwara kuti vanongororerwa ropa. Apo CLL inokonzera zviratidzo, zvimwe zvezvinowanzozivikanwa ndezvekuti: kunzwa kuneta uye kushaya simba; kana kuve nokuputika lymph nodes mumutsipa, pasi pemaoko kana mumupura; kana kuwira kurwara kune zvirwere nyore nyore kupfuura zvinowanzoitika; kana kuva nemhepo, kana kutuka kukuru panguva yeusiku; kana kurasikirwa pasina kuedza.
MuCLL, masero ekenza anowanzowanika muropa, marora, uye lymph nodes. Chimwe chiitiko chakafanana, chinonzi lymphocytic leukemia, kana SLL, chirwere chinotanga muB-cell mhuri yemasero, sekufanana neCLL, zvisinei, munhu ane SLL haana huwandu hwemasero machena muropa ravo.
Kuongororwa kweCLL kunoda kuongororwa kweropa, uye nhamba yeB-seli muropa rako inofanira kutsanangurirwa. CLL inoratidzwa nekuvapo kwe-5 000 zvisina kuchena B-masero paundi yemaropa, uye B-masero anofanirwa kunge ari "makopi" kana kuti majekesheni akafanana nemasero emubereki akaipa. Izvi zvinonzi monoclonality.
I-CLL masero anodikanwawo kuongororwa kuti aone zviri pamusoro pavo. Vangave vane nhamba ipi neipi yeprotein tags kana zviratidzo. Laboratories dzinoreva mavara emapuroteni aya achishandisa tsamba dzeCD dzakatevedzerwa nemashoko ekuverenga. MuCLL, masero anogona kunge ane mazita anonzi CD5, CD19, uye CD23 pavari; vamwe vangave vane CD20, asi hapana ane CD10. Mune zvimwe zviitiko, unofanirwa kuva nemimwe miedzo inowanikwa kuwedzerwa kuongororwa kweropa, yakadai semakirini anonzi nymph nodes kana bone marrow biopsy-zvisinei, iyi haisi iyo inowanzoitika yekuongorora kweCLL.
CLL vs. MBL
Zvidzidzo zvinoratidza kuti 3 kusvika ku5 muzana vanhu vanopfuura makore makumi mana, kana vakaedzwa nematambudziko akaoma, vanoratidzira clonal population ye lymphocytes, kufanana neCLL. Uku kuwanikwa kwaita kuti kusikwa kuongororwa kweMML, iyo inonzi inofanirwa kuitika kune CLL.
Kana uine vashoma kupfuura 5,000 monoclonal B-seli, hapana lymph node yokuwedzera uye hapana zvimwe zviratidzo zveCLL, unogona kuonekwa ne monoclonal B-lymphocytosis (MBL). Izvi zvakajairika kune vakwegura vakuru, uye hachisati yava nekenza. Vanhu vashoma zvikuru vane BML vanoenderera mberi kukura CLL; kunyange zvakadaro pane izvozvi, uye naizvozvo kurinda kumirira kunorumbidzwa.
Kunyange kana iwe uine hutano hweCLL, chisarudzo chekubata chingasave chakafanirwa kuguma. Munguva yakapfuura, vanachiremba vakaudza varwere vane CLL kuti nguva "yekumirira yakatarisa" inofanira kutevera kuongororwa kusvikira chirwere chichifambira mberi, panguva iyo chirwere chichatanga. Kunyange zvazvo ichi chichiri kuitika mumatambudziko akawanda, pane kunzwisisa kunowedzera kuti mamiriro akasiyana eCLL angaita nenzira yakasiyana, uye mamwe mamiriro eCLL angadaidza kurapa kwakakurumidza.
Chikamu chekugadzirira iwe iwe nachiremba wako kuchaita kuti uone kana kurapa kwe CLL yako kunotanga. Ichisarudzo chinoitwa maererano nemararamiro eCLL, zvinoguma kubva kuongororo yebazi uye kuongororwa kwemashoko. NeCLL, hurongwa hweRai stage huri kushandiswa, kubva paChechi I kusvika kuSiteji IV. Kunewo Binet staging system yeCLL iyo inosarudza zvikamu A, B, neC, asi hazvisi zvinobatsira pakusarudza kuti ndirini kutanga kutapwa.
Vanachiremba vanoparadzanisa zvikamu zveRai muzvikamu zvakaderera, zvepakati, uye zvepamusoro apo pavanosarudza nzira dzokurapa.
- Nhanho 0 inofungidzirwa pasi pengozi.
- Nhanho I uye II dzinofungidzirwa kuti dziri pakati pengozi.
- Nhanho III uye IV dzinofungidzirwa sengozi huru.
Kune vanhu vane CLL ye RAI zvidzidzo 0, ini ne2, zvinogoneka kuti kurapwa kungave kusingadikanwi pakarepo. Zvisinei, kune munhu ane chirwere chekutanga uye chirwere cheC CLL-semuenzaniso nekuvapo kwezviratidzo zveCLL zvakadai sokuneta zvakanyanya kana fevhiri, usiku kusuruvara kana kurasikirwa kwekurema-kwete kurapwa kunorayirwa.
Zvimwe zvikonzero pamwe nesero dzimwe nguva zvinofungidzirwa apo pachitarisa pane zvekurapa. Zviitiko zvinosanganiswa nenguva shomanana yekupona zvinonzi zvinopesana nekufungidzira zvinhu, asi zvinhu zvinobatanidzwa nekupona kwenguva refu zvinofadza kufungidzira zvinhu.
Zvimwe zviitiko zvine chokuita nemasero eukemia 'genetic profile uye pamusoro pezviratidzo zvinoshandiswa zvakare: ZAP-70, CD38, uye mutered gene yeGIHV kubatsira kuburitsa mhaka dzeCLL mumapoka maviri, dzinokura nekukura nekukurumidza. Vanhu vane chirwere chinowedzera kukura cheLLL vanorarama kwenguva yakareba uye vanogona kukononoka kurapwa kwenguva yakareba zvakare.
Mishonga inowanikwa yeCLL inowanzopinda mumakamuri makuru ehutachiona semakemotherapy, chinangwa cherapi, immunotherapy, immunomodulators, uye steroids. Hakusi kurapwa kwose kunokodzera vanhu vose vane CLL. Kana vanachiremba vakawanda vachidzidza pamusoro pemhando dzakasiyana dzeCLL, zvakanyanya kunyanya kurapwa kungave zvakakodzera kune dzimwe mhaka dzeCLL asi kwete vamwe.
Mimwe mishonga inobvunzurudza uye ingangosvikeka kana ukapinda muchechi yekutongwa. Kubva pamakiriniki ekuedzwa, kamwechete kurapwa kwakatemwa kuva yakachengeteka uye kwakabudirira kweCLL, mushonga unogamuchirwa neCDA uye unova wakapararira zvikuru.
Zera uye hutano huzhinji hunovawo hunokosha pakufunga pahutano. Semuenzaniso, mamwe maitiro ekurapa kwekutanga kweCLL angasarudzwa seakakodzera zvakanyanya kune vanhu vaduku uye vane utano hwakanaka neCLL; mamwe maitiro ekurapa kwekutanga kana marejimi angaratidzwa zviri nani kune avo vakwegura kana mune utano husina kunaka.
Kuchengetedza kurapwa kunenge kusingarapiki kenza asi chinangwa chekuita hupenyu ne CLL zviri nani kwauri. Kunyatsotsigira kunosanganisira zvinhu zvakadai sezvirwere, kuwedzerwa ropa, mishonga inodzivirira, uye kunyange rubatsiro nekugadzirisa kuchengetedza kana pane vanachiremba vakawanda vakabatanidzwa.
Vanhu Vakwegura Vane AML
Maererano neAmerican Cancer Society, myeloid achirwe neukemia inowanzova chirwere chevanhu vakwegura uye isingazivikanwi vasati vava nemakore makumi mashanu nemashanu. Avhareji yemakore yemurwere ane AML inenge makore 67.
Zviratidzo zve AML zvinowanzobatana nehutsika hwemunhu huri pasi. Apo masero emukemukemia anotora pamusoro pemafupa emapfupa, anobuda kunze kwemasero masero ekugadzira ropa, zvichikonzera kushaiwa kweropa rako. Kushayikwa kwemasero matsvuku eropa kunotungamirira ku chirwere chekushaya ropa uye zviratidzo sekushaya simba uye kuneta zvakanyanya. Kushayikwa kwemasero matsvuku eropa kunotungamirira ku-neutropenia, zvichida nezviratidzo zvakadai sefivha uye utachiona. Kushayikwa kweplatelets kunotungamirira ku thrombocytopenia uye zviratidzo zvakadai sekubuda ropa kusina kujairika kana kuputika . Uye kuwirirana kwezviratidzo izvi zvakajairika.
Mukuongororwa kwe AML, kune zvisiri izvo mukuongorora kweropa; asi, kusiyana nekuonekwa kweCLL, mafupa emafuta anoshuva / biopsy inowanzodiwa kuongorora uye kuongorora AML. Zvizhinji zvakasiyana- siyana zve AML zvino zvinozivikanwa kuvapo.
Mushure mekunge AML ichicherechedza, pamwe chete neboka rako rekuchengetedza utano, unova nechinangwa chezvinangwa zverapi, uyewo nemigumisiro yemishonga. Vanenge hafu yevakuru vakwegura vaAml vanoenda mukuregererwa mushure mekutanga kurapwa, maererano neAmerican Cancer Society. Vanhu vanobudirira kuregererwa kwakakwana vane unhu hunovandudzwa hwehupenyu huenzaniswa nevarwere ivavo vanogadziriswa kurapwa, zvichida nekuda kwezvipatara zvishoma, kuwedzerwa ropa, nemishonga inorwisa mabhakitiriya. Nguva refu-refu AML vakapona vanomiririrwa mumapoka ose emakore; zvisinei, kudzoka shure kwekurapa kwokutanga kwakanyanya. Kazhinji, varwere vane AML vanokurudzirwa kunyoresa mumakiriniki ekuedza kuti vashandise maitiro matsva ekurapa uye kusanganiswa mune tariro yekuvandudza zvavanoita.
Kuvatana vakwegura avo vasina kusimba kana kazhinji kana vachirwara zvikuru, kana kuti vane hutachiwana hwekushanda, dzimwe nguva kutarisirwa kunotsigira uye / kana kushandiswa kwakanyanya kwemakemikrasi kunosarudzwa. Kunyatsotsigira kunosanganisira kuwedzerwa ropa, antibiotics, nemamwe mishonga inobatsira hutano hwemunhu asi isingabvise kenza.
> Sources:
> America Society of Hematology. Kurapa kwevakwegura vakwegura vane chirwere chinokonzera chirwere chinonzi myeloid leukemia.
> Chiorazzi N, Rai K, Ferrarini M. Chronic Lymhocytic Leukemia. N Engl J Med. 2005; 352: 804-15.
> NCCN Mirayiridzo. Chronic Lymphocytic Leukemia. Shanduro 1. 2016.