Kumirira, Chemotherapy, Monoclonal Antibodies, kana kuti Stem Cell Transplant for CLL
Ndezvipi zvirongwa zvakanakisisa zvechirwere lymphocytic leukemia (CLL)?
Kudzokorora kweL Chronic Lymphocytic Leukemia (CLL)
Kana iwe uchiziva nezvezviratidzo uye ngozi dzeCLL , uye wapfuura nehutachiona uye staging yeCLL iwe unenge wakagadzirira kutora danho rinotevera. Mushure mezvose, wakanzwa zvakawanda pamusoro pemishonga yakasiyana-siyana inowanikwa nekenza.
Zvinosuruvarisa kuti panguva ino hapana chirwere chinonzi chinoporesa chronic lymphocytic leukemia (CLL). Asi kunyange pasina mushonga, vamwe vanhu vanogona kurarama kwemakore uye kunyange makumi emakore vane chirwere. Penguva ino, kurapa kunotungamirirwa nekupa varwere vane zororo kubva kune zviratidzo zvavo, vane tarisiro yekuvimbisa hupenyu hwakanaka hwehupenyu uye kuregererwa kwenguva refu.
Rinda uye Mirira
Varwere vasina kuona zviratidzo zve CLL, zvakadai seusiku kuputika, fever, kuora muviri, anemia (aine tsvuku dzeropa rekuverengera,) thrombocytopenia (low platelet counts) kana kuti zvirwere zvinowanzoitika hazvibatsiri pakurapa. Kurapa panguva ino muhosha yacho hakuzowedzereri hupenyu hwako, uyewo hazvizoperi kukura kweukwepa yako. Nokudaro, nzira ye "kurinda-uye-kumirira" inowanzoitwa. Mamiriro ekurinda-uye-kumirira, iwe uchange uchiteverwa nehutemikari kana kuti oncologist uye unoda kuva nebasa reropa uye kuonekwa neunyanzvi hwako mwedzi mitanhatu kusvika kune gumi nembiri.
Pakati pekushanyira, iwe uchada kubhadhara zviratidzo zvekuti kenza yako inogona kufambira mberi. Unogona kuona:
- Kuchengetedza mukati mako lymph nodes
- Kushungurudza pamuviri kana kurwadziwa
- Zviratidzo zveanemia zvakadai seganda rakasviba uye kunzwa kuneta zvakanyanya
- Kuramba uine zvirwere kana utachiona hunongoramba huchienda
- Matambudziko ekubvisira kana kuti kupwanya nyore
Varwere vazhinji vanogona kuramba vakarinda uye vakamirira makore vasati voda kurapwa kweCLL yavo . Zvinogona kuva zvakaoma kwazvo kuziva kuti une kenza, saka "kumirira kuti iwedzere" usati waita. Iwe unganzwa sokuti iwe unongoda kurwisa iro reyemia uye kuitora nayo!
Kunyange zvazvo zvingava zvakaoma kuva nemwoyo murefu, zvakakosha kuti iwe unzwisise kuti kutarisa uye kumirira ndiyo inowanikwa apo CLL haina kuratidza zviratidzo. Kutsvakurudza kusvika apa hakuna kuratidza chero kubatsirwa kutanga kutanga kurapwa kare.
Chemotherapy
Kwenguva yakawanda, muromo chemotherapy neLeukeran (chlorambucil) yaiva yemhando yekurapa kweCLL kana kenza yakatanga kufambira mberi. Kunyange zvazvo varwere vakawanda vakaita zvakanaka kwazvo pamusoro pekurapa uku, hauna kupa mhinduro yakakwana (CR) kakawanda. Mazuva ano, chlorambucil inoshandiswa chete kune varwere vane zvimwe zvinetso zvehutano izvo zvinovadzivirira kubva pakuwana simba, zvinodhaka zve chemotherapy.
Munguva pfupi yapfuura, Fludara (fludarabine) chemotherapy yakaratidzwa kuva yakakosha mukurapa kusatorwa uye zvakare kudzorerwa CLL. Yakagadzirisa CR uye kupfuurira-kusina-kuponeswa kwehupfumi (PFS) kana ichienzaniswa neklorambucil, asi zvisati zvave zvichange zvisingaratidzi mukana muhupenyu hwehupenyu hwose (OS) paishandiswa chete.
Imwe mishonga inobva kumhuri imwe chete, Nipent (pentostatin,) yakashandiswawo sechikamu chechirwere cheLLL.
Kuvandudzika kwechokwadi muCLL kurapa kwakaitika apo Cytoxan (cyclophosphamide) yakawedzerwa pamwe chete ne fludarabine therapy. Kushandisa iyi regimen ("FC" kana "Flu / Cy"), kupindura kwekurapa kwakawedzerwa sezvinoratidzwa neC CR, PFS, uye OS. Kunyange zvazvo kubatanidza mishonga iyi pamwe chete kunokonzera kuwedzera kwehuwandu hwehutachiona, hahuratidzi hunoita kuti pave nehuwandu hwehutachiona hwakanyanya.
Monoclonal Antibodies
Zvakagadzirwa muLLL therapy zvakave zvichivandudzwa nekuwedzera kwekuchengetedzwa kwemaronda anonzi monoclonal.
Monoclonal antibodies inonyanya kurwisa masimba anokonzera kenza. Kunyange iwe maune immune system anoona mapuroteni asina kukwana ari pamusoro pebhakitiriya kana kuti hutachiona, mishonga iyi "inoziva" zvisingaiti zvachose pamusoro pekenza masero. Kuwedzerwa kwe monoclonal antibody Rituxan (rituximab) kune regimen ("FCR" protocol) yakapa vanhu vane CLL mhinduro ye 90% uye 96% uye CR ye 50% inosvika 70%.
Imwe nyanzvi inonzi monoclonal antibody, Campath (alemtuzumab) yakagamuchirwa neU.S. Food and Drug Administration (FDA) iyo inoshandiswa mukurapa CLL. Iyo inotarirwa kune imwe sero remasero antigen "marker" kupfuura rituximab, uye inogona kushandiswa pachayo kana inosanganiswa nekemotherapy.
Cell Cell Stp Transplant
Mune mimwe yemhando yekenza yeropa, tsvakurudzo yakawanda yakaitwa kuitira kuenzanisa migumisiro yekupona kwevarwere vanowana chemotherapy, pamusoro pe stem cell transplant . Sezvo muvhareji wemakore emurwere weLLL achangobva kuongororwa uri pakati pemakore makumi matanhatu nemazana makumi matanhatu nemakore makumi manomwe, zvichiwanzokwegura zvekare kuti zvionekwe somunhu anokwidziridzwa, izvi zvidzidzo hazvina kuitwa pamusoro pevanhu ava.
Sezvo ataura izvozvo, 40% yeVACL varwere vari pasi pemakore makumi matanhatu uye 12% vari pasi pezera remakore makumi mashanu. Stem cell transplant inogona kupa mukana wekuporesa kuvarwere vaduku vechiLL vane chirwere chisina kunaka.
Allogeneic stem cell transplant (kushandiswa achishandiswa mashandisi emasero masero) anoshandisa zvakanyanya kukwirira kwemakemikrasi kuti arapwe neukemia uye anopiwa masero ekudzivirira kugadzirisa zvirwere zvemurwere. Kubatsira kune allogeneic stem cell transplant ndeyokuti kunyange zvazvo inogona kuva yakanyanyisa, inogona kukonzera "kubatanidzwa-ne-leukemia". Ichocho, kuti zvipo zvinokonzerwa nemasero anoona masero eukemia seasina kurwisa uye kuvarwisa.
Kunyange zvazvo matanho aya ari kuwedzera zvinoshamisa, kune zvimwe zvipingamupinyi zvikuru mu 15 kusvika ku25 muzana yevarwere, imwe inobatanidzwa nehuwandu hwechirwere umo mhuka dzinopa ruzivo dzinoziva kuti varwere vane mazamu kune dzimwe nyika uye vanotanga kurwisa.
Nemhaka yezvinokonzerwa nemagumisiro emagumisiro e-allogeneic stem cell transplant, haasi kuratidzirwa kuvandudza migumisiro kuvarwere vakwegura.
Pari zvino, tsvakurudzo yekutsvaga basa rekusaita mitoablative , kana kuti "mini" kuenderera muCLL iri kuitika. Zvisizvo zvisingaiti myeloablative transplants zvinotsigira zvishomanana nezvehuwandu hwehuputi hwechemotherapy uye zvizhinji pamusoro pe "kubatanidzwa-ne-leukemia" inobudirira kubata chirwere. Izvi zvinogona kupa chirongwa chekurapa kune vanhu vakwegura vasingakwanisi kubvumira chimiro chekushandiswa kwechigadzirwa cheallogeneic.
Autologous stem cell inoshandiswa mukurapa kweCLL yakaratidza maitiro asina kunaka uye yakawanda yezvirwere zvekare zvakare, dzimwe nguva kunyange makore mushure mekugadzirwa. Kunyange zvazvo zvingave zvakaderera kutyisa, autologous transplant haisi yakakosha mukurapa CLL pane kusinga-myeloablative therapy . Somugumisiro, autologous transplant haisi inowanzokurudzirwa kuvarwere veCLL.
Radiation Therapy
Mune varwere vane CLL, kushandiswa kwemishonga inonzi radiation kunongopedzisira kugadzirisa zviratidzo. Inogona kushandiswa kugadzirisa nzvimbo dzakarema lymph nodes dzinokonzera kusagadzikana kana kupindira nekufambisa kana kushanda kwenhengo dziri pedyo.
Splenectomy
Kune varwere vari kuwana chirwere chakawedzerwa nekuda kwekuunganidza kweCLL masero, splenectomy , kana kubviswa kushandiswa kwepleen, zvingangotanga kubatsira kubatsira kuwedzera kuwedzerwa kweropa uye kubvisa zvimwe zvinorwadza. Sezvakaita neradio yemahara, splenectomy inoshandiswa kubatsira kutarisa zviratidzo zvechirwere uye hahupi kupa mushonga weukemukari.
Kuisa pfungwa yacho kumusoro
Panguva ino, apo kurapwa kweCLL kunogona kukwanisa kupa varwere vane ruregerero rwechiratidzo nekudzivirira kweukwepa hwavo, haigoni kupa chirwere, uye iyo chirwere chacho chinopesana zvikuru pakati pevanhu vakasiyana. Zvisinei, kunzwisisa kwatinoita rudzi urwu rwakasiyana-siyana rweukemia rinoramba richiwedzera. Kushandiswa, somuenzaniso, we stem cell transplants kune vanhu vane CLL vakagadziriswa zvinoshamisa munguva ya2006 kusvika muna 2016. Ongororo dzekutsvakurudza dzicharamba dzichifambira mberi uye dzinogona kupa kurapwa nekutora nguva kwenguva refu kana kurapa kweCLL.
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