Myelodysplastic syndrome, kana MDS, inosanganisira zvinetso zvakasiyana-siyana zvinokanganisa marora emashonga ari kushanda. Bone marrow inogadzira masero matsvuku eropa, masero machena uye maplatelets okuvhara, marora maroro basa rinogona kutungamirira kune chirwere chemahyamu, pasi mashoma, uye mamwe matambudziko.
Zvinonyanya kukosha ne MDS ndezvi) izvi zvakaderera uye zvinetso zvose zvinosangana; uye b) mukana we MDS kuchinjwa kuva kenza - yakaoma myeloid leukemia , kana AML.
Mhando dzakasiyana dzeMDC dzinobatwa zvakasiyana zvakasiyana. Hasi mapepa ose e MDS akakodzera kune varwere vose vane MDS. Zvasarudzwa zvekutora MDS zvinosanganisira kutarisira kutsigira, kupera-simba kwepachirapa, high-intensist therapy, uye / kana kliniki miedzo.
Kurapa Kufungidzirwa
Paunenge uchikurukura chirongwa chako chekurapa kwe MDS nechiremba wako, izvo zvinonzi zvinonzi murwere-zvine chokuita zvinogona kuva zvakakosha zvikuru. Mienzaniso yezvido zvinoshushikana zvinosanganisira zvinotevera:
- Waive uchiita sei pamwe nemabasa ezuva nezuva musati wanyatsoongorora MDS
- Zvimwe zvehutano mamiriro ako
- Zera rako
- Mari yekubhadhara kwemari yakasiyana-siyana
- Ndezvipi ngozi dzekurapa zvinogamuchirwa kwauri
Unhu hwehupenyu hwako hweMDC hunokoshawo. Mienzaniso yezvichemo uye zvitsva zvinosanganisira zvinotevera:
- Zvikwereti nemigumisiro yekuongororwa kwemafupa emapfupa ako, ayo anobatsira kutsvaga zvingasarudzwa kwauri, mukana wako wekuti MDS yako ichafambira mberi kuhuukema , uye zvii zvingatarisirwa kubva kune dzimwe nzira dzokurapa.
- Kuti MDS yako inobata sei nhamba yemasero ane utano muropa rako rinopararira
- Iyo yakaoma sei chirwere chako maererano nehuwandu hwekusava nemafuta "kukurumidza" masero mumuro wako
Zvinangwa zvako kune zvaunoda kubva kunze kwechirwere zvinosanganisirawo muurongwa. Mienzaniso yezvinangwa zvakasiyana-siyana zvekurapa inosanganisira zvinotevera:
- Kungonzwa kunzwa zviri nani
- Ita kuti uwedzere kudiwa kwako kuti uwedzere kuwedzerwa ropa
- Kuvandudza ropa rako, neutropenia , uye thrombocytopenia
- Ita ruregerero
- Kuporesa MDS yako
Rinda uye Mirira
Kune varwere vane dambudziko rakanyanya MDS sezvinotsanangurwa neInternational Prognostic Scoring System, kana IPSS, uye yakagadzikana yakazara nhamba yeAIDS (CBC) , dzimwe nguva nzira yakanakisisa yekurapa ndeyokucherechedza uye kutsigirwa, sezvinodiwa.
Muchiitiko ichi, iwe unoda kuongororwa nekuda kwekuchinja mumarora ako angaratidza kufambira mberi kwechirwere. Nguva dzose CBCs, pamwe chete nemafuta emafuta aspirate uye biopsy , inogona kuva chikamu chekuongorora.
Kutsigira Kunotsigira
Kutarisira kunotsigira kunoreva kurapwa kunoshandiswa kurapa uye kutarisira MDS; idzi kurapwa zvinogona kuchinja zvikuru mamiriro ehupenyu hwevanhu, asi dzinomira pfupi pakurwisa masero anokonzera MDS.
Transfusions
Kana ropa rako rinotanga kuwira uye iwe uine zviratidzo, unogona kubatsirwa nekuwedzerwa kwemasero matsvuku eropa kana maplatelet. Chisarudzo chekuwedzerwa ropa chinoenderana nemamwe mararamiro aunayo uye kuti uri kunzwa sei.
Iron Overload uye Chelation Therapy
Kana iwe uchitanga kudikanwa kuwedzerwa kuwedzerwa ropa mwedzi woga woga, unogona kunge uri pangozi yekugadzirisa chirwere chinonzi iron inowedzera.
Izvo zvakakwirira masimbi muropa tsvuku rekuisira ropa zvinogona kukonzera kuwedzera mune zvese zvakachengetwa mumutumbi wako. Kukwirira kwakadaro kwesimbi kunogona kukuvadza nhengo dzako.
Vanachiremba vanogona kubata uye kudzivirira dare rinorema kubva pane kuwedzerwa ropa nekushandisa mishonga inonzi iron chelators, iyo inosanganisira chirwere chinonzi oral, deferasirox (Exjade), kana inonzi inferoxamine mesylate (Desferal). Dzidzira mazano neNational Comprehensive Cancer Network, kana NCCN, inopa zvinogona kuitwa nachiremba wako kuti asarudze kana uchida iron chelation therapy.
Kukura Kwezvinhu Vamwe vanhu vane MDS anemia vanogona kubatsirwa nekuwana kukura kwezvinhu zvinoshandiswa mishonga inonzi erythropoietin stimulation agents kana mapuroteni (ESAs).
Mienzaniso yeESAs inosanganisira epoetin alfa (Eprex, Procrit kana Epogen) kana nguva yakareba darbepoetin alfa (Aranesp). Iyi mishonga inopiwa sejekisi mumafuta ako (subcutaneous injection). Kunyange zvazvo mishonga iyi isingabatsiri vose varwere veMDC, vanogona kubatsira kudzivirira kuwedzerwa ropa kune vamwe.
Chiremba wako angakupa kuti atange iwe pa- colony inokurudzira chimwe chinhu , chakadai seG-CSF (Neupogen), kana GM-CSF (leukine) , kana sero rako rega rega rega richiva rakaderera semubairo we MDS yako. Zvinhu zvinokonzera Colony-zvinosimudzira zvinobatsira kukurudzira muviri wako kuti uwane hutano huri kurwisa masero machena eropa anonzi neutrophils. Kana yako neutrophil yakawanda yakaderera, iwe uri pangozi yakakwirira yekudzivirira utachiona hunotyisa. Ramba uchinge wakatarisa chero zviratidzo zvehutachiwana kana fever, uye ona mutapi wehutano nokukurumidza kana zvichibvira kana iwe uine hanya.
Low-Intensity Therapy
Kuderedza-kupisa kwemaitiro kunoreva kushandiswa kwekatsika-kemikemikari kana majaira anozivikanwa sebiologic response modifiers. Aya maitiro ekurapa anonyanya kugoverwa mumararamiro ekurapa, asi mamwe acho angada kutarisirwa kuchengetwa kana kuti pane imwe nguva muchengeti mushure mekunge, somuenzaniso, kubata chirwere chinoguma.
Epigenetic Therapy
Rimwe boka remishonga inonzi hypomethylating kana demethylating agents ndiyo zvombo zvitsva mukurwisa MDS.
Azacitidine (Vidaza) yakagamuchirwa neDFA kuti ishandiswe muFrench-American-British (FAB) nekugadzirisa uye zvose zvePSS zvinokonzerwa nezvikamu zve MDS. Iyi mishonga inowanzopiwa sechikamu chemajasi kwemazuva manomwe mumutsara, mazuva ese makumi mana nemasere kusvika makumi mana. Zvidzidzo zveAzacitidine zvakaratidza mhinduro dzemapato makumi matanhatu kubva muzana, uye inenge 23 muzana yekuwana kusarura kana kukwana kuregererwa kwechirwere chavo. Azacitidine kazhinji inokonzera kudonha kwekutanga mumasero emuviri kunogona kuti haukwanisi kudzoka kusvikira mushure mokutanga kana maviri maitiro.
Imwe yerudzi rwe hypomethylating agent inoshandiswa mukurapa kweMDC ndeye decitabine (Dacogen). Izvo zvakafanana pakugadzira azacitidine, zvakare FDA inogamuchirwa kune marudzi ose e MDS. Mishonga yekurapa yaiwanzobatanidzwa nechepasi-simba-type toxicities, uye saka inofungidzirwawo kuti yakadzika-yakasimba kurapwa. Decitabine inogona kupiwa mukati kana pasi. Chimwe chidzidzo umo decitabine yakapiwa intravenously kwemazuva mashanu yakaratidza kuregererwa kwekuregererwa kwemazana anenge 40 muzana. Mamwe mapepa ekurapa ari kuongororwa.
Immunosuppressive Therapy uye Biologic Response Modifiers
Mu MDS, masero matsvuku eropa, masero emachena eropa uye maplatelets anourawa kana kufa asati vasvika pakukura zvakakwana kuti vasunungurwe kubva mumapfupa emapfupa kusvika mune ropa. Mune zvimwe zviitiko, lymphocytes (rudzi rwemuchena weropa rega) ndiro rinoita izvi. Kune varwere ivavo, zvinogona kunge zvakashandisa kushandiswa kwerapi inobatsira maitiro ezvirwere zvemuviri.
Non-chemotherapy, low-intens agent (biologic response modifiers) vanosanganisira anti-thymocyte globulin (ATG), cyclosporine, thalidomide, lenalidomide, anti-tumor necrosis factor receptor fusion protein, uye vitamin D yakafanana. Zvose izvi zvakaratidza zvishoma mumatambudziko ekutanga, asi vazhinji vari kudiwa mamwe majekiseni emakiriniki kuti vanzwisise kubudirira mumhando dzakasiyana dzeMDC.
Vanhu vane rumwe rutivi rweMDC runonzi 5q-syndrome, umo maine chiremera chema genetic mu chromosome 5, inogona kuva nemhinduro kumushonga unonzi lenalidomide (Revlimid). Kazhinji, lenalidomide inoshandiswa kune varwere vane chirwere chakaderera kana chakadzika-pasi pePSS ngozi MDS iyo inopa ropa rekuisira ropa. Mune zvidzidzo zve lenalidomide, varwere vazhinji vakange vaita kuderedza kuwedzerwa ropa-inoda makumi manomwe kubva muzana, chaizvoizvo-asi vakaramba vachiwana pasi shorelet uye neutrophil nhamba. Kubatsirwa kwekutapira dambudziko reMDC, kana subtypes kunze kwe 5q- syndrome ne lenalidomide vachiri kuongororwa.
High-Intensity Therapy
Chemotherapy
Vamwe varwere vane ngozi yakanyanya MDS, kana FAB mavara RAEB ne RAEB-T, vanogona kurapwa nemakemikrasi yakasimba. Ichi chemotherapy, iyo iyo iyo iyo inoshandiswa mukurapa kwemazwi akaremara eyelogenous leukemia (AML), inotarisira kuparadza huwandu hwemasero asina kukwana mumusepa wepfupa unotungamirira kuMDC.
Kunyange zvazvo chemotherapy inogona kubatsira kune vamwe varwere veMDC, zvinokosha kufunga kuti varwere vakwegura vane mamwe mararamiro vanotarisana nezvimwe zvinetso. Izvo zvingave zvinobatsira zverapi iyo inofanira kupfuurira kune ngozi inobatanidzwa.
Kutsvakurudza kuri kuramba kuchienzaniswa nemigumisiro yemakemikrasi yakasimba pamusoro peazacitidine kana decitabine.
Cell Cell Stp Transplant
Varwere vane ngozi yakanyanya IPSS MDS vanogona kukwanisa kurapwa kwechirwere chavo ne allogeneic stem cell transplantation . Zvinosuruvarisa, hutsika hukuru hwekuita izvi hunogumira kushandiswa kwayo. Ichokwadi, allogeneic stem cell transplant inogona kuva nehutano hwehutano hwehutano hunosvika 30%. Nokudaro, kurapwa uku kunowanzoshandiswa chete kuvarwere vaduku vane utano hwakanaka.
Zvidzidzo zvemazuva ano zviri kutsvaga basa rekusava myeloablative inonzi "mini" kuenderera kune vatana vakwegura vane MDS. Kunyange zvazvo aya maitiro ekutsvaga akagara achifungidzirwa seasingasviki kudarika kufanana kwemazuva ose, kupera kwavo kuderedzwa kunogona kuvaita sarudzo kune varwere avo vangave vasina kukodzera.
Summary:
Nemhaka yemhando dzakasiyana dzeMDC uye marudzi akasiyana-siyana emarwere, hapana humwe hukuru-hunokodzera-zvose zvinorapwa. Saka zvakakosha kuti varwere ve MDS vataure zvose zvingasarudzwa neboka ravo rezvehutano, uye vowana rubatsiro ruchavapa zvakanakisisa zvinobatsira nehuwandu hwehuwandu hwehutachiona.
Mishonga yemakiriniki nemishonga mitsva ye MDS iri kuenderera mberi, saka gara uchiona. Somuenzaniso, ruxolitinib (Jakafi) iri kuongororwa kuti kurapwa kwevarwere vane chirwere chakaderera kana chepakati-1 cheMDC.
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