Chaka chilichonse, kupita patsogolo kwa mankhwala ndi zamakono kumabweretsa njira zatsopano zopezera khansa ya m'magazi ndi lymphoma komanso kuthandiza anthu omwe ali nawo kale kapena akudwala. Nthaŵi zina, kupita patsogolo koteroko kumangosintha pa njira zamakono, pamene ena amaimira zamakono zamakono komanso njira zina zomwe zimakhala zovuta.
Zotsatirazi ndizowonjezereka zinayi zomwe zikufufuzidwa ndi khansa ya khansa ya m'magazi ndi lymphoma yomwe imachokera ku njira zosiyanasiyana zofukufuku mu 2017.
1. Chojambulidwa
Rituximab , katswiri wa ma laboratory omwe amagwiritsa ntchito ma laboratory monoclonal, wakhala mmodzi mwa miyala yamakono ya mankhwala enaake omwe si a Hodgkin. Mafupa amatha kukhala m'magulu awiri, Hodgkin ndi osakhala Hodgkin, kapena NHL.
Rituximab yasonyeza kuti imagwiritsira ntchito mafotokozedwe ena a mitundu iŵiri yofala kwambiri ya NHL :
- Follicular lymphoma
- Kuphwanya lalikulu B-cell NHL (DLBCL)
Rituximab imasonyezanso kuti imagwiritsa ntchito pazinthu zina za matendawa:
- Lymphocytic khansa ya m'magazi
- Matenda a nyamakazi
- Wegener granulomatosis
- Microscopic polyangiitis
- Immune thrombocytopenic purpura (ITP)
- Pemphigus vulgaris
Wothandizira Tethered
Ndi ntchito zonsezi, komanso ndi rituximab mankhwala otchukawa ku NHL, opanga mankhwala akhala akuyang'ana rituximab kuti awone ngati angatembenuke kuchokera kuchipatala cha IV (IV) chomwe chingaperekedwe ngati kuwombera.
Ngati munakhalapo wodwalayo akusowa mankhwala a IV, ndiye kuti mumadziwa kupempha mankhwalawa kwa chinachake chimene chingaperekedwe ngati kuwombera.
Pamene rituximab imaperekedwa mwakachetechete, mumagwiritsa ntchito thumba la pulogalamu ya IV, ndipo kufufuza pamagudumu ndi chikwama chake kumakhala "wokondedwa wanu" kwa maola angapo otsatira kapena kuposa.
Kawirikawiri izi zikutanthawuza kuti, ngati mukuyenera kupita ku bafa, muyenera kuyendetsa bwenzi lanu limodzi ndi inu. Nthawi zina, pangakhale kukhumudwitsa ndi kuwamva phokoso likuchokera ku makina a IV pamene mukuyesera kuwerenga, penyani TV kapena mutenge maganizo anu. Kwa odwala omwe ali ndi khansa ya magazi, maola ochulukirapo ambiri omwe angakhale akugwiritsidwa ntchito kale, ndiye kuti chilichonse chomwe chimathandiza kuchepetsa vutoli chimavomerezedwa.
Njira Yatsopano
Kulinganiza kwatsopano kumeneku ndikusakaniza kwa rituximab ndi chinthu chotchedwa hyaluronidase, chomwe chimathandiza kupereka mankhwala pansi pa khungu. Chivomerezo cha US chikuyembekezeka chilimwe 2017, ndipo chivomerezedwa kale ku Ulaya. Mukapatsidwa pansi pa khungu, likhoza kuperekedwa maminiti asanu kapena asanu, poyerekeza ndi ola limodzi ndi theka kapena kuposerapo kwa intravenous rituximab. Kafukufuku wambiri wasonyeza kuti kusintha kwatsopano kwa rituximab komwe kumatulutsidwa pansi pa khungu ndi kotetezeka ndipo kumagwira ntchito pamodzi ndi rituximab yowonongeka, zomwe zimayambitsa magawo ofanana ndi mankhwala m'magazi. Injected version yavomerezedwa ku European Union kuyambira 2014. Ngati FDA ikuvomereza, IV rituximab idzapitirira kupezeka kwa odwala a ku America.
2. Kachipangizo kakompyuta ka Acute Myeloid Leukemia
Kodi sizingakhale zabwino ngati madokotala angadziwe amene angabwererenso atachiritsidwa ndipo ndani angakhululukidwe?
Eya, ochita kafukufuku omwe amathandizidwa ndi National Cancer Institute, komanso mabungwe ena angapo, akuchita zomwezo, pogwiritsa ntchito makompyuta.
Mitsempha Yambiri ya Myeloid Leukemia
Mitsempha yambiri ya myeloid (AML) ndi mtundu wa khansa ya magazi imene maselo oyera amagazi amadzimadzi amamera mwamsanga m'mafupa ndipo amalepheretsa kupanga maselo achibadwa. Pali mitundu inayi ikuluikulu ya khansa ya m'magazi - ma leukemia awiri ovuta, kapena omwe akukula mofulumira, ndi 2 aakulu, kapena kukula mofulumira. AML ndi yofala kwambiri , kapena kukula kwa khansa ya m'magazi mwa akuluakulu. AML ndiyo yachiwiri ya khansa ya m'magazi mwa ana, ndipo khansa ya m'magazi, makamaka, ndi khansa yambiri ya ubwana.
Kufufuza kwadongosolo
Kupanga matenda a AML kumafuna kudziwa zotsatira za mayeso ena a ma laboratory, kuphatikizapo zizindikiro za matenda omwe angakhalepo. Izi zimaphatikizapo chinachake chotchedwa cytometry yothamanga, njira yowerengera ndi kupanga tinthu tating'onoting'onoting'ono ting'onoting'onoting'ono ting'onoting'onoting'ono ta madzi; Panopa, maselo a khansa ya m'magazi ndi zizindikiro zawo, mapuloteni ndi mapuloteni omwe amatha kukhala othyoka ngati mbali za maselo. Kusanthula deta kuchoka ku cytometry kungakhale nthawi yambiri.
Lowani: Ophweka Amakompyuta
Ofufuza kuchokera ku yunivesite ya Purdue ndi Roswell Park Cancer Institute akhala akugwiritsa ntchito makina othandizira makina omwe angathandizire kutsogolo, ndipo amakhulupirira kuti akhoza kutulutsa mfundo kuchokera ku deta kuposa anthu.
Kuphunzira makina kumatanthawuza nthambi ya sayansi yomwe imagwiritsa ntchito makompyuta kuti iwonjezeke pazinthu zina zomwe zakhala zikukonzedwa kapena zowonongeka kupyolera mu "zochitika," popanda kukonzedwa bwinobwino kuti zichite. Gululi linanena kuti likhoza kugwiritsa ntchito deta yamtundu wa cytometry kuti liwonetsetse zotsatira zazomwe zimakhalapo pakati pa 90 ndi 100 peresenti.
3. Kusasuntha Kwambiri Kufufuza Kubwereza
Gawo la odwala onse omwe ali ndi Hodgkin lymphoma ndi yaikulu B-cell lymphoma (yomwe imakhala yofala kwambiri osati ya Hodgkin lymphoma) idzabwereranso ndipo imafuna thandizo linalake. Chifukwa cha chiwerengerochi, kodi odwalawo ayenera kuyesedwa kangati kuti awonetsetse kuti khansayo siinabwerere?
Bwanji Osayesa Kujambula? Kuli Bwino Kwambiri Kusiyana ndi Pepani
Ngati kujambula kachitidwe kachitidwe kachitidwe kawiri kawiri kamatha kuyambiranso kumayambiriro, pamene palibe zizindikilo, ndipo ngati izi zimapangitsa kuti odwalawo apulumuke, izi zikhoza kukhala zabwino, koma pali mafunso ambiri omwe alibe yankho m'dera lino.
Pamwamba, zikuwoneka kuti ndibwino kuti anthu omwe adachiritsidwa kuti apeze matendawa, azionetsetsa kuti khansayo siidabwerere. Izi ndi zoona, koma kumbali ina ya equation, miyendo yomwe ilipo kuchokera kumalo oterewa imayambitsa chiwonongeko chachiwiri. Simungafune anthu omwe ali pachiopsezo chachikulu, omwe matenda awo adatulutsidwa ndi mankhwala othandiza, kuti awonongeke mobwerezabwereza, kuwawonetsa kuti awonekere, akuyang'ana kubwezeretsa komwe sikungayambe kuchitika. Kuganiziranso kwina ndikuti zinthu zabodza zimachitika. Malingana ndi kafukufuku waposachedwapa, kachigawo kakang'ono ka odwala amayenera kuthana ndi zotsatira zowonongeka, zomwe zimabweretsa nkhawa yowonjezera komanso thandizo lachipatala.
Ofufuza kuchokera ku yunivesite ya Emory ndi ochokera ku chipatala cha Mayo posachedwapa atulutsa zotsatira kuchokera ku kafukufuku omwe adachita pofuna kufufuza ena mwa mafunso awa. Iwo adayang'ana momwe polojekitiyi ikuyendera ndikubwezeretsanso zomwe zimapangitsa kuti odwala omwe ali ndi Hodgkin lymphoma kapena DLBCL asakhale Hodgkin lymphoma. Kawirikawiri, iwo adapeza kuti njira zamakono zojambula zowonongeka siziwonekeranso nthawi zambiri asanatuluke zizindikiro kapena kuti apulumuke.
Kuzindikira Matenda Oopsa Kwambiri
Izi zikuti, si anthu onse m'magulu omwe adafufuzidwa mu phunziro ili ali pangozi yomweyi yobwereranso. Kotero, izo zikukweza funsoli, ndi magulu ati a odwala omwe ali ndi chiwopsezo chokwanira chobwezeretsanso kuti phindu la kufufuza kachitidwe kachitidwe kawiri kawiri lingadwale zoopsa? Ofufuza apeza kuti maphunziro otsogolera m'tsogolomu ndi ofunikira kuti awonetse ngati kuwerengera kanthawi koyenera kubwereza kungapindulitse mukasankha odwala oyenera kuwunika, omwe amatchedwa "anthu osankhidwa kwambiri."
Pakalipano, gulu lino la ochita kafukufuku linawona kuti ndilolondola kwa odwala omwe ali ndi DLBCL ndi zidziwitso zapamwamba zoopsa-kuphatikizapo International Prognostic Index (IPI) ya 3 mpaka 5-kuti azindikire zochitika payekha pokhapokha atakambirana za ngozi ndi phindu komanso kudziwa kuzindikira koyambirira kwa kubwereranso sikukunatsimikizidwe kutsimikizira kupulumuka.
4. Chithandizo cha Nano-CAR-T
Kwa odwala khansa ya magazi ndi okondedwa awo, pali chisangalalo chokhudzana ndi mankhwala a CAR-T. Mapulogalamu atsopano ophatikizapo mankhwala a CAR-T amavomerezedwa kawirikawiri, amawonekera tsiku lililonse.
About Cells CAR-T
T-maselo ndi mtundu wa maselo a mthupi omwe tonse tili nawo mthupi lathu. Amadziwika bwino monga T-lymphocytes, mtundu wa selo loyera la magazi. T-maselo ali ndi mapulogalamu pa malo awo, otchedwa T-cell receptors, kapena TCRs. Ma TCRswa amamanga ma antigen kwa othawa kunja kapena maselo oopseza, monga maselo a kansa, kumathandiza thupi kuti likhale ndi chitetezo cha mthupi, kuti limenyane ndi vutoli.
Pamene T-maselo amagwiritsidwa ntchito pa kansa ya khungu la CAR-T, amayamba kusonkhanitsidwa pamwazi wa wodwalayo. Kenaka, mu labotale, T-maselo amasinthidwa kuti apange mapepala apadera pamtunda wawo wotchedwa chimeric antigen receptors, kapena CAR, zomwe zimatha kumanga mapuloteni ena apadera a maselo a khansa. Maselo a T omwe ali ndi CAR awo amatha kuyambitsa matenda a khansa, kamodzi akabwezeretsanso mwa wodwalayo.
Katswiri Wamakono Akuyendera Magulu a CAR-T
Chimodzi mwa ziwalo zovuta kwambiri zokhudzana ndi mankhwalawa zakhala kuti maselo a wodwalayo akufunika kukololedwa, opangidwa kunja kwa thupi, ndiyeno abwezeretsedwanso pokhapokha pali angapo kuti agwire ntchitoyo. Kodi sizingakhale bwino ngati sitepe yanu yamakono idzachitidwe mwamsanga mumaselo anu, mwina ndi zipangizo zamakono zojambulajambula? Limeneli ndilo lingaliro la ntchito ya nanotechnology mu ntchitoyi. Pulojekitiyi ikugwiritsidwa ntchito pogwiritsa ntchito makina ang'onoang'ono kuti apindulitse thupi.
Ochita kafukufuku ku Fred Hutchinson Cancer Center posachedwapa anasonyeza kuti maselo omenyera chitetezo cha maselo amatha kusintha kapena kuchepetsa kukula kwa khansa ya m'magazi m'machitidwe awo a labatayi. Kafukufuku wa "umboni wa mfundo" ndi sitepe yoyamba, ndipo zofukufukuzo zinafalitsidwa mu "Nanotechnology ya Nature." Dr Matthias Stephan, wofufuza m'bungwe lino, adatinso "Kachipangizo kathu ndichokamba kuti timadziwa mwamsanga kuti pulogalamuyi imatha kukhala ndi mawonekedwe a T cell popanda kuwatenga kuti ayambe kugwiritsira ntchito ma laboratory."
> Zotsatira:
> Genentech. Komiti ya uphungu wa FDA imavomereza motsimikiziridwa ndi Genentech's subcutaneous rituximab kwa khansa zina zamagazi.
> Stanford Medicine. Mapulogalamu a pakompyuta amaneneratu zotsatira za odwala khansa ya m'magazi.
> Cohen JB, Behera M, Thompson A, et al. Kupenda chithunzi chowunika cha B-cell lymphoma ndi Hodgkin lymphoma. Magazi. 2017; 129: 561-564.