Kuchokera pa Kafukufuku wa Khansa ya Magazi
Chaka chilichonse American Society of Hematology (ASH) imakhala ndi msonkhano wopereka kafukufuku waposachedwa wa mankhwala ndi chithandizo chamankhwala ena. Mankhwala omwe akukambidwa pamsonkhanowu ali m'mbali zosiyana siyana za chitukuko cha kuchipatala. Mwa kuyankhula kwina, ena mwa iwo ali mankhwala omwe alipo, amayesedwa ndi oona, amavomerezedwa kale ndipo amagwiritsidwa ntchito, ndipo ena alidi kufufuza mankhwala, kutanthauza kuti sitikudziwa zambiri za iwo.
Tengani rituximab, mwachitsanzo. Mu 2016, Rituximab inkaonedwa kuti ndi "mankhwala okalamba" omwe akhala akugwiritsidwa ntchito kwa zaka zambiri kuti athetse mitundu yosiyana ya non-Hodgkin lymphoma. Mankhwala achikulire, omwe amatha kukhazikika angakhoze kupanga mafunde pa imodzi mwa misonkhanoyi, mwachitsanzo, pamene ntchito yatsopano imapezeka.
Mankhwala ena omwe anakambidwa pa ASH ali pa gawo loyamba la chitukuko-ndiko kuti, zomwe zidapezeka zomwe zilipo ndizoyambirira. Kawirikawiri, maphunzirowa akufotokozedwa "magawo-ine maphunziro." Gawo 1 limatchula mayesero am'chipatala omwe amayesa mankhwala kapena mankhwala atsopano pa kagulu kakang'ono ka anthu-nthawi yoyamba kuti aone ngati ikugwira ntchito, kuti apeze mlingo wabwino zamtunduwu, ndi kuzindikira zotsatira zake. Mayesero a Phase I ali ngati mbewu: pamapeto pake mungapeze chomera kapena chipatso chogonjetsa mphoto zomwe mungathe kuziwonetsera pazifukwa za boma, komabe mungathe kuphuka kapena chomera chosabala zipatso zambiri.
Kafukufuku pa DLBCL
Kufalitsa lalikulu B-cell lymphoma, kapena DLBCL, ndi lymphoma yofulumira kwambiri.
Ndilo mtundu wofala kwambiri wa lymphoma mwa akuluakulu, ndipo umachokera ku maselo oyera a B-lymphocytes omwe amachititsa kupanga kachilombo koyambitsa chitetezo cha mthupi. Anthu osiyana ali ndi mitundu yosiyanasiyana ya DLBCL ndipo ofufuza akufufuza njira zatsopano za odwala omwe ali ndi DLBCL .
Rituximab Plus CHOP kapena DA-EPOCH-Rituximab
Phunziro lina lachitatu linakhala ndi odwala 524 omwe analembetsa (262 pa mkono uliwonse wa mankhwala) pakati pa May 2005 ndi May 2013. Kafukufukuyu anayerekeza chithandizo cha R-CHOP ndi mankhwala a DA-EPOCH-R, chithandizo chowonjezereka cha mankhwala a chemotherapy, pokhulupirira kuti adzapulumuka. odwala omwe ali ndi gawo lachiwiri lachiwiri kapena lapamwamba la DLBCL.
Ophunzira anali osachepera zaka 18 ndipo alibe HIV. Pakadali pano, DA-EPOCH-R inagwirizanitsidwa ndi poizoni ndi zotsatirapo zina, ndipo panalibe kusiyana pakati pa maguluwa monga momwe amapindulira mankhwala. Komabe, ofufuzira akuyang'ana kuti awone za magulu angapo a anthu omwe ali ndi DLBCL ndipo ngati angapindule ndi DA-EPOCH-R adzawonetsedwa kwa magulu ang'onoang'ono. Kufufuza kukupitirira.
Obinutuzumab Plus CHOP kapena Rituximab Plus CHOP
Ichi chinali phunziro lina lachitatu ndi anthu 1,418 omwe adawunikira kufunika ndi chitetezo cha obinutuzumab vs. rituximab plus CHOP kwa odwala omwe ali ndi DLBCL. Ophunzira anali ndi zaka 18 kapena kupitilira ndipo sanatengedwenso ku DLBCL. Zonsezi, panalibe kusiyana kwakukulu pakati pa magulu awiriwa mwazinthu zopindulitsa, ndipo zochitika zina zovuta zinafotokozedwa kwa odwala mu obinutuzumab-CHOP kuposa gulu la rituximab-CHOP. Zonsezi, chiwerengero cha anthu omwe amamwalira ndipamwamba kwambiri ndipo amachotsedwa kuchipatala chofala kwambiri mu obinutuzumab -CHOP mkono.
Komabe, ofufuzawo akukonzekera kuyang'ana magulu ang'onoang'ono ndi DLBCL kuti ayese kupeza phindu lililonse kapena zoopsa zomwe sizinawonetsedwe mu gulu lonse.
Lenalidomide mwa Odwala Omwe Awalowanso DLBCL
Anthu omwe sali oyenerera kugwiritsira ntchito mafupa a mafupa kapena akusowa kubwezeretsa pambuyo pakupaka mafuta m'thupi amakhala ndi mwayi wochepa wochiritsidwa, choncho gulu lina la kafukufuku linayang'ana kugwiritsa ntchito mankhwala kuti apitirize kupulumuka mwa odwalawa.
Iwo apeza kuti wothandizira lenalidomide ndi woyenera kulandira mankhwala chifukwa cha mankhwala osokoneza bongo, omwe akugwira ntchito motsutsana ndi DLBCL yomwe ingatengedwe kwa zaka ndi mbiri yovomerezeka ya poizoni.
Phunziroli linasonyeza kuti okalamba omwe ali ndi mitundu yosiyanasiyana ya DLBCL amapindula ndi lenalidomide maintenance treatment ndi kupulumuka kwabwino. Thandizo la kusamalira limaphatikizapo kuchiza khansa ndi mankhwala, kawirikawiri pamakhala mankhwala oyamba.
Kafukufuku wa Follicular Lymphoma
Follicular lymphoma ndi mtundu wamba wa mankhwala osokoneza bongo-omwe ndi, ochedwa-kukula-lymphoma. Ngakhale kuti obinutuzumab sinawoneke ubwino uliwonse koma mu phunziro la DLBCL limene tatchula pamwambapa, sizinali choncho kwa obinutuzumab mu follicular lymphoma.
Thandizo la Obinutuzumab Limaonjezera Kupulumuka kwa Anthu Osauka Osagwiritsidwa Ntchito Pakati pa Odwala Amene Kale Anali Osadziwika Lulupili Lymphoma
Mayesero a GALLIUM anali kafukufuku wapadziko lonse lapansi omwe amawunikira kuti ali ndi mphamvu komanso chitetezo cha rituximab kapena obinutuzumab ndi chemotherapy ndi zotsatira zowonongeka monga chithandizo choyamba cha mankhwala osadziwika omwe si a Hodgkin lymphoma.
Kwa odwala omwe kale anali osatulutsidwa follicular lymphoma, pulogalamu ya obinutuzumab-based chemotherapy regimen ndi yokonzetsa pulogalamu inachititsa kuti kusintha kwapadera kwapulumuka popanda matenda akufalikira -pafupi kuchepa kwa 34 peresenti pa chiopsezo cha kupita patsogolo poyerekeza ndi rituximab-based treatment. Obinutuzumab anali ndi maulendo apamwamba pa zochitika zina zovuta monga zotsatira zokhudzana ndi kulowetsedwa, magazi ochepa, ndi matenda. Ochita kafukufuku anatsimikizira kuti regimen imathandizira kuti dokotala asamalire matenda odwala matenda opatsirana pogwiritsa ntchito follicular lymphoma.
Kafukufuku wa Hodgkin Lymphoma
Pali mitundu ikuluikulu isanu ya Hodgkin lymphoma (HL) imene munthu angapezeke nayo. Classical Hodgkin lymphoma ndi nthawi yakale yomwe amagwiritsidwa ntchito pofotokoza gulu la mitundu iwiri yomwe imakhala pamodzi yomwe imaphatikizapo 95 peresenti ya milandu yonse ya HL m'mayiko otukuka.
Kutetezedwa kwa Mthupi kwa Mthupi Komwe Kudabweretsedwe Kwachikale Kwambiri Kachilombo ka Hodgkin Lymphoma
Zakale za Hodgkin lymphoma zikuwoneka kuti zakhala ndi kusintha kwa majeremusi zomwe zingayambitse mankhwala atsopano otchedwa immune checkpoint inhibitors , pogwiritsa ntchito maphunziro apitalo. Choncho, gulu la kafukufuku wa ASH linawoneza odwala 210 kuti athandizidwe ndi matendawa kapena kuti abwererenso HL kuti awone momwe inhibitor pembrolizumab idzachitira.
Maselo ena a khansa amapanga PD-L1 ambiri, ndipo izi ndizowathandiza kuthawa chitetezo cha mthupi. Pembrolizumab ingathandize kuimitsa izo. PD-1 blockade ndi pembrolizumab amagwira ntchito m'magulu a odwala omwe ali ndi HL okalamba omwe adagwiritsidwa ntchito kwambiri ndi mankhwala ena. Pembrolizumab inali ndi mpata wothamanga kwambiri ngakhale mu matenda omwe sanagonjetsedwe ndi chemotherapy. Zotsatira zina, kuphatikizapo momwe yankho likugwiritsidwira ntchito nthawi yaitali likuyembekezeka pamsonkhano.
Kafukufuku wa khansa ya m'magazi
Thandizo Lothandizira Odwala ndi AML - Eltrombopag
Odwala omwe akudwala mankhwala oopsa kwambiri a myelogenous leukemia (AML) , nthawi zina mtengo wa platelet umakhala wotsika pambuyo pa mankhwala a chemotherapy, ndipo izi zingachititse ngozi zoopsa za magazi, kufunikira kwa magazi ambiri, komanso odwala angayambe kupanga ma chitetezo m'magulu, zomwe zonse zimatetezera patsogolo.
Mu 2016 gulu linalengeza pogwiritsa ntchito eltrombopag, mankhwala omwe amachititsa thupi kupanga mapulateletti ambiri, mwa anthu achikulire omwe anali akuchiritsidwa kwa AML.
Zotsatira zinali zoyambirira-izi zinali gawo loyamba lophunzirira-koma iwo amawoneka kuti ali ndi kupambana poyambitsa anthu kuti abwere mwamsanga kuchokera ku chemo kuti asafunike kuika magazi ambirimbiri. Panali kudera nkhaŵa kuti wothandizira monga eltrombopag angayambe kuchulukitsa matenda a khansa ya m'magazi, kuphatikizapo phindu lothandizira pulogalamuyi kuti ipeze, komabe, pakali pano mu phunziro ili palibe umboni wa chiopsezo chimenecho kukhala chenicheni.
Kubwezeretsedwa kapena Kutsitsika Kwambiri Matenda a Mthemphabasiki (ALL)
Palibe regimen yowonongeka YONSE. Inotuzumab ozogamicin ndi mankhwala opatsirana a FDA odwala omwe ali ndi kachilombo ka magazi (ALL). Mu mayesero am'chipatala chimodzi, inotuzumab ozogamicin inapanga kusintha kwakukulu pa mankhwala omwe ali odwala onse omwe amatsutsa, kapena osayankha, mankhwala ena.
Inotuzumab ozogamicin ndi osakaniza mankhwala osokoneza bongo omwe amapangidwa ndi anti-antibody omwe amagwiritsidwa ntchito ndi wothandizira omwe angathe kupha maselo a kansa. Pamene mankhwalawa amamanga pamtundu wotchedwa CD22 pa maselo a khansa, umalowa mkati mwa selo yomwe imayambitsa DNA, zomwe zimachititsa kuti maselo afe.
Zimene Kafukufuku Akukutanthauza
Ngakhale makonzedwe kawirikawiri amawongolera kupereka madokotala pa kafukufuku waposachedwapa, nthawi zambiri mauthengawa amakhala ofunika kwa omwe amapezeka ndi zikhalidwe, komanso okondedwa awo. Mukapita kukaonana ndi dokotala funsani zomwe zili zatsopano m'munda - kukhala mudzidzidzi kungakuthandizeni kuti muzimva bwino pa thanzi lanu.
> Zotsatira:
> 469 Gawo Lachitatu Phunziro Loyamba la R-CHOP Versus DA-EPOCH-R ndi Mapulogalamu Aakulu a Banda Lymphoma Osaneneka Osaneneka: CALGB / Alliance 50303
> 474 Lenalidomide Maintenance Amapangitsa Kuti Odwala Azikhala Omwe Amakhala ndi Odwala Omwe Amakhala ndi Mavuto Aakulu Aakulu-Bulu Lymphoma (rDLBCL) Amene Sali Oyenerera Kutsegula Maselo Ovomerezeka (ASCT): Zotsatira Zotsatira za Multicentre Phase II Yoyesera
> 470 Obinutuzumab kapena Rituximab Plus CHOP mwa Odwala omwe kale analibe B-Cell Lymphoma omwe sanadziwitsidwe: Zotsatira zomaliza kuchokera ku Tselo lotseguka, Phunziro lachidule la Gawo 3 (GOYA)
> 1107 Pembrolizumab mu Zowonongedwa / Zokonzanso Zakale za Hodgkin Lymphoma: Primary End Point Kufufuza kwa Phase 2 Keynote-087 Phunziro
> 447 Chida Chokha Chokha, Phunziro Lachiwiri Phunziro la Eltrombopag Kupititsa patsogolo Pulogalamu Yowonjezera Kuchuluka kwa Odwala Okalamba Ndi Odwala Myeloid Amagazi Okhudzidwa ndi Kupatsirana Kwambiri
> 6 Kuchokera kwa Obinutuzumab-Based Based and Maintenance Kupitiriza Kupulumuka Osasunthika (PFS) mwa Odwala Amene Anakhalabe Osatulutsidwa Follicular Lymphoma: Maphunziro Otsogolera Omwe Anasinthidwa Gawo 3 GALLIUM Study