Kupititsa patsogolo Chithandizo kwa Anthu Odwala Magazi Khansa

Mankhwala atsopano akubwera pang'onopang'ono mofulumira kwa odwala omwe ali ndi khansa ya magazi , kapena matenda a khansa ya magazi , monga khansa ya m'magazi , lymphoma, ndi multipleeloma .

Zomwe zili m'munsimu zitha kuonedwa ngati zochepa, m'malo mopitilira; Komabe, mankhwalawa angapangitse ubwino wopulumuka umene ungakhale wofunikira kwambiri kwa omwe akukhudzidwa.

Nthawi zina, mankhwala ochizira omwe angatuluke amatha kukhalabe ndi moto wa chiyembekezo-kuti mankhwala opatsirana monga kuperekera mafupa amatha kutsata-ngakhale kale, izi sizinali zosankha.

Zopindulitsa pakupulumuka zimayenera kuganiziridwa limodzi ndi zotsatirapo ndi poizoni; muzochitika izi, odwala amafunika kukhala ndi moyo komanso momwe angathere (umoyo wa moyo), komanso malinga ndi momwe angathere.

Mankhwala Ovomerezedwa Posachedwapa

1. Inotuzumab Ozogamicin (Besponsa) ya Acute Lymphocytic Khansa ya m'magazi

Nyuzipepala ya American Cancer Society inanena kuti pafupifupi 5,970 atsopano a khansa ya m'magazi yoopsa kwambiri (ALL) anayembekezeka ku United States mu 2017, ndipo pafupifupi 1,440 anamwalira chaka chomwecho. Ngakhale kusintha kwa zaka makumi angapo zapitazo pochiza khansa zambiri zamagazi, zizindikiro za odwala onsewa amakhala osauka.

Kachilombo kameneka kameneka kameneka kameneka kamene kamatulutsa mafupa ( fupa la mafuta a mafupa kuchokera kwa wopereka) limapereka lonjezo, mwinamwake, lachiritso kwa akuluakulu onse. Komabe, pali vuto loti ligonjetsedwe: mitengo yochepa ya chikhululukiro chathunthu ndi zamakono za chemotherapy. Kulowetsa maselo a maselo kumafuna kuti munthu apeze chikhululukiro chonse cha matenda, ndipo mwatsoka, izi zikutanthauza kuti anthu ochepa chabe omwe abwereranso kapena akutsutsa B-cell ALL (matenda omwe abwera, ngakhale atachiritsidwa) angathe kufika kumalo opatsirana.

Motero, opanga mankhwala akhala akuyang'ana zida zatsopano zowunikira maselo a khansa. Kuwombera maselo omwe ali ndi chizindikiro chotchedwa CD22 angakhale chinthu chimodzi chotere, panthawi yoyenera. CD22 ndi molekyu yomwe imapangidwa ndi maselo ena m'thupi ndipo imayikidwa ndi maselo amenewa, pafupifupi ngati ma tag, kunja kwa selo, mkati mwa maselo. Kwa odwala omwe ali ndi B-cell ALL, maselo a khansa ali ndi molecule iyi ya CD22 pafupifupi 90 peresenti ya milandu-ndipo izi zimakhala bwino kwambiri mu bizinesi ya kansa.

Inotuzumab ozogamicin (Besponsa) ndi wodwala wodwala anti-CD22 wodwala wodwalayo womwe umagwirizanitsidwa ndi calicheamicin, wothandizira amene angaphe maselo okhudzidwa.

Inotuzumab ozogamicin imatchedwa conjugate chifukwa ndi wotsutsakhristu amene amamangiriridwa, kapena wothandizidwa ndi, wothandizira omwe angaphe maselo. Gawo la anti-antibody limayang'ana maselo omwe ali ndi chizindikiro cha CD22, ndipo gawo la conjugate limawononga selo lolunjika.

A FDA amavomereza inotuzumab ozogamicin pogwiritsa ntchito umboni wochokera kuchipatala komwe akatswiri anafufuza za chitetezo cha mankhwalawa ndi mphamvu zawo poyerekeza ndi njira ina yothetsera mankhwala. Mlanduwu unaphatikizapo odwala 326 omwe anabwezeretsedwa kapena akutsutsa B-cell ALL ndipo adalandira mankhwala amodzi kapena awiri asanayambe kuchipatala.

Malinga ndi a FDA, pa 218 odwala, oposa 35.8 peresenti omwe analandira inotuzumab ozogamicin adamva kwathunthu, kwa miyezi 8.0 yapakati; a odwala omwe adalandira mankhwala enaake amodzi, 17,4 peresenti ndi omwe adayankhidwa kwathunthu, kwa miyezi 4.9 yapakati.

Choncho, inotuzumab ozogamicin ndi njira yatsopano yopangira chithandizo chobwezeretsanso kapena chotsutsa B-cell ALL.

Zotsatira zofanana za inotuzumab ozogamicin zimaphatikizapo m'munsi mwa maselo ofooketsa (thrombocytopenia), maselo ochepa a maselo oyera a magazi (neutropenia, leukopenia), matenda, kuchepa kwa maselo ofiira a magazi (kuchepa kwa magazi), kutopa, kutaya magazi kwambiri (kutaya kwa magazi), malungo ( pyrexia), kupwetekedwa mtima, kupweteka kwa mutu, kuchepa kwa maselo oyera a magazi ndi fever (febrile neutropenia), kuwonongeka kwa chiwindi (transaminases ndi / kapena gamma-glutamyltransferase kuwonjezeka), kupweteka m'mimba, ndi kuchuluka kwa bilirubin m'magazi (hyperbilirubinemia). Kuti mudziwe zambiri zokhudzana ndi chitetezo, onani zolemba zonse.

2. Lenalidomide (Revlimid) Pambuyo Kusindikiza mu Multiple Myeloma

Njira yothandizira yokhala ndi lenalidomide yomwe ikutsatiridwa ndi mavitamini omwe amachititsa kuti thupi likhale lopatsirana.

McCarthy ndi anzake adaganizira deta ya odwala kuchokera ku mayesero atatu omwe anawasintha kuchokera ku United States, France ndi Italy. Maphunzirowa anaphatikizapo odwala omwe anali atangophunzira kumene a myeloma omwe adalandira kupatsako mafupa amodzi (autologous) ndipo 1,208 awo anachiritsidwa ndi lenalidomide pambuyo pake, pamene odwala okwana 603 analandira malo otchedwa placebo kapena ankangowonongeka, kapena kuyang'aniridwa.

Odwala omwe anali ndi lenalidomide anali ndi moyo wathanzi, popanda matenda awo, poyerekeza ndi omwe adalandira malo awo (kapena miyezi 52.8 miyezi 23.5). Onse okwana 490 anamwalira. Kupindula kwakukulu kwapulumuka kunawoneka m'gulu la lenalidomide.

Ambiri mwa odwala m'gulu la lenalidomide anapeza chiwindi chachiwiri chachilombo ndi chotupa cholimba chachiwiri chachilendo; Komabe, chiwerengero cha kupititsa patsogolo, kufa chifukwa cha zifukwa zonse, kapena imfa chifukwa cha myeloma onse anali akuluakulu mu gulu la anthu owona malo.

3. Zosakaniza-Combination Chemotherapy for Acute Myeloid Leukemia

AML ndi kupitirira mofulumira kansa yomwe imayambira m'mafupa ndipo mwamsanga imayambitsa kuchuluka kwa maselo oyera a magazi m'magazi. Anthu pafupifupi 21,380 adzapezeka ndi AML chaka chino, ndipo odwala 10,590 omwe ali ndi AML adzafa ndi matendawa.

Vyxeos ndigwirizanitsa mankhwala a chemotherapy daunorubicin ndi cytarabine omwe angathandize odwala ena kukhala ndi moyo nthawi yayitali kuposa ngati adzalandira mankhwala awiriwa padera. A FDA adavomereza Vyxeos kuti azitsata anthu akuluakulu omwe ali ndi mitundu iwiri ya myeloid ya m'magazi (AML):

• Aml omwe amapezeka opatsirana ndi AML (t-AML), ndi
• AML ndi kusintha kwa myelodysplasia (AML-MRC).

T-AML imakhala ngati vuto la chemotherapy kapena radiation pafupifupi pafupifupi 8 mpaka 10 peresenti ya odwala onse omwe amachitira khansa. Kawirikawiri, zimachitika pasanathe zaka zisanu kuchokera kuchipatala. AML-MRC ndi mtundu wa AML umene umakhudzidwa ndi kukhala ndi mbiri ya matenda ena ndi zina kusintha kwakukulu m'maselo a khansa ya m'magazi. Odwala onse omwe ali ndi AM-AML ndi omwe ali ndi AML-MRC ali ndi chiyembekezo chochepa cha moyo.

Kuyezetsa magazi, odwala 309 omwe ali ndi t-AML kapena AML-MRC omwe atangoyamba kumene kupeza mankhwala omwe anapatsidwa mankhwala a Vyxeos kapena omwe amathandiza kuti adziwe daunorubicin ndi cytarabine, odwala omwe analandira Vyxeos amakhala ndi moyo nthawi yaitali kuposa odwala omwe analandira mankhwala osiyana a daunorubicin ndi cytarabine. kupulumuka kwathunthu miyezi 9.56 vs. miyezi 5.95).

Zotsatira zoyipa zimaphatikizapo zochitika zowononga magazi (kutaya magazi), malungo omwe amawoneka kuti ndi ofunika kwambiri m'magazi (febrile neutropenia), kuthamanga, kutupa kwa matenda (edema), kunyowa, kutupa kwa mucous membranes (mucositis), ndi zotsatira zina zoipa kuphatikizapo m'mimba mavuto , matenda akuluakulu komanso mtima wosagwirizana (arrhythmia).

> Zotsatira:

> FDA News Release. FDA imavomereza chithandizo chatsopano kwa anthu akuluakulu ndi kubwezeretsedwa kapena kusokoneza kachipatala kamene kamayambitsa khansa ya m'magazi. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm572131.htm.

> FDA News Release. FDA imavomereza chithandizo choyambirira kwa mitundu yina ya matenda osauka kwambiri odwala myeloid khansa ya m'magazi. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm569883.htm.

> FDA imavomereza kugwiritsa ntchito Lenalidomide Watsopano mu Multiple Myeloma. https://www.cancer.gov/news-events/cancer-currents-blog/2017/fda-lenalidomide-myeloma-maintenance.