Kuchulukira ndi Chithandizo cha Lutphoma Yachilendo Yomwe Silikuwombera Hodgkin
Kuopsa kokhala ndi lymphoma kumakhala kochulukanso pambuyo poti thupi likhale lopatsirana, monga matenda a impso, chiwindi cha chiwindi, kusintha kwa mtima kapena mapapu. Mafupa amenewa amatchedwa "matenda osokoneza bongo" kapena kuti PTLDs.
Kodi Zimakhala Zogwirizana Bwanji ndi Lymphoma Pambuyo Pakunena Zamagulu?
PTLD imaphatikizapo zizindikiro zosiyanasiyana zogwiritsira ntchito mankhwala ochepetsa thupi (HSCT) ndipo zimatha kukhala 10 peresenti ya akuluakulu.
Mtundu wa 1 mpaka 20 peresenti umagwiritsidwanso ntchito kulingalira chiwerengero chonse cha LPD pambuyo pake.
Nchifukwa chiyani ma Lymphoma Amachita Katemera Wachiwalo?
Mankhwala am'mimba amatha kufalitsa matenda ndi Epstein Barr Virus (EBV) . Kutengera kwa Epstein Barr Virus kumayambitsa kusintha kwa B-maselo (mtundu wa lymphocyte kapena selo loyera la magazi) lomwe limakhala khansa. Mu maselo ena onse maselo a chitetezo cha mthupi angathe kuthana ndi matenda a EBV, koma kwa anthu omwe ali ndi ziwalo zowononga thupi, kumwa mankhwala osokoneza bongo omwe amaletsa chitetezo cha mthupi ayenera kuchitidwa. Popanda kuteteza matendawa, mwayi wokhala ndi lymphomas ukuwonjezeka.
Kodi Ndi Zifukwa Zowonjezera Zowopsa Zomwe Zimayambitsa Lymphoma?
Zinthu zazikulu ziwiri zomwe zimapangitsa mwayi wopeza lymphoma ndi awa:
- Kodi kuchuluka kwa chithandizo cha immunosuppressive ndi chofunika bwanji - Kuwonjezera pa kuteteza thupi, kutengeranso mwayi wa EBV matenda.
- Udindo wa EBV serology wa wolandizidwa - Ngati munthuyo wakhala atatengedwera ndi EBV (ali ndi mbiri ya kukhala ndi mono) mwayi ndi wakuti thupi limakumbukira kachilombo ndipo magazi ali nawo mapuloteni apadera otchedwa antibodies omwe angathe kudziwa ndi kupha kachirombo ka HIV. Izi zingayesedwe mwa kutenga zitsanzo za magazi.
Kodi Mankhwala Am'mimba Amayamba Bwanji?
Pafupifupi, ngati PTLD idzachitika, nthawi yeniyeni yoti ichite izi ndi pafupi miyezi 6 yotsatila posindikizidwa mu thupi lokhazikitsa odwala ndi miyezi 2-3 mu HSCT omwe alandira, koma izi zachitika posachedwa sabata imodzi mochedwa zaka khumi mutatha kuziika.
Mankhwala ammimba amatha kutuluka mosiyana ndi maymphini omwe sali a Hodgkin . Maselo a khansa a lymphoma iyi ndi osakaniza osiyanasiyana. Ngakhale kuti odwala ambiri ali ndi ma lymph nodes, ziwalo zina zimakhudzidwa kwambiri - chodabwitsa chotchedwa 'extranodal' . Izi zikuphatikizapo ubongo, mapapo ndi matumbo. Chiwalo chogwiritsidwa ntchito chikhoza kuthandizanso.
Kodi Kutuluka kwa Lymphoma Kumapeto Kwambiri Kumakhala Bwanji?
Nthawi iliyonse, chithandizo cha immunosuppressive chiyenera kuchepetsedwa kapena kuimitsidwa. Kwa iwo omwe ali ndi matenda aang'ono ndi omwe amapezeka, opaleshoni kapena ma radiation angayesedwe. Ngati sichoncho, mzere woyamba wa mankhwala nthawi zambiri ndi Rituxan (rituximab) , wodwalayo wochuluka kwambiri womwe umalowera makamaka maselo a lymphoma. Izi zikadatha ndi chemotherapy kuyesedwa. Chemotherapy imaloledwa mpaka pakufunika monga momwe anthu ena amadzimadzimadzi amathandizira kuti mankhwalawa athe kuwonjezera chiopsezo cha matenda .
Kwa iwo omwe amayamba lymphomas pambuyo pa kusintha kwa mafupa a mafupa, kupatsirana kwa leukocyte wopereka chithandizo kungakhale kothandiza kwambiri.
Kodi zotsatirapo ndi ma Lymphomas pambuyo pa Kukula?
Kawirikawiri, PTLD ndilo chifukwa chachikulu cha matenda ndi imfa, mbiriyakale ndi zofalitsa zowonjezera kufala mpaka 40-70 peresenti kwa odwala omwe ali ndi ziwalo zolimba komanso 90 otsogolera odwala pambuyo pa HSCT. Mankhwala osagwiritsidwa ntchito a mtundu wa Hodgkin omwe amapezeka pambuyo poyambitsa ziwalo amakhala ndi zotsatira zosauka kuposa NHL zina. Chiwerengero china chotsindikizidwa chakhala chakuti pafupifupi 60-80% pamapeto pake akugonjetsedwa ndi lymphoma yawo. Komabe, kugwiritsidwa ntchito kwa Rituxan kwasintha mtundu wa moyo, ndipo anthu ena amachita bwino kwambiri ndipo akhoza kuchiritsidwa.
Kuphatikizidwa kwa ziwalo zina, makamaka ubongo, kumakhala kosavuta.
Zotsatira:
Iye, G., Wang, C., Tan, H., ndi S. He. Rituximab pambuyo poti autologous maselo opangira maselo amathandizira kupulumuka kwa odwala B-cell lymphoma: meta-analytical and reviewatic review. Transplant Proceedings . 2015. 47 (2): 517-22.
Katabathina, V., Menias, C., Pickhardt, P., Lubner, M., ndi S. Prasad. Zovuta za Thandizo la Immunosuppressive in Transplantation Solid Organ. Maphunziro a Zamankhwala a ku North America . 2016. 54 (2): 303-19.
> Metser U, Lo G. FDG-PET / CT m'mimba yomwe imatulutsa matenda opatsirana pogonana. Br J Radiol . 2016; 89 (1057): 20150844.
Petrara, M., Giunco, S., Serraino, D., Dolcetti, R., ndi A. De Rossi. Matenda opatsirana pogwiritsa ntchito matendawa: Kuchokera m'magazi kupita kuchipatala. Mayankho a Khansa . 2015. 369 (1): 37-44.