Khansa ya m'magazi si matenda amodzi, koma ambiri. Asayansi akuyamba kumvetsa kuti ngakhale kamodzi kokha, kamene kamene kamakhala ndi khansa ya m'magazi ali ndi magawo omwe amasiyana mosiyana.
Mitundu inayi ikuluikulu ya khansa ya m'magazi imadalira kuti ndi yoopsa kapena yodwala, komanso imeloid kapena lymphocytic leukemias, ndipo magulu akuluakuluwa ndi awa:
- Matenda a myeloid (kapena myelogenous) a m'magazi (CML)
- Matenda a m'mimba (kapena amphineblastic) a m'magazi (ALL)
- Lymphocytic khansa ya m'magazi (CLL)
About AML
Matenda a myelogenous leukemia ndi khansara ya mafupa -madzimadzi a mafupa, kumene maselo amapanga-komanso ndi khansa ya magazi.
AML amaonedwa kuti ndi "acute" khansa ya m'magazi chifukwa imakula mofulumira. Gawo lotchedwa myelogenous limachokera ku maselo a myeloid-gulu la maselo omwe nthawi zambiri amayamba kukhala mitundu yambiri ya maselo okhwima, monga maselo ofiira a m'magazi, maselo oyera ndi maselo.
AML ali ndi zifukwa zambiri: Mthemphasiyumu yambiri ya khansa ya m'magazi imadziwikanso monga myeloid khansa ya m'magazi, myeloblastic leukemia, yovuta granulocytic khansa ya m'magazi komanso yoopsa ya nonlymphocytic khansa ya m'magazi.
AML ingawononge anthu a mibadwo yonse. Pulojekiti ya World Health Organisation ya GLOBOCAN ya 2012 inati anthu 352,000 padziko lonse anali ndi AML, ndipo matendawa akufala kwambiri ngati anthu ambiri.
Zizindikiro za AML ndizo:
- Fever
- Kupweteka kwa mafupa
- Lethargy ndi kutopa
- Kupuma pang'ono
- Khungu lenileni
- Matenda opatsirana
- Kulira kosavuta
- Kutuluka kwachilendo, monga nthawi zambiri nosebleeds ndi kutuluka m'magazi
Zotsatira
Mndandanda wa AML wochokera ku maonekedwe aakulu a khansa, kapena morphology, ikuwonjezeredwa ndi zatsopano zopezeka pa kusintha kwa majini kapena kusintha kwa thupi komwe kumakhudza mitundu yosiyanasiyana ya matendawa.
Ofufuza pa bungwe la Wellcome Trust Sanger ndi othandizira posachedwapa anawonjezera ku chidziwitso, zokhudzana ndi kusintha kwa majini zomwe zimathandiza kumvetsetsa AML-kupitiriza kusintha maganizo a AML kuchokera ku matenda amodzi kwa mitundu khumi ndi iwiri yosiyana siyana malungo , ndi kusiyana komwe kungathandize kufotokozera kuti odwala omwe ali ndi AML amakhala osasintha.
Ofufuzawa anafalitsa kafukufuku wawo pa jini la AML mu magazini ya June 2016 ya "New England Journal of Medicine," ndipo akatswiri amakhulupirira kuti zotsatirazi zikhoza kusintha mayesero a zachipatala ndipo zimakhudza momwe odwala AML amapezera ndi kuchiritsidwa m'tsogolomu.
Phunziro la NEJM
Ochita kafukufuku anapeza odwala 1,540 omwe ali ndi AML omwe analembedwera m'mayesero a zachipatala. Iwo adayesa majini oposa 100 omwe amadziwika kuti amayambitsa khansa ya m'magazi ndi cholinga chozindikiritsa "zizindikiro zapachibadwa" pambuyo pa chitukukochi.
Iwo adapeza kuti odwala AML akhoza kugawa m'magulu akuluakulu khumi ndi awiri, aliyense ali ndi magulu osiyanasiyana a kusintha kwa majini ndi makhalidwe osiyanasiyana. Malingana ndi kafukufuku, odwala ambiri anali ndi kusintha kwa mitundu yosiyanasiyana ya majeremusi yomwe imayambitsa matenda awo a khansa, zomwe zingathandize kufotokozera chifukwa chake AML imasonyeza kusiyana kotereku m'miyoyo yawo.
Zotsatira
Kudziwa kuti chibadwa cha khansa ya m'magazi kumapangitsa kuti thupi likhale lopambana lingathandize kuti muwone ngati mankhwalawa angakhale othandiza. Chidziwitso cha mtundu uwu chingagwiritsidwe ntchito popanga mayesero atsopano a kachipatala kuti apange mankhwala abwino pa AML subtype iliyonse; ndipo pamapeto pake, kuyesa kwakukulu kobadwa kwa AML pa matendawa kungakhale kozoloŵera.
M'dziko la 2008 la World Health Organisation (WHO), asayansi ayamba kale kupanga AML akuluakulu kuti akhale "magulu a maselo" osiyanasiyana, kuphatikizapo kusintha kwa majini kapena kuvulala kwa ma chromosomes monga: t (15; 17), t (8; 21) (16) -t (16; 16), t (6; 9), inv (3) -t (3; 3), majeremusi amtundu wa MLL, ndi kusintha kwa nthawi, kusintha kwa CEBPA kapena kusintha kwa NPM1.
Komabe, monga momwe tawonera mu maphunziro aposachedwapa a NEJM, ma maselo a WHO omwe sagwira ntchito sagwira bwino ntchito zambiri za AML. Phunziroli, odwala 736 omwe ali ndi AML, kapena 48 peresenti ya iwo, sakanakhala ndi gulu lochokera m'magulu a WHO, ngakhale kuti 96 peresenti ya odwalawo anali ndi zotchedwa kusintha kwasinthika komwe kumawathandiza malignancy.
Kupezeka kwa majeremusi atsopano a khansa ya m'magazi, kusintha kwapadera kwa odwala, ndi kusintha kwamasinthasintha kwapangitsa kuti ofufuza apitirize kuonanso mtundu wa AML kuyambira pachiyambi.
Mafotokozedwe a AML Othandizira, Malinga ndi kusintha kwa Genetic
Choncho, ochita kafukufukuwo adabwerera ku zojambulazo kuti ayese kupanga dongosolo latsopano kuti athe kupanga AML yomwe imagwiritsa ntchito zidziwitso zakudziwika.
Mndandanda wovomerezeka kwambiri komanso njira zowonetsera AML zimagwiritsa ntchito gulu la WHO - kuphatikizapo zotchedwa cytogenic lesions-mwachitsanzo t (15; 17) -ndipo ndi NPM1, FLT3ITD, ndi CEBP, monga momwe tafotokozera pamwambapa.
Malinga ndi kafukufuku watsopano, olemba adalangiza kuti, posachedwa, TP53, SRSF2, ASXL1, DNMT3A, ndi IDH2 ziyenera kuganiziridwa kuti zilowetsedwe muzitsogozo zowonjezera chifukwa ndizofala ndipo zimakhudza kwambiri zotsatira zachipatala.
Pogwiritsa ntchito gulu la AML, kuyesa kwa "jekeseni ya chinthu" RUNX1, ASXL1, ndi MLLPTD pozindikira kuti zikhoza kudziwitsa odwala mu "gulu la chromatin-spliceosome." Ichi chinali gulu lalikulu lachiwiri la odwala AML mu phunziro, ndipo mosiyana ndi Ophunzira a AML a AML, palibe vuto limodzi la chibadwa limene limatanthawuza gulu lino.
Pogwiritsira ntchito dongosololi, okwana 1,236 a 1,540 odwala omwe amasinthasintha amatha kukhala m'gulu limodzi, ndipo odwala 56 anakumana ndi zigawo ziwiri kapena zingapo. Onse okwana 166 omwe ali ndi kusintha kwa oyendetsa galimoto anakhalabe osazindikira.
Chiyambi cha machitidwe omwe alipo
AML sichiwerengedwa monga ena ambiri khansa. Malingaliro a munthu yemwe ali ndi AML amadalira pazinthu zina, monga chigawo chogwiritsidwa ntchito ndi mayesero a labu, komanso zaka za wodwalayo, ndi zotsatira zina za mayeso.
AML subtypes angagwirizane ndi momwe wodwala akuonera komanso mankhwala abwino kwambiri. Mwachitsanzo, mankhwalawa amachititsa kuti mankhwalawa akhale osiyana kwambiri ndi omwe amagwiritsidwa ntchito pa maulendo ena a AML.
Machitidwe awiri omwe adagwiritsidwa ntchito kugawa AML kukhala subtypes ndi chikhalidwe cha French-American-British (FAB) ndi chigawo chatsopano cha World Health Organization (WHO).
Chikhalidwe cha French-American-British (FAB) cha AML
M'ma 1970, gulu la French, American, ndi British leukemia akatswiri adagawani AML kukhala subtypes, M0 kupyolera M7, pogwiritsa ntchito selo yomwe khansa ya m'magazi imayambira komanso momwe maselo alili okhwima. Izi zinkadalira makamaka momwe maselo a khansa ya m'magazi amayang'anirana ndi microscope pambuyo pa kuwonetsa nthawi zonse.
Dzina la FAB subtype
M0 Osayanjanitsidwa kwambiri ndi mitsempha ya m'magazi
M1 Mitsempha yambiri ya myeloblastic ndi matenda osakanikirana
M2 Mitsempha yambiri ya mitsempha ndi kusasitsa
M3 Acute promyelocytic leukemia (APL)
M4 Mwamtheradi wa myelomonocytic khansa ya m'magazi
M4 eos Amamva myelomonocytic khansa ya m'magazi ndi eosinophilia
M5 Mtheradi wa monocytic khansa ya m'magazi
M6 Mthempha ya m'mimba kwambiri
M7 Mthempha ya m'magazi yambiri
Mankhwala a M0 kudzera mwa M5 onse amayamba mu mitundu yochepa ya maselo oyera a magazi. M6 AML imayambira mu mawonekedwe ochepa kwambiri a maselo ofiira a magazi, pamene M7 AML imayambira mu mawonekedwe a maselo omwe amapanga mapulogalamu.
Gawo la World Health Organisation (WHO) la AML
Mchitidwe wa FABwu uli othandiza ndipo umagwiritsidwa ntchito popanga gulu la AML kukhala subtypes, komabe chidziwitso choyambirira chokhudzana ndi kufotokoza ndi malingaliro a mitundu yosiyanasiyana ya AML, ndipo zina mwa kupita patsogoloku zinawonetsedwa mu dongosolo la World Health Organization (WHO) la 2008.
Mchitidwe wa WHO umagawaniza AML m'magulu angapo:
AML ali ndi zinthu zina zosawerengeka
- AML ndi translocation pakati pa chromosomes 8 ndi 21
- AML ndi translocation kapena kupotoza mu chromosome 16
- AML ndi translocation pakati pa chromosomes 9 ndi 11
- APL (M3) ndi translocation pakati pa chromosomes 15 ndi 17
- AML ndi translocation pakati pa chromosomes 6 ndi 9
- AML ndi translocation kapena kupotoza mu chromosome 3
- AML (megakaryoblastic) ndi translocation pakati pa chromosomes 1 ndi 22
AML ndi kusintha kwa myelodysplasia
AML yokhudzana ndi chemotherapy kapena radiation yapitayo
AML sinafotokozedwe mwachindunji (AML yomwe sichigwera m'modzi mwa magulu omwe ali pamwambawa ndipo ndiyomwe yapangidwanso ngati zomwe zinachitidwa mu FAB):
- AML ali ndi kusiyana kwakukulu (M0)
- AML popanda kusasitsa (M1)
- AML ndi kusasitsa (M2)
- Zachilendo za myelomonocytic leukemia (M4)
- Chimake choopsa cha m'magazi (M5)
- Mthempha ya m'mimba yambiri (M6)
- Matenda a m'magazi a m'magazi (M7)
- Zomwe zimapangitsa kuti magazi azidwala khansa ya m'magazi
- Zovuta za panmyelosis ndi fibrosis
Myeloid sarcoma (yomwe imatchedwanso granulocytic sarcoma kapena chloroma)
Kuwonjezeka kwa Myeloid wokhudzana ndi Down syndrome
Mankhwala osayanjanitsika ndi ophatikizidwa ndi leukemias :
Izi ndi ma leukemias omwe ali ndi ziwalo zamakono ndi myeloid. Nthaŵi zina amatchedwa ALL ndi myeloid markers, AML ndi zizindikiro za lymphoid, kapena zosakaniza za leukemias.
Pamwamba pa mitundu ya WHO inasinthidwa kuchokera ku American Cancer Society.
Zotsatira:
Papaemmanuil E, Gerstung M, et al. Zolemba za mtundu wa Genomic ndi kufotokozera mu mitsempha yambiri ya myeloid ya m'magazi. N Engl J Med . 2016; 374 (23): 2209-21.
Institute of Wellcome Trust Sanger. Mitsempha ya m'mitsempha yambiri imakhala ndi matenda khumi ndi awiri. Idapezeka mu June 2016.
American Cancer Society. Kodi mitsempha ya m'mitsempha yambiri imakhala bwanji? Idapezeka mu June 2016.