Lymphoma imatha kumalo osiyanasiyana osiyanasiyana m'thupi, ndipo malo ena ndi osiyana kwambiri ndi ena. Kwa khansa yochepa, nthawi zina palibe chinthu chofanana ndi mankhwala oyenera. Pazochitikazi, madokotala amachita zonse zomwe angathe kuti athe kupeza chithandizo chomwe chidzapambana kwambiri ndi poizoni. Ukalamba wanu ndi umoyo wanu wonse zingakhale zifukwa zazikulu posankha njira zochiritsira zomwe zingakhale zabwino kwa inu.
Chipangizo Choyambirira cha Mitsempha Yam'mimba Lymphoma
Njira yapakatikati ya mitsempha yotchedwa lymphoma (PCNSL) ndi mtundu wosawerengeka komanso wamwano wa mtundu wa non-Hodgkin lymphoma . Zizindikirozi zimakhala zosauka kwambiri kwa anthu a zaka 60 ndi okalamba.
Gawo la milandu yonse ya PCNSL imachitika m'badwo uno.
Ngakhale kuti sizowoneka, PCNSL yakhala ikuwonjezeka zaka 30 zapitazo. Kafukufuku wa odwala 579 omwe anapezeka ndi PCNSL m'zaka za m'ma 1990 ku US anasonyeza kuti kupulumuka kwapakati kunali miyezi isanu ndi iwiri yokha. Panthawiyo, ubongo wonse wa radiotherapy wokha unali mankhwala ochiritsira kwambiri m'zaka zino, pa 46 peresenti.
Ngakhale anthu achikulire angalekerere mankhwala oopsa a chemthritisheni kwa PCNSL, amakhala ndi vuto loyipa poyerekeza ndi odwala omwe ali ocheperapo. Anthu achikulire amakhudzidwa kwambiri ndi poizoni, makamaka zotsatira za ubongo pambuyo pa ubongo wonse wa radiotherapy.
Odwala omwe ali ndi masewera olimbitsa thupi a CNS amachitilidwa magawo awiri: gawo lolowetsedweramo, lopangitsa kuti chikhululukirocho chikhalepo, ndipo gawo lophatikizidwa, limaperekedwa kamodzi kukhululukidwa.
Chithandizo chofala kwambiri ndi mankhwala a Trexall (methotrexate) -wachizira mankhwala omwe amatsatiridwa ndi consolidation lonse-ubongo radiotherapy, koma odwala ambiri amadwala ndi kufa ndi lymphoma kapena kukhala ndi chiopsezo cha poizoni kwa dongosolo la mitsempha.
Zitsanzo Zothandizira
Chifukwa cha vutoli, Dr. Benjamin Kasenda ndi anzake adayang'ana mwachidwi kuti apeze kafukufuku wa mankhwala ochiritsira matendawa kwa anthu oposa 60.
Mwachindunji, iwo ankafuna kudziwa njira zomwe mankhwala ochizira odwala amachigwiritsa ntchito monga mankhwala oyamba omwe nthawi zambiri odwala omwe ali ndi PCNSL atsopano.
Iwo anapeza maphunziro 20 omwe anafalitsidwa, kuphatikizapo chidziwitso kuchokera kwa odwala 783 omwe adakumana ndi njira zawo zophunzirira, zomwe zakhala zikupezeka ndi PCNSL, zaka zoposa 60 komanso chitetezo cha m'thupi. Ambiri, adapeza mankhwala oyamba omwe ali m'gulu lino amasiyana, ndipo panalibe chithandizo choyenera cha odwala omwe ali ndi PCNSL.
Zotsatira Zopindulitsa
- Ofufuza apeza kuti, kwazaka khumi zapitazi, kufotokozera mu gulu lino kwasintha.
- Mankhwala omwe ankaphatikizapo methotrexate ya dose yapamwamba anali ogwirizana ndi zotsatira zabwino kwambiri.
- Mankhwala otchuka kwambiri komanso mankhwala osokoneza bongo ena awiri - mankhwala opweteka - poyerekeza ndi mlingo wamtundu wa methotrexate komanso mankhwala opatsirana ammimba sanali oyanjana ndi kuyankhidwa bwino kapena kupulumuka
- Kwa anthu omwe adalandira mankhwala ochizira kwambiri a methotrexate, ubongo wa radiotherapy wonse unagwirizanitsidwa ndi kupulumuka kwabwino, komabe ndi chiopsezo chowonjezereka cha zotsatira za mitsempha.
- Methotrexate tsopano ndi mankhwala ophunziridwa kwambiri pochiza PCNSL. Odwala ochepa tsopano akuchiritsidwa ndi mankhwala onse a ubongo, okha.
Pansi
Phunziroli linayang'ana kumbuyo pa zomwe zinachitika kale. Icho chinali phunziro lachidziwitso ndi loyang'ana, ndipo chotero liri ndi zoperewera zina zofunika. Komabe, deta yowonjezereka kwambiri kuchokera ku mayesero omwe akuyembekezeredwa ndi PCNSL okalamba sapezeka. Apa pali zomwe gulu ili linatsiriza:
- Mankhwala apamwamba a mlingo-methotrexate ayenera kuperekedwa ngakhale kwa odwala ofooka, ngati n'kotheka.
- Chithandizo choyamba chokhala ndi mlingo waukulu wa methotrexate pamodzi ndi olemba mawu, procarbazine kapena temozolomide, mwachitsanzo-ankawonekeranso kuti akulonjeza ndipo amayenera kufufuzidwa.
- Ubongo wonse wa radiotherapy ukhoza kusintha zotsatira, koma umagwirizanitsidwa ndi chiopsezo chowonjezeka cha zotsatira za mitsempha.
Pomaliza, Kasenda ndi anzake adalongosola kufunikira kwa mayesero omwe angakonzekere odwala achikulire a PCNSL.
> Zotsatira:
Ferreri AJM, Cwynarski K, Pulczynski E, et al. Chemoimmunotherapy Ndi Methotrexate, Cytarabine, Thiotepa, ndi Rituximab (MATRix Regimen) mwa Odwala Ndi Maphunziro Aakulu CNS Lymphoma: Zotsatira za Kuyamba Kuwongolera kwa International Exranodal Lymphoma Study Group-32 (IELSG32) gawo lachiwiri. Lancet Hematology. 2016; 5; e217-e227.
Kasenda B, Ferreri AJM, Marturano E, et al. Chithandizo Cha Choyamba ndi Zotsatira za Okalamba Okalamba Amene Ali ndi Matenda Aakulu Amphamvu Aakulu Lymphoma (PCNSL) - Ndondomeko Yodalirika ndi Dokotala Wodwala Meta-Analysis. Ann Oncol . 2015. [Epub patsogolo pa kusindikiza].
Roth P, Hoang-Xuan K. Mavuto mu Chithandizo cha Odwala Okalamba Amene Ali ndi Matenda Aakulu Omwe Amakhala Otsika Kwambiri Lymphoma. Curr Opin Neurol. 2014; 27: 697-701.
Panageas KS, Elkin EB, Ben-Porat L, et al. Zitsanzo Zothandizira Okalamba Achikulire Amene Ali ndi Matenda Aakulu Amtundu Wambiri Wam'mimba Lymphoma. Khansara 2007; 110: 1338-1344.