Kubwereza kwa Zowonjezera Zosakaniza Zowonjezereka
Chithandizo chokhacho chochizira cha myelofibrosis (PMF) choyamba ndi kusamba kwa maselo , komabe, mankhwalawa akulimbikitsidwa ndi odwala omwe ali payekha komanso omwe ali pakati pawo. Ngakhale mu gulu lino, zaka ndi zochitika zina zachipatala zingathe kuonjezera ngozi zomwe zimagwirizanitsidwa ndi kuika mchere ndikuzipanga kukhala zochepetsetsa. Kuonjezerapo, sikuti anthu onse omwe ali ndi chiopsezo chachikulu cha pakati pa PMF adzakhala ndi mphotho yoyenera yoperekera wothandizira.
Ndibwino kuti anthu omwe ali ndi chiopsezo chachikulu cha PMF adzalandire chithandizo chofuna kuchepetsa zizindikiro za matendawa.
Mwinanso dokotala wanu akulangiza kuti kusakaniza si njira yabwino kwa inu, kapena palibe wopereka wabwino angadziwidwe, kapena simunalekerere mankhwala ena oyambirira a PMF. Mwachibadwa, funso lanu lotsatira lingakhale -loti njira zina zamankhwala zilipo? Mwamwayi, pali maphunziro ochulukirapo ambiri akuyesera kupeza njira zina zothandizira mankhwala. Tidzakambirana zina mwa mankhwalawa mwachidule.
JAK2 Inhibitors
Ruxolitinib , JAK2 inhibitor, ndiyo njira yoyamba yothandizidwa ndi PMF. Zosinthika mu JAK2 zakhala zikugwirizana ndi chitukuko cha PMF.
Ruxolitinib ndi mankhwala oyenera kwa anthu omwe amasintha kusintha kumeneku omwe sangathe kulumikizidwa. Mwamwayi, zapezeka kuti zothandiza ngakhale kwa anthu opanda kusintha kwa JAK2.
Pali kafukufuku wopitiriza kuyang'ana kupanga mankhwala ofanana ndi ena (JAK2 inhibitors) omwe angagwiritsidwe ntchito pochiza PMF komanso kuphatikiza mankhwala a ruxolitinib ndi mankhwala ena.
Momelotinib ndi wina wa JAK2 inhibitor amene akuphunzira kuti athe kuchipatala PMF. Maphunziro oyambirira adanena kuti 45 peresenti ya anthu omwe adalandira momelotinib anali ndi kuchepa kwa kukula kwa nthonje.
Pafupifupi theka la anthu omwe adaphunzira anawongolera kuperewera kwa magazi m'thupi ndipo oposa 50 peresenti anatha kuletsa kuika magazi. Thrombocytopenia (kuwerengeka kochepa kwa platelet) kungapangitse ndipo ingachepetse mphamvu. Momelotinib adzafaniziridwa ndi ruxolitinib mu maphunziro atatu a gawoli kuti adziwe momwe amachitira mankhwala a PMF.
Mankhwala Osokoneza Bongo
Pomalidomide ndi mankhwala osokoneza bongo (mankhwala omwe amasintha chitetezo cha mthupi). Zimayenderana ndi thalidomide ndi lenalidomide. Kawirikawiri, mankhwalawa amaperekedwa ndi prednisone (mankhwala a steroid).
Thalidomide ndi lenalidomide zaphunziridwa kale monga chithandizo cha mankhwala mu PMF. Ngakhale kuti onsewa amapindula, ntchito zawo nthawi zambiri zimakhala zolephereka. Pomalidomide inapangidwa ngati njira yochepa yoopsa. Odwala ena ali ndi vuto la kuchepa magazi m'thupi koma palibe zotsatira zomwe zimawoneka mu kukula kwa mpeni. Chifukwa chopindula chochepa ichi, pali maphunziro apitiriza kuyang'ana kuphatikiza polmalidomide ndi ena othandizira monga ruxolitinib kuti azisamalira PMF.
Matenda a Epigenetic
Mankhwala a Epigenetic ndi mankhwala omwe amachititsa kuti majeremusi ena asinthe m'malo mowasintha. Gulu limodzi la mankhwalawa ndi hypomethylating agents, omwe amaphatikizapo azacitidine ndi decitabine.
Mankhwalawa amagwiritsidwa ntchito pochiza matenda a myelodysplastic . Kafukufuku akuyang'ana udindo wa azacitidine ndi decitabine ali kumayambiriro oyambirira. Mankhwala ena ndi histone deacetlyase (HDAC) omwe amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda.
Everolimus
Everolimus ndi mankhwala omwe amadziwika kuti ndi ofanana ndi mankhwala a MTT. Ndi FDA (Food and Drug Administration) omwe amavomereza kuti azitha khansa zingapo (khansa, renal cell carcinoma, zotupa za neuroendocrine, ndi zina zotero) komanso kuteteza kukanidwa kwa anthu omwe adalandira kulumikiza thupi (chiwindi kapena impso). Everolimus imatengedwa pamlomo.
Kafukufuku oyambirira amasonyeza kuti ikhoza kuchepetsa zizindikiro, kukula kwa nthonje, kuchepa kwa magazi, kuchuluka kwa mapepala ndi kuchuluka kwa maselo oyera.
Imetelstat
Imetelstat yawerengedwa m'matenda angapo a kansa komanso myelofibrosis. Poyambirira, maphunzirowa athandiza anthu omwe amafa ndi zizindikiro za PMH) mwa anthu ena omwe ali ndi kachilombo ka HIV pakati pawo.
Ngati simukugwirizana ndi chithandizo chamankhwala oyamba, kulembetsa mayesero a kachipatala kungakupatseni mwayi wopita kuchipatala. Pakalipano, pali mayesero oposa 20 omwe amafufuza njira za chithandizo kwa anthu omwe ali ndi myelofibrosis. Mungathe kukambirana njirayi ndi dokotala wanu.
> Zotsatira:
> Cervantes F. Mmene ndimachizira myelofibrosis yoyamba. Magazi. 2014; 124: 2635-2642.
> Geyer HL ndi Mesa RA. Thandizo la mayeloplimsative neoplasms: ndi liti, wothandizira, ndi motani? Magazi. 2014; 124: 3529-3537.