Khansa ya m'magazi, khansara ya maselo opanga magazi, nthawi zambiri imaganiziridwa ngati mkhalidwe umene umakhudza ana ndi achinyamata-makamaka, khansa yambiri ya ubwana. Komabe, khansa ya m'magazi imakhudzanso anthu akuluakulu komanso anthu omwe ali m'zaka zoposa 60, makamaka.
Ngakhale kuti chithandizo cha okalamba achikulire chingakhale chovuta, lero pali chiwerengero chowonjezeka cha zosankha-ngakhale mutakhala okalamba mokwanira kukumbukira Eisenhower ndi JFK.
Pali mankhwala atsopano omwe akuthandizira kuthana ndi matenda, ngakhale pamene thupi lanu silingathenso kuwonongeka kwa mankhwala a chemotherapy. Izi zinati, ngakhale masiku ano, khansa ya m'magazi ndi mdani wodabwitsa kwa ambiri.
Mitundu ya khansa ya m'magazi mu Okalamba Achikulire
Lymphocytic khansa ya m'magazi (CLL) ndi imene imayambitsa khansa ya m'magazi akuluakulu, omwe amakhala ndi zaka pafupifupi 71. Mitsempha yambiri ya myeloid (AML) imakhala yachiwiri kwa anthu akuluakulu, ali ndi zaka zapakati pa zaka makumi asanu ndi awiri; ndipo oposa 60 peresenti ya odwala atsopano omwe ali ndi AML ali oposa 60. Momwemonso, CLL ndi AML zimagwiritsidwa ntchito kwambiri pano, komabe akuluakulu akhoza kukhala ndi mitundu iwiri ya khansa ya m'magazi. Zaka za zaka zoposa 70 ndizoopsa kwa akuluakulu a acythniblastic leukemia (ALL), omwe amatchedwanso kuti akuluakulu am'kakiteriya a khansa ya m'magazi. Ndipo chifukwa cha matenda aakulu a myelogenous leukemia (CML), pafupifupi 50 peresenti ya odwala ali ndi CML ali ndi zaka 66 kapena kuposerapo.
Anthu Okalamba Amadziwika ndi Khansa ya m'magazi
CLL ndi AML ndiwo mitundu yowopsa ya khansa ya m'magazi yomwe imawonekera mtsogolo m'moyo. Pa awiriwa, AML ndi matenda ofulumira kwambiri. Chiwerengero cha zipolowe ziwiri (magulu onse a zaka) mu 2016 ndizo:
- 18,960 atsopano ndi imfa 4,660 kuchokera ku CLL
- 19,950 atsopano ndi imfa 10,430 kuchokera ku AML.
CLL ndi AML ndi matenda osiyana kwambiri, kusonyeza kusiyana kwakukulu pakati pa acute ndi matenda aakulu a leukemias, ambiri. Ma leukemia onse amayamba pamene maselo a mafupa-fakitale ya thupi lanu kupanga maselo atsopano a magazi-amayamba kupanga maselo oyera achizungu. Maselo amathithi mumphuno wa mafupa nthawi zambiri amapereka maselo onse a magazi nthawi zonse, kupanga maselo atsopano kuti alowe m'malo akalewo. Kachilombo koyambitsa matenda kamene kamakhudzana ndi maselo amagazi opanga magazi ndipo amayamba kukula mofulumira kwambiri. Khansa ya m'magazi imaphatikizapo maselo opanga magazi omwe ali okhwima kwambiri, koma adakali achilendo, komanso ma leukemia aakulu amayamba kukula pang'onopang'ono, pa miyezi ndi zaka.
CLL
CLL ndi khansara ya maselo oyera m'magazi a B-lymphocyte. B-lymphocytes, kapena B-maselo, ndi ma lymphocytes omwe amatha kuyambitsa ndi kutsogolera kupanga opanga mankhwala. Mitundu ina ya ma lymphocytes ndi T-maselo, omwe ali ngati maseĊµera a chitetezo cha mthupi, kapena maselo a msilikali.
CLL sizimayambitsa zizindikiro kumayambiriro, ndipo munthu sakudziwa kuti ali ndi CLL poyamba. Ndipotu, kawirikawiri, anthu amapezeka kuti atha kuyesa magazi. Pamene CLL imayambitsa zizindikiro, zina mwazofala ndizo: kumva kutopa ndi kufooka; kapena kukhala ndi lymph node yotupa m'khosi, pansi pa mkono kapena m'mimba; kapena kugwidwa ndi matenda odwala mosavuta; kapena kukhala ndi malungo, kapena thukuta lalikulu usiku; kapena kutaya thupi popanda kuyesera.
Mu CLL, maselo a khansa amapezeka makamaka m'magazi, m'mafupa, ndi m'magazi. Matenda ofanana, omwe amatchedwa kansalu yambiri ya m'magazi, kapena SLL, ndi khansa yomwe imayambira mu B-cell ya maselo, monga CLL, komabe munthu yemwe ali ndi SLL alibe ma selo oyera a magazi m'magazi awo.
Kuzindikira kwa CLL kumafuna kuyesa magazi, ndipo chiwerengero cha maselo a B m'magazi anu chiyenera kutsimikiziridwa. CLL imapezeka ndi kupezeka kwa maselo osachepera 5,000 B mlingo uliwonse mwa magazi, ndipo maselo a B ayenera kukhala "makopi" kapena makina a selo lofanana la makolo. Izi zimatchedwa monoclonality.
Maselo a CLL amafunikanso kuyesedwa kuti awone chomwe chiri pamwamba pawo. Iwo akhoza kukhala ndi zizindikiro zamapuloteni aliwonse kapena zizindikiro. Ma laboratories amatchula zizindikiro za mapuloteniwa pogwiritsa ntchito makalata a CD motsatiridwa ndi manambala. Mu CLL, maselo akhoza kukhala ndi zizindikiro zomwe zimatchedwa CD5, CD19, ndi CD23 pamwamba pawo; ena akhoza kukhala ndi CD20, koma palibe CD10. Nthawi zina, muyenera kuyesedwa mayeso ena kupatula kuyezetsa magazi, monga matenda a mitsempha ya mitsempha kapena mafupa a mafupa. Komabe, izi sizomwe zimakhalapo nthawi zonse kuti muzindikire CLL.
CLL vs. MBL
Kafukufuku amasonyeza kuti anthu 3 mpaka 5 peresenti anthu omwe ali ndi zaka zoposa 40, akayesedwa ndi mayesero ovuta, amasonyeza kuti ali ndi ma lymphocyte, monga mu CLL. Kupeza kumeneku kunachititsa kuti chilengedwe chidziwike kwa MBL, chomwe chimaonedwa kuti ndi chithunzithunzi cha CLL.
Ngati muli ndi osachepera 5,000 B-maselo osakanikirana, mulibe lymph node ndipo mulibe zizindikiro zina za CLL, mukhoza kupezeka ndi monoclonal B-lymphocytosis (MBL). Izi ndi zachilendo kwa akulu akulu, ndipo sikuti ndi khansa. Anthu ochepa omwe ali ndi BML akupitiliza kupanga CLL; komabe pali kuthekera kotero, choncho kuyembekezera kuyembekezera kukulimbikitsidwa.
Ngakhale mutakhala ndi matenda a CLL, chisankho chochita sizingakhale zomveka. M'mbuyomu, madokotala anawauza odwala omwe ali ndi CLL kuti nthawi yodikira iyenera kutsatiridwa mpaka matendawa apitirire, panthawi yomwe mankhwalawo adzayambe. Ngakhale izi zikhoza kukhala choncho nthawi zambiri, pali kumvetsetsa kochuluka kuti machitidwe osiyanasiyana a CLL angakhale osiyana, ndipo zina za CLL zingapemphe thandizo lachangu.
Chimodzi mwa mapulani omwe inu ndi dokotala wanu mudzachite ndi kudziwa ngati mankhwala a CLL anu ayambe. Chigamulocho chapangidwa kuchokera pa zizindikiro za CLL, zotsatira za mayeso a lab ndi kuyesa ma stage. Kwa CLL, njira ya Rai ikugwiritsidwa ntchito, kuyambira pa Gawo I kupita ku Gawo la IV. Palinso dongosolo la Binet la CLL lomwe limakhazikitsa magawo A, B, ndi C, koma sizothandiza pa nthawi yoyamba mankhwala.
Madokotala amalekanitsa magawo a Rai kukhala magulu otsika, omwe ali pakati, ndi omwe ali ndi chiopsezo chachikulu pozindikira njira zothandizira.
- Gawo 0 limatengedwa kuti ndi loopsa.
- Ndondomeko yoyamba I ndi yachiwiri ikuonedwa kuti ndi yoopsa.
- Ndondomeko III ndi IV zimaonedwa kuti ndizoopsa.
Kwa anthu omwe ali ndi CLL ya RAI magawo 0, I ndi II, n'zotheka kuti chithandizo chisafunike nthawi yomweyo. Komabe, kwa munthu yemwe ali ndi matenda oyamba msinkhu komanso CLL-mwachitsanzo ndi kukhalapo kwa zizindikiro za CLL monga kutopa kapena malungo, usiku kutuluka kapena kutaya kwadzidzidzi- mankhwala amauzidwa.
Zinthu zina pamodzi ndi siteji nthawi zina zimaganiziridwa poyang'ana njira zosamaliramo mankhwala. Zinthu zomwe zimagwirizanitsidwa ndi nthawi yayitali zimatchedwa zizindikiro zowonongeka, pomwe zifukwa zomwe zimakhudzana ndi kukhalapo kwa nthawi yaitali ndizovomerezeka.
Zina mwa zinthu zokhudzana ndi maselo a khansa ya khansa ya m'magazi ndi zizindikiro zapamwamba zimagwiritsidwanso ntchito: ZAP-70, CD38, ndi gene mutated ya IGHV kuthandiza kuthandizira ma CLL m'magulu awiri, kukula mofulumira ndi kukula mofulumira. Anthu omwe ali ndi mtundu wochepa wa CLL amakhala ndi moyo nthawi yayitali ndipo amatha kuchepetsa mankhwala nthawi yayitali.
Mankhwala opatsirana a CLL amagwera m'magulu akuluakulu monga mankhwala, chemotherapy, chithandizo chamankhwala, immunotherapy, immunomodulators, ndi steroids. Osati mankhwala onse ali oyenera kwa anthu onse okhala ndi CLL. Madokotala ambiri akamaphunzira za mitundu yosiyanasiyana ya CLL, njira zowonjezereka zothandizira zikhoza kukhala zoyenera milandu ya CLL koma osati ena.
Zochiritsira zina ndizofufuzira ndipo zingatheke kupezeka ngati mutalowa muyeso wa kuchipatala. Malingana ndi mayesero a kachipatala, kamodzi kokha mankhwala atatsimikiziridwa kukhala otetezeka ndi ogwira ntchito kwa CLL, mankhwalawa amavomerezedwa ndi FDA ndipo amapezeka kwambiri.
Ukalamba komanso umoyo wathanzi umakhalanso wofunika kwambiri pakusankha mankhwala. Mwachitsanzo, mankhwala ena oyamba a CLL angasankhidwe kukhala oyenerera kwa achinyamata ndi omwe ali ndi thanzi labwino la CLL; Njira zina zothandizira nthawi yoyamba kapena ma regimens angaoneke kuti ndi abwino kwa iwo omwe ali okalamba kapena odwala.
Kusamalidwa ndi chithandizo chimene sichichiza khansa koma cholinga chake ndi kupangitsa moyo ndi CLL kukhala bwino kwa inu. Kusamalira chithandizo kumaphatikizapo zinthu monga katemera, kuikidwa magazi, mankhwala othandiza, komanso kuthandizira kuti azisamalira ngati madokotala osiyanasiyana akukhudzidwa.
Anthu Achikulire Amene Ali ndi AML
Malinga ndi American Cancer Society, myeloid yaukhuta yaikulu ndi matenda a anthu okalamba ndipo ndi yachilendo asanakwanitse zaka 45. Avereji ya wodwala ndi AML ndi pafupifupi zaka 67.
Zizindikiro za AML nthawi zambiri zimagwirizana ndi chiwerengero cha magazi ochepa. Pamene maselo a khansa ya m'magazi amatenga mafupa, amachotsa maselo omwe amapanga magazi, omwe amachititsa kuti upewe magazi. Kuperewera kwa maselo ofiira a magazi kumabweretsa kuchepa kwa magazi ndi zizindikiro monga kufooka ndi kutopa kwambiri. Kuperewera kwa maselo oyera a mitsempha kumatsogolera ku neutropenia, mwinamwake zizindikiro monga fever ndi matenda. Kuperewera kwa mapuloteni kumabweretsa thrombocytopenia ndi zizindikiro monga kutuluka mwadzidzidzi kapena kuvulaza . Ndipo zizindikiro izi ndizofala.
Mu matenda a AML, pali zosawerengeka m'mayesero a magazi; Komabe, mosiyana ndi matenda a CLL, kupuma kwa mafupa / biopsy kawirikawiri kumafunika kufufuza ndi kuyesa AML. Magulu osiyanasiyana a AML tsopano amadziwika kuti alipo.
Pambuyo pa matenda a AML, pamodzi ndi gulu lanu la thanzi, mumakhala ndi cholinga cha mankhwala, komanso zotsatira za mankhwala. Pafupi theka la odwala akuluakulu a AML amapita kuchipatala atalandira chithandizo choyamba, malinga ndi American Cancer Society. Anthu omwe amapeza chikhululukiro chathunthu amakhala ndi moyo wabwino poyerekeza ndi odwala omwe amalandira chithandizo chamagetsi, mwina chifukwa cha kuchepetsedwa kwa odwala, kuikidwa magazi, ndi ma antibiotic. Otsalira a AML a nthawi yayitali amaimiridwa m'mibadwo yonse; Komabe, kubwereranso pambuyo poti mankhwalawa akufala kwambiri. Kawirikawiri, odwala omwe ali ndi AML amalimbikitsidwa kuti alowe m'mayesero a kachipatala kuti adzipangire njira zothandizira zatsopano komanso kuyembekezera kukonza zotsatira zawo.
Odwala okalamba omwe ali odwala kapena ambiri odwala, kapena osowa thupi, nthawi zina amasamalidwa komanso / kapena mankhwala ochepa kwambiri a mankhwalawa. Kusamalira chithandizo kumaphatikizapo kuikidwa magazi, maantibayotiki, ndi mankhwala ena omwe amathandiza thanzi la munthu koma samachotsa khansa.
> Zotsatira:
> American Society of Hematology. Kuchiza odwala okalamba omwe ali ndi mitsempha ya m'mitsempha yambiri.
> Chiorazzi N, Rai K, Ferrarini M. Chronic Lymhocytic Leukemia. N Engl J Med. 2005; 352: 804-15.
> Zotsatira za NCCN. Chronic Lymphocytic Leukemia. Tsamba 1. 2016.