So wɔama wo stem cell transplant afi obi hɔ? Momma yɛnhunu saa (Graft vs. Host Disease) yi!

Ebia woate stem cell a wɔde ma obi foforo ho asɛm. Wɔyɛ ayaresa a ɛho hia paa ma nyarewa bi. Nanso, ɛnnɛ yɛrebɛka ɔhaw bi a ebetumi aba wɔ nipadua foforo a ɛte saa akyi ho asɛm. Wɔfrɛ eyi `(Graft vs. Host Disease)` anaa `(GvHD)` tiawa. Mma ɛnhaw wo, momma yɛnka eyi ho asɛm tiawa.

Dɛn ne `(Graft vs. Host Yare - GvHD)`? Sɛ yɛbɛkyerɛkyerɛ mu tiawa a...

Fa no sɛ wɔama wo ntini mu nkwammoaa foforo afi obi foforo hɔ, obi a ɔde ma . Yɛfrɛ eyi sɛ allogeneic transplant. Saa ntini mu nkwammoaa yi te sɛ nkwammoaa a ennyinii wɔ wo nipadua adwumayɛbea a wɔyɛ mogya, anaasɛ ntini mu nkwammoaa a ɛma mogya yɛ adwuma no. Eyinom ne nkwammoaa a akyiri yi ɛbɛyɛ mogya mu nkwammoaa kɔkɔɔ ne mogya mu nkwammoaa fitaa a wo nipadua hia no.

Afei, bere bɛn na wubehia ntini mu nkwammoaa a efi obi a ɔde ma te sɛ eyi hɔ? Sɛ wowɔ kokoram te sɛ mogya mu kokoram anaa lymphoma, anaa yare foforo a wo nnompe mu ntini nyɛ adwuma yiye te sɛ aplastic anemia a, ebia wubehia sɛ wɔde saa nipadua foforo yi ma wo.

Okay, afei dɛn ne `(GvHD)` yi? Wɔ `(GvHD)` mu no, nea ɛba ne sɛ, donor cells a wo nsa kaa (graft) no hu nkwammoaa a ɛwɔ wo nipadua mu (host) no sɛ biribi a ɛyɛ nwonwa, a wunnim. Ɛte sɛ nea wo nipadua yɛ beae foforo ma wɔn. Enti, saa nkwammoaa a wɔde ma yi fi ase tow hyɛ wo nipadua mu nkwammoaa so. Ɛno nti na wɔfrɛ no `(Graft vs. Host Disease)`, a ɛkyerɛ "graft against host." So wote ase?

GvHD ahorow atitiriw bɛn na ɛwɔ hɔ?

GvHD ahorow atitiriw abien na ɛwɔ hɔ. Bere bi a atwam no, nnuruyɛfo gyina bere a egye ansa na yare no ho sɛnkyerɛnne afi ase so na ɛkyekyɛ mu. Nanso seesei, wɔhwɛ yare no ho sɛnkyerɛnne ne nea efi sɔhwɛ mu ba de hu ɔkwan pɔtee a wɔfa so yɛ no.

1. GvHD a ɛyɛ hu (aGvHD) .

Eyi taa ba bere a wɔde wo ntini mu nkwammoaa foforo ama wo akyi bere tiaa bi , mpɛn pii no wɔ nnafua 100 a edi kan no mu . Nanso, ɛtɔ mmere bi a, yare no ho sɛnkyerɛnne betumi afi ase akyiri yi. GvHD a emu yɛ den taa ka wo honam ani, wo aduan mu nhyehyɛe (GI kwan), anaa wo mmerɛbo.

2. GvHD a enni sabea (cGvHD) .

GvHD a enni sabea betumi aba bere biara wɔ allogeneic transplant akyi. Nanso, ɛtaa fi ase wɔ mfe abien ntam . GvHD a enni sabea betumi aka wo honam ani, w’ano, wo mmerɛbo, w’ahurututu, wo GI kwan, wo ntini, wo nkwaa, anaa wo honam ani fã.

Nea ɛho hia: Ebia wubenya GvHD ahorow yi mu biako, abien no nyinaa, anaa emu biara. Ɛsono nnipa biara.

Dɛn ne `(GvHD)` ho sɛnkyerɛnne? Hwɛ eyinom so yiye!

GvHD ho sɛnkyerɛnne gu ahorow wɔ onipa biara mu. Ebia nnipa binom benya yare no ho sɛnkyerɛnne a emu nyɛ den , ebinom betumi anya yare no ho sɛnkyerɛnne a ɛkɔ fam , na afoforo nso betumi anya yare no ho sɛnkyerɛnne a emu yɛ den.Ebetumi ayɛ nea emu yɛ den koraa (de nkwa mpo to asiane mu).

Nsɛnkyerɛnne a ɛkyerɛ sɛ `(GvHD)` a emu yɛ den

Yɛaka dedaw sɛ GvHD a emu yɛ den taa ka honam ani, GI kwan, ne mmerɛbo.

• Wora (aGvHD): Nsɛnkyerɛnne a ɛtaa ba ne honam ani a ɛyɛ mmerɛw anaasɛ ɛyɛ kɔkɔɔ (te sɛ owia a ɛhyew). Ebia ɛyaw ne ɛyaw bɛba. Mpɛn pii no, akisikuru no fi ase wɔ kɔn, mmati, aso, nsateaa, ne nan ase. Afei ebetumi atrɛw akɔ nipadua no afã afoforo.
• Yafunu mu (GI) kwan (aGvHD): Nsɛnkyerɛnne a ɛtaa ba ne akisikuru, ɔfe, ne akisikuru (akisikuru). Saa sɛnkyerɛnne ahorow yi betumi ayɛ nea emu nyɛ den anaasɛ emu yɛ den araa ma ebehia sɛ wɔde no kɔ ayaresabea.

GvHD a emu yɛ den ho sɛnkyerɛnne a ɛtaa ba no bi ne:

• Honam ani akisikuru ne/anaasɛ ɛyɛ akisikuru.
• Ayamtuo.
• Akisikuru ne ɔfe.
• Yafunu mu yaw, a ɛyɛ mmerɛw.
• Jaundice (honam ani ne/anaasɛ aniwa a ɛyɛ kɔkɔɔ).

GvHD a enni sabea ho sɛnkyerɛnne

GvHD a enni sabea taa ka wo honam ani, mmerɛbo, GI kwan, ne w’ahurututu. Nanso, ebetumi aka wo nipadua no fã biara.

Ebia sɛnkyerɛnne ahorow no bi ne:

• Honam ani akisikuru ne/anaasɛ ɛyɛ akisikuru.
• Wora a ɛyɛ den na ɛho ahonhon.
• Nwi a ɛtɔ wɔ ti ne nipadua so.
• Ano a ɛyɛ nwunu.
• Ano mu akuru.
• Anom yare.
• Aniwa a ayow, a ɛte sɛ nea anhwea bi akata mu.
• Nsakrae a ɛba wɔ anisoadehu mu.
• Ayamtuo.
• Akisikuru ne ɔfe.
• Wora ne/anaasɛ aniwa a ɛyɛ kɔkɔɔ (jaundice).
• Ɔhome a ɛyɛ den (dyspnea).
• Ɔfe a ɛyɛ nwunu a ɛkɔ so daa.
• Ɔbrɛ.
• Ntini mu mmerɛwyɛ, akisikuru, anaa ɛyaw.
• Sɛ wontumi nkotow nkwaa na wɔtrɛw mu yiye.
• Mmea betumi anya wɔn awotwaa mu ayow, ayɛ wɔn yaw, anaa wɔate yaw bere a wɔrenya nna mu kyɛfa no.
• Mmarima betumi ate wɔn akyi berɛmo anaa wɔn awotwaa mu yaw, anaasɛ ɛyaw bere a wɔrenya nna mu kyɛfa no.

Adɛn nti na saa `(GvHD)` yi ba? Dɛn na ɛde ba?

Sɛ yɛbɛka no tiawa a, GvHD ba bere a ntini mu nkwammoaa a efi ɔdemafo a wogyee no no mu no hu w'ankasa nipadua mu nkwammoaa sɛ "ahɔho" na wofi ase tow hyɛ wɔn so.

Eyi ne nea ɛtaa ba: Wo nipadua mu nkwammoaa a ɛko tia nyarewa (nkwaboaa a ɛwɔ wo mogya mu) bɔ wo ho ban fi nyarewa ho. Wɔko tia nneɛma a efi amannɔne te sɛ mmoawa ne mmoawa. Nanso, saa nkwammoaa yi ntow nhyɛ w’ankasa wo nkwammoaa so. Eyi te saa efisɛ wo nkwammoaa no wɔ protein soronko bi a wɔfrɛ no ``Human Leukocyte Antigens'', anaa ``HLA''. Eyi te sɛ tag a wɔakyerɛw din wɔ so. Saa ``HLA'' yi ne nea ɛka kyerɛ wo nipadua mu nkwammoaa a ɛko tia nyarewa no sɛ, "Hey, eyi yɛ yɛn de no mu biako."

Adeɛ a ɛho hia paa ne sɛ, gye mmanoma a wɔyɛ pɛ a, ɛsono obiara `(HLA)` wɔ ne yɔnko ho.

Sɛ wonya stem cell transplant fi obi foforo hɔ wie a, mogya nkwammoaa foforo a ɛwɔ wo nipadua mu no nni wo `(HLA)`, na mmom `(HLA)` a nea ɔde mae no . Enti, sɛ saa ɔdemafo yi `(HLA)` yɛ soronko koraa wɔ `(HLA)` a ɛwɔ wo nipadua mu no ho a, saa mogya nkwammoaa foforo no fi ase tow hyɛ wo nipadua mu nkwammoaa so. Ɛno ne bere a `(GvHD)` ba.

Eyi nti na nnuruyɛfo hwɛ nea ɔde ma no no HLA yiye hwɛ sɛ ɛbɛn wo de no sɛnea wobetumi ansa na wɔayɛ ntini mu nkwammoaa foforo. Sɛ wunya obi a ɔne no yɛ pɛ a ɔte saa a, ɛtew asiane a ɛwɔ hɔ sɛ wubenya GvHD no so. Nanso, sɛ woannye nkwammoaa amfi twin a ɛyɛ pɛ hɔ a, hokwan da so ara wɔ hɔ sɛ wubenya GvHD, ɛmfa ho sɛ wobɛbɔ mmɔden sɛ wobɛfa nsɛso dodow ahe.

Hena na ɔwɔ asiane kɛse sɛ obenya GvHD?

Asiane a ɛho hia sen biara ne sɛnea nea ɔde ma no HLA ne wo de no hyia yiye. Wowɔ asiane kɛse mu sɛ wubenya GvHD sɛ:

• Wo nsa kaa ntini mu nkwammoaa fii wo busuani bi hɔ, nanso ɛnyɛ nea ɛne HLA hyia pɛpɛɛpɛ .
• Wo nsa kaa stem cells fii obi a ɔnyɛ wo busuani, nanso ɔyɛ `(HLA)` match .

Nneɛma afoforo a ɛde asiane ba ne:

• Ɛsɛ sɛ nea ɔde ma no yɛ ɔbea a wanyinsɛn pɛn.
• Mfe a nea ɔde ma no anaa w’ankasa wo mfe a ɛkɔ soro.
• Bɔbeasu a ɛne ne ho nhyia wɔ nea ɔde ma no ne wo ntam (e.g. nkwammoaa a wonya fi ɔbarima a ɔde ma no hɔ kɔ ɔbea hɔ, anaasɛ efi ɔbea a ɔde ma no hɔ kɔ ɔbarima bi hɔ).
• Sɛ wogye nea ɔde ma no ntini mu nkwammoaa fi mogya ntini (mogya) mu sen sɛ wobegye afi nnompe mu ntini (beae a wɔyɛ mogya mu nkwammoaa) mu a.

Sɛ woanya `(aGvHD)` a emu yɛ den dedaw a, wowɔ asiane kɛse mu sɛ wubenya `(cGvHD)` a enni sabea.

Ɔkwan bɛn so na wohu GvHD?

Wo duruyɛfo betumi ahu GvHD denam wo mu nhwehwɛmu, wo sɛnkyerɛnne ahorow a ɔbɛhwɛ, ne nhwehwɛmu a wɔayɛ wɔ lab ne nea efii biopsy mu ba a ɔbɛhwɛ so. Nea ɛka biopsy ho ne sɛ wobɛfa wo ntini anaa wo nkwammoaa ketewaa bi na wode akɔ lab ma wɔayɛ ho nhwehwɛmu.

Wɔ GvHD a enni sabea (cGvHD) mu no, sɛnkyerɛnne ahorow no bi betumi ayɛ te sɛ nyarewa afoforo. Enti, oduruyɛfo no bɛpow nneɛma afoforo a ɛde ba nyinaa ansa na wahu cGvHD no yiye.

Dɛn ne ayaresa ahorow a wɔde sa GvHD?

Sɛ wɔde ntini mu nkwammoaa foforo ma wo wie a, wɔbɛma wo nnuru a ɛmma nipadua no tumi ko tia nyarewa sɛ ɔkwan a wɔfa so siw ano a ɛbɛma nkwammoaa a wɔde ma no tumi akɔtow ahyɛ w’ankasa wo ntini so no so.

Sɛ saa nnuru yi ntumi nsiw GvHD nkɔso ano a, wo duruyɛfo no begyina sɛnea wo tebea no mu yɛ den ne GvHD ko a wowɔ so akyerɛw wo ayaresa.

GvHD a emu yɛ den a wɔsa

Mpɛn pii no, nnuruyɛfo sa nnipa a wɔwɔ GvHD a emu yɛ den no yare yiye denam nnuru a esiw nipadua no mu tumi a ɛko tia nyarewa ano a wɔma ɛkɔ soro no so. Eyinom ka nnuru kuw bi a wɔfrɛ no corticosteroids ho. Wobetumi de ano, wɔde ahyɛ ntini mu, anaasɛ wɔde ahyɛ nipadua no so. Sɛ steroids ntumi nyɛ adwuma a, ebia wo duruyɛfo bɛkyerɛw aduru bi te sɛ Ruxolitinib (Jakafi®). Ebia wubenya hokwan nso de wo ho ahyɛ ayaresabea sɔhwɛ ahorow a ɛsɔ ayaresa foforo hwɛ mu.

GvHD a enni sabea a wɔde sa yare

Wɔtaa de nnuru a ɛma nipadua no tumi ko tia nyarewa a ɛtra hɔ kyɛ na ɛsa GvHD a enni sabea. Sɛ nnuru yi mmoa a, ebia wo duruyɛfo bɛkyerɛw nnuru te sɛ:

• `Ruxolitinib (Jakafi®)`
• `Belumosudil (RezurockTM)`
• `Ibrutinib (Imbruvica®)`
• Photopheresis (Eyi yɛ ɔkwan titiriw a wɔfa so sa yare) .

Ebia wo nso wobɛfata ama ``clinical trials.'' Oduruyɛfo no bɛka saa asɛm no akyerɛ wo.

Dɛn ne nsɛnnennen/nsunsuanso bɔne a efi ayaresa mu ba?

Esiane sɛ nnuru a ɛma nipadua no tumi ko tia nyarewa yi ma wo nipadua mu tumi a ɛko tia nyarewa no yɛ mmerɛw nti, ɛda adi sɛ wubenya fungal, bacteria, ne virus yare mmoawa . Enti, wo duruyɛfo bɛkyerɛw wo nnuru afoforo pii de abɔ wo ho ban afi nyarewa a ɛyɛ hu yi ho.

So wobetumi asiw GvHD ano?

Tissue typing labs reyɛ nhwehwɛmu foforo a egyina DNA so a edi mu kɛse bere nyinaa na wɔde di dwuma. Eyi ma w’aduruyɛfo kuw no tumi paw nea ɔde ma a ɔwɔ HLA a ɛne no hyia kɛse ma wo. Dodow a match no ye no, dodow no ara na hokwan a ɛwɔ hɔ sɛ wubesiw GvHD ano no ye.

Afei nso, wo duruyɛfo bɛkyerɛw nnuru a ɛma nipadua no tumi ko tia nyarewa de siw GvHD ano bere a wɔde wo ntini mu nkwammoaa foforo ama wo no akyi.

So wobetumi asa GvHD koraa?

Mpɛn pii no, nnuruyɛfo tumi di tebea no ho dwuma yiye (GvHD). Ɛne sɛ, wobetumi adi sɛnkyerɛnne ahorow no so na wɔaboa wo ma woatra ase sɛnea ɛsɛ.

Saa bere yi nyinaa, nhwehwɛmufo resua akwan foforo a wɔbɛfa so asiw GvHD ano denam nnuruyɛ mu sɔhwɛ ahorow so. Sɛ nhwɛso no, wɔreyɛ nnuru ahorow a ɛma nipadua no tumi ko tia nyarewa ne nnuru foforo a wɔde siw yare ano mu nhwehwɛmu.

So GvHD betumi de nkwa ato asiane mu?

Yiw, ɛtɔ mmere bi a GvHD betumi de nkwa ato asiane mu. GvHD a enni sabea ne ade titiriw a ɛma nnipa a wɔde allogeneic stem cell transplant ma wɔn no wuwu, sɛ wɔn yare titiriw no da nkyɛn a.

Enti, ansa na wobɛyɛ ayaresa biara – mpo stem cell transplant – ɛho hia yiye sɛ wo ne wo duruyɛfo susuw asiane ahorow no ho. Obetumi akyerɛkyerɛ asiane ahorow mu akyerɛ wo na waboa wo ma woasusuw mfaso ne ɔhaw ahorow a ɛwɔ ayaresa no mu no ho.

So ɛtɔ da bi a mfaso bi wɔ `(GvHD)` so?

Mma ɛnyɛ wo nwonwa, ɛwom sɛ GvHD betumi anya nkɛntɛnso bɔne wɔ w’asetra pa so de, nanso ɛwɔ mfaso ahorow bi nso. Nkwammoaa a ɛko tia nyarewa koro no ara a ɛtow hyɛ wo nkwammoaa a ɛteɛ so no nso hwehwɛ kokoram nkwammoaa biara a ebia aka wɔ wo nipadua mu na ɛsɛe. Wɔfrɛ eyi sɛ graft-versus-tumor effect. Wɔahu sɛ nnipa a wonya GvHD no ntaa nnya wɔn yare titiriw (titiriw kokoram) no bio.

Mɛyɛ dɛn ahwɛ me ho? Di afotu yi akyi!

Wo duruyɛfo bɛkyerɛkyerɛ sɛnea ɛsɛ sɛ wohwɛ wo ho bere a wɔde wo ntini mu nkwammoaa foforo ama wo no mu akyerɛ wo. Sɛ nhwɛso no, sɛnkyerɛnne ahorow a ɛsɛ sɛ wohwɛ yiye wɔ ho ne sɛnkyerɛnne ahorow a ɛsɛ sɛ wofrɛ w’aduruyɛfo kuw no ntɛm ara sɛ wunya bi a. Sɛ wowɔ asiane mu sɛ wubenya GvHD a, wobetumi nso ama wo akwankyerɛ foforo a ɛfa ɔhwɛ ho. Akwankyerɛ ahorow yi bi ne:

• Bɔ wo honam ani ho ban fi owia ho. Hyɛ ntade a nsa tenten ne pantalon atenten. Fa aduru a ɛbɔ wo ho ban fi owia ho a anyɛ yiye koraa no SPF 50. (Owia a wode bɛbɔ no betumi ama GvHD asɛe anaasɛ akanyan.)
• Kura w’ano akwahosan pa mu. Eyi bɛma asiane a ɛwɔ hɔ sɛ obi benya anom yare no so atew.
• Kwati nnuan a ɛyɛ nnuhwam a ebetumi ahaw wo yafunu na ama w’ano ayɛ kurukuruwa.
• Fa nneɛma bi bɔ wo ho ban fi mmoawa ho. (Wo duruyɛfo bɛka eyi ho nsɛm pii akyerɛ wo.)

Bere bɛn na ɛsɛ sɛ mekɔ oduruyɛfo nkyɛn?

Ɛho hia sɛ wobɔ wo duruyɛfo amanneɛ ntɛm ara sɛ wowɔ nipadua mu nsakrae biara, titiriw sɛnkyerɛnne a ɛkyerɛ sɛ woanya ɔyare mmoawa ne atiridiinini (100.4 Fahrenheit / 38 Celsius anaa nea ɛboro saa). Sɛ wonom nnuru a ɛma nipadua no tumi ko tia nyarewa a, asiane kɛse wom sɛ wubenya nyarewa a ebetumi de wo nkwa ato asiane mu.

Sɛ wɔde allogeneic stem cell si ananmu wie a, wo duruyɛfo bɛhwɛ wo yiye sɛ ebia nsɛnnennen te sɛ Graft vs. Host Disease (GvHD) wɔ hɔ anaa. Sɛ wunya GvHD a emu yɛ den anaa enni sabea ho sɛnkyerɛnne a, wo duruyɛfo betumi asesa wo nnuru anaasɛ ɔbɛkyerɛw wo aduru foforo. Fa nnuru no nyinaa sɛnea wɔakyerɛw ama wo no pɛpɛɛpɛ. Di wo duruyɛfo akwankyerɛ a ɛfa sɛnea wobɛhwɛ wo ho, titiriw sɛnea wobɛbɔ wo ho ban afi nyarewa ho no akyi.

Nneɛma a ɛho hia sen biara a ɛsɛ sɛ yɛkae tiawa!

Okay, enti Graft vs. Host Disease, anaa GvHD, yɛ ɔhaw a ebetumi aba bere a wɔanya stem cell transplant afi obi foforo hɔ akyi. Sɛ yɛbɛka no tiawa a, ɛyɛ bere a nkwammoaa a wɔde ma no tow hyɛ w’ankasa nkwammoaa so no.

Kae sɛ ayaresa ahorow wɔ hɔ a wɔde sa GvHD, na wobetumi adi tebea no ho dwuma. Ade a ɛho hia sen biara ne sɛ wubedi w’aduruyɛfo kuw no akwankyerɛ akyi yiye na woama wɔahu sɛnkyerɛnne foforo biara ntɛm ara sɛnea wubetumi.

Sɛ wowɔ nsɛmmisa foforo bi fa eyi ho a, nsuro sɛ wubebisa wo duruyɛfo. Wɔn na wobetumi aboa wo yiye.

` GvHD, stem cell transplant, allogeneic transplant, nipadua mu ahoɔden a ɛko tia nyarewa, HLA, nkwammoaa a wɔde ma, sɛnkyerɛnne ahorow