So ɛsɛ sɛ yehu PTLD (Post-Transplant Lymphoproliferative Disorders) bere a wɔde akwaa foforo ahyɛ obi foforo akyi?

Ebia wo anaa obi a wunim no ayɛ oprehyɛn kɛse bi a egye nkwa, te sɛ akwaa foforo. Anaasɛ stem cell a wɔde bɛma obi foforo. Saa nneɛma yi akyi no, nsɛnnennen a wɔntaa nhu wɔ hɔ a wɔnhwɛ kwan. Nsɛnnennen a ɛte saa no biako ne PTLD, anaasɛ Post-Transplant Lymphoproliferative Disorders. Esiane sɛ eyi betumi ayɛ aniberesɛm kakra nti, momma yɛnka ho asɛm wɔ ɔkwan a ɛyɛ mmerɛw a wubetumi ate ase so.

Dɛn ankasa ne PTLD?

Sɛ yɛbɛka no tiawa a, PTLD yɛ ɔhaw a ɛde nkwa to asiane mu a ebetumi aba bere a wɔde akwaa foforo ama obi foforo anaasɛ wɔde allogeneic stem cell ahyɛ obi foforo akyi. Nea ɛkɔ so wɔ ha ne sɛ mogya mu nkwammoaa fitaa bi a ɛwɔ yɛn nipadua mu a wɔfrɛ no lymphocytes no mu paapae ntɛmntɛm na ɛkɔ soro a yentumi nni so.

Saa tebea a wɔfrɛ no PTLD yi yɛ lymphoma bi ankasa . Lymphoma yɛ kokoram bi a ɛba yɛn ntini mu. Saa tebea yi ba bere a mogya mu nkwammoaa fitaa dan kokoram na enyin ntɛmntɛm a enwu no.

Mpɛn pii no , Epstein-Barr Virus (EBV) na ɛde PTLD ba . Eyi yɛ mmoawa a yɛn nyinaa wɔ wɔ yɛn nipadua mu. PTLD ahorow ahorow wɔ hɔ, na ɔkwan a ɛfa so ka obi no betumi ayɛ soronko. Asɛmpa no ne sɛ nnuruyɛfo betumi asa. Nanso, ɛtɔ mmere bi a tebea no betumi asan aba bio.

Dɛn ne PTLD ahorow atitiriw?

Nnuruyɛfo gyina sɛnea lymphoma nkwammoaa no hwɛ wɔ afiri a wɔde hwɛ nneɛma nketenkete mu so kyekyɛ PTLD mu ahorow atitiriw anan:

• Akuru a Ɛba Mfiase: Saa nkurɔfo yi nya sɛnkyerɛnne ahorow a ɛte sɛ nea wohu wɔ Epstein-Barr mmoawa (EBV) ho no.
• Polymorphic PTLD: Ɛha yi, wɔde lymphoma nkwammoaa fra mogya mu nkwammoaa fitaa ahorow afoforo te sɛ lymphocytes a ɛteɛ ne plasma nkwammoaa.
• Monomorphic PTLD: Eyi ne PTLD a abu so sen biara . Lymphoma nkwammoaa a ɛwɔ ha no te sɛ nea wohu wɔ lymphoma ahorow afoforo mu, te sɛ ``Non-Hodgkin Lymphomas''. Sɛ nhwɛso no, ``Diffuse Large B-cell Lymphoma'' anaa ``Burkitt Lymphoma''.
• Classic Hodgkin Lymphoma - PTLD type: Eyi ne PTLD a ɛnyɛ kɛse koraa .

Wɔfrɛ tebea yi sɛ PTLD abu so dɛn?

Sɛnea yɛadi kan aka no, PTLD yɛ tebea a ɛntaa nsi koraa . Ɛno kyerɛ sɛ ɛnto obiara. Sɛ yɛbɛka no tiawa a, nnipa 100 biara mu bɛyɛ 2 a wɔde stem cell transplantation ayɛ wɔn (`(2%)`) benya PTLD. Nnipa a wɔayɛ wɔn akwaa foforo no taa nya PTLD kakra. Nanso ɛno nso gu ahorow gyina akwaa a wɔde ahyɛ nipadua foforo mu no so.

Susuw ho saa kwan yi so, bere a nnipa 100 biara mu bɛyɛ baasa a wɔde asaabo foforo ama wɔn (`(3%)`) nya saa tebea yi no, abenfo ka sɛ nnipa 100 biara mu bɛyɛ du a wɔde wɔn ahurututu ama wɔn (`(10%)`) betumi anya saa tebea yi. Enti, biribiara nni hɔ a ɛsɛ sɛ wohaw wo ho, eyi nyɛ biribi a ɛto nnipa dodow no ara.

Dɛn ne PTLD ho sɛnkyerɛnne ahorow a ebetumi aba?

Ebia nnipa binom rennya yare no ho sɛnkyerɛnne biara mfiase no. PTLD ho sɛnkyerɛnne betumi ada adi bere biara, efi asram kakraa bi kosi mfe pii wɔ nipadua foforo a wɔde ma akyi. Sɛ sɛnkyerɛnne ahorow no da adi ampa a, ebia nea ɛka ho ne:

• Ɔbrɛ kɛse a wɔte nka (`Ɔbrɛ`) : Nkate a ɛte sɛ nkwa a enni hɔ ara kwa.
• Atiridiinini a ntease biara nnim .
• Aduan yɛ nea ɛnyɛ dɛ .
• Mu duru a ɛso tew a wɔnhwɛ kwan .
• Fifiri a ɛboro so anadwo (`Anadwo fifiri`) .
• Ntini a ɛho ahonhon : Ɛte sɛ akuru wɔ kɔn ne abasa mu.

Dɛn nti na PTLD yi ba? Dɛn na ɛde ba?

Eyi yɛ ade a ɛtrɛw kakra a ɛsɛ sɛ yɛte ase. PTLD ba efisɛ mmoawa bi a abu so yiye de mmerɛwyɛ bi a ɛwɔ yɛn nipadua mu ahoɔden a ɛko tia nyarewa mu no di dwuma .

Fa no sɛ woresiesie wo ho ama stem cell a wɔde bɛma obi foforo. Ansa na ɛno bɛba no, wɔbɛma wo nnuru a wɔde kum kokoram nkwammoaa a ɛwɔ wo nnompe mu no. Wɔfrɛ eyi conditioning. Eyi ma tumi a wo nipadua mu tumi a ɛko tia nyarewa no bɔ wo ho ban fi nyarewa ho no yɛ mmerɛw. Ne titiriw no, tebea a wɔde hyɛ nipadua mu no ma T nkwammoaa (T-nkwaboaa) a wɔanya EBV na wɔasan ayɛ adwuma bio no dwumadi so tew.

Afei, sɛ wɔde ntini mu nkwammoaa anaa akwaa no si ananmu wie a, wɔma wo nipadua no nnuru a ɛma nipadua no tumi ko tia nyarewa na amma ampow ade foforo no. Bere a saa nnuru yi bɔ akwaa anaa nkwammoaa foforo no ho ban no, ɛma yɛn nipadua no ahobammɔ nso yɛ mmerɛw, na ɛma ɛyɛ mmerɛw kɛse sɛ ahɔho a wɔtow hyɛ yɛn so te sɛ mmoawa.

Wɔ PTLD mu no, ɔyare mmoawa titiriw ne Epstein-Barr mmoawa (EBV) . Wɔde EBV abata PTLD a ɛba wɔ afe biako anaa abien mu wɔ ntini mu nkwammoaa anaa akwaa a wɔde ma obi foforo akyi no ho. Nanso, wɔda so ara nnim nea ɛde PTLD a ɛba wɔ mfe pii akyi wɔ nipadua foforo mu no ba. Abenfo nso reyɛ nhwehwɛmu sɛ ebia mmoawa te sɛ cytomegalovirus (CMV) anaa adenovirus (Adenovirus) betumi adi dwuma bi anaa.

Sɛnea abenfo kyerɛ no, yɛn nnipa dodow bɛyɛ 90% anya EBV wɔ bere bi mu wɔ wɔn mmofraberem anaa mmerantebere ne mmabaabere mu. Ebia wowɔ mmoawa no a wunni sɛnkyerɛnne biara, na ebia wunnim mpo. EBV mmoawa no nya yɛn B nkwammoaa no na ɛkɔ so "da" wɔ nipadua no mu, kyerɛ sɛ, ɛwɔ ``Latent'' tebea mu, a ɛmfa ɔhaw biara mma. (Ebia woanya mmoawa no nso afi obi a ɔde mae no hɔ.)

Esiane sɛ worenom saa nnuru a ɛma nipadua no tumi ko tia nyarewa no nti, wo nipadua no mu tumi a ɛko tia nyarewa no ntumi nni saa EBV a ɛda hɔ no so. Afei, B nkwammoaa a EBV ayɛ wɔn no fi ase kyekyɛ na ɛdɔɔso ntɛmntɛm. Ɛno na ɛde PTLD ba.

Hena na ɔwɔ asiane kɛse mu sɛ obenya PTLD?

Ebia asiane a ɛwɔ hɔ sɛ wubenya PTLD no akɔ soro esiane nneɛma a edidi so yi nti:

• Epstein-Barr virus (EBV) a wowɔ wɔ wo nipadua mu anaa onipa a ɔmaa wo akwaa/nkwaboaa (`(Donor)`) no nipadua mu.
• Sɛ woanya ayaresa (`Pre-transplant conditioning') a ɛtew wo T nkwammoaa no dwumadi a ɛfata so ansa na wɔde ama wo.
• Nnuru a ɛma nipadua no tumi ko tia nyarewa a wobɛnom na amma wo nipadua no ampo akwaa anaa nkwammoaa foforo no.
• Nsonsonoe a ɛwɔ awosu mu nkwaadɔm bi mu (`(Genes)`) a ɛma asiane a ɛwɔ hɔ sɛ wobenya PTLD no yɛ kɛse.

Ɔkwan bɛn so na nnuruyɛfo hu tebea a wɔfrɛ no PTLD yi?

Nnuruyɛfo bedi kan ayɛ wo nipadua mu nhwehwɛmu na wɔahwɛ w’aduruyɛ ho abakɔsɛm yiye. Nea ɛka ho no, wɔtaa yɛ sɔhwɛ ahorow a edidi so yi:

• Mogya Kan a Edi Mu (`Mogya Kan a Edi Mu - CBC`) .
• Metabolic Panel a Ɛkɔ Akyiri .
• Lactate dehydrogenase (LDH) dodow a ɛwɔ nipadua no mu.
• Nsu mu nhwehwɛmu , a uric acid dodow ka ho.
• Sɔhwɛ a wɔde hu nnuru a ɛko tia EBV mmoawa no wɔ nipadua no mu .
• CT scan (`Kɔmputa so Tomography - CT scan`) .
• MRI mfonini (Magnetic Resonance Imaging - MRI) .
• PET scan (`Positron Emission Tomography - PET nhwehwɛmu`) .
• Nnompe mu ntini mu nhwehwɛmu .

Saa nhwehwɛmu ahorow yi na ɛma nnuruyɛfo tumi hu sɛ PTLD wɔ hɔ anaasɛ enni hɔ ankasa, na sɛ ɛte saa a, sɛnea ɛte.

Dɛn ne ayaresa ahorow a wɔde sa PTLD?

Mpɛn pii no nnuruyɛfo fi ase denam nnuru a wɔde siw nipadua no mu tumi a ɛko tia nyarewa ano a wɔtew so . Ɛtɔ mmere bi a eyi betumi ama nsakrae kɛse aba. Nea ɛka ho no, ayaresa afoforo wɔ hɔ te sɛ:

• Chemotherapy : Aduru a ekum kokoram nkwammoaa.
• Mframa a wɔde sa yare : Kokoram nkwammoaa a wɔde mframa a ahoɔden wom kɛse sɛe.
• Immunotherapy with monoclonal antibodies : Eyi hwehwɛ sɛ wɔde protein pɔtee bi (monoclonal antibodies) di dwuma de tow hyɛ kokoram nkwammoaa so.
• Oprehyɛn : Wɔntaa nyɛ eyi. Sɛ PTLD no wɔ baabiara na wotumi yi fi hɔ dwoodwoo nkutoo a, na wosusuw oprehyɛn ho. Sɛ nhwɛso no, sɛ PTLD nya akisikuru no so nkɛntɛnso a, wobetumi ayi akisikuru no afi hɔ.

So biribi wɔ hɔ a yebetumi ayɛ de asiw PTLD ano?

Biribiara nni hɔ ankasa a yebetumi ayɛ de asiw PTLD ano tẽẽ. Nanso, nnuruyɛfo ne nhwehwɛmufo rehwɛ nnuru bi a wobetumi de adi dwuma ansa na wɔde obi foforo ama ne/anaasɛ bere a wɔde ama akyi na ama asiane a ɛwɔ hɔ sɛ wobenya PTLD no so atew. Enti, anidaso wɔ hɔ sɛ eyi ano aduru pa bɛba daakye.

Sɛ wunya PTLD a, dɛn na ɛba? So wobetumi asa no yare?

Sɛnea wobɛyɛ w’ade wɔ PTLD ho no betumi ayɛ soronko wɔ onipa biara ho. Egyina nneɛma pii so.

Sɛ nhwɛso no, ɛtɔ mmere bi a PTLD tu mpɔn sɛ nnuruyɛfo tew nnuru a ɛma nipadua no tumi ko tia nyarewa no so kɛkɛ mpo a.

Nnansa yi nhwehwɛmu ahorow ada no adi sɛ nnipa a wonya lymphoma bere a wɔde akwaa a wɔde ma akyi na wɔde immunotherapy ne nnuru a wɔde sa yare sa wɔn yare no mu 60% kosi 70% anya yare no ho sɛnkyerɛnne no so atew anaasɛ ayera (remission) .

So wobetumi asa PTLD? Yiw, wobetumi de `Immunotherapy` nkutoo asa PTLD anaasɛ wɔde `Chemotherapy` aka ho. Nhwehwɛmu ahorow ada no adi sɛ nnipa a wɔde saa ayaresa yi ma wɔn no mu 50% kosi 60% ho tɔ wɔn koraa . Enti, eyi yɛ biribi a ɛsɛ sɛ yenya anidaso wɔ ho.

Nsɛm bɛn na ɛho hia paa a ɛsɛ sɛ mibisa me duruyɛfo?

Sɛ wowɔ PTLD a, ɛyɛ papa sɛ wubebisa wo duruyɛfo nsɛm te sɛ eyinom:

• Adɛn nti na eyi too me?
• Ɔkwan bɛn so na wɔsa PTLD?
• Sɛ metew nnuru a ɛma nipadua no tumi ko tia nyarewa no so a, hokwan bɛn na ɛwɔ hɔ sɛ me nipadua bɛpo akwaa/nkwaboaa foforo no?
• Sɛ m’ayaresa no yɛ yiye a, hokwan bɛn na ɛwɔ hɔ sɛ tebea yi bɛsan aba?

Wɔ nsɛmmisa yi akyi no, nsuro sɛ wubebisa oduruyɛfo no biribiara a ɛwɔ w’adwenem.

Bere bɛn na ɛsɛ sɛ mekɔ oduruyɛfo nkyɛn?

Sɛ wowɔ PTLD a, wo duruyɛfo bɛhwɛ w’akwahosan nyinaa yiye . Wɔbɛhwehwɛ nsɛnkyerɛnne a ɛkyerɛ sɛ wo tebea no reyɛ kɛse. Sɛ wɔresa wo yare wɔ PTLD ho a, wo duruyɛfo bɛkyerɛkyerɛ nsakrae a worehyia mu anaasɛ sɛ wo sɛnkyerɛnne ahorow no reyɛ kɛse a. Ɛho hia sɛ woka kyerɛ wo duruyɛfo ntɛm ara sɛ eyi ba a.

Nea etwa to no, nneɛma a ɛsɛ sɛ yɛkae

Ɛtɔ mmere bi a akwaa a wɔde si ananmu ne ntini mu nkwammoaa a wɔde si ananmu betumi agye nnipa nkwa anaasɛ ɛtrɛw . Nanso, esiane sɛ eyinom yɛ aduruyɛ mu akwan atitiriw nti, ebetumi de asiane ahorow aba. PTLD yɛ ɔhaw ahorow a ɛntaa nsi, nanso ebetumi ayɛ aniberesɛm a ɛte saa no mu biako.

Sɛ woyɛ obi a wopɛ sɛ wɔde akwaa anaa ntini mu nkwammoaa bɛma wo a, w’akwahosan kuw no ne wo bɛkasa afa asiane a ɛwɔ hɔ sɛ wubenya PTLD , ne asiane afoforo pii ho. Nnuruyɛfo ne nhwehwɛmufo rehwehwɛ akwan a wɔbɛfa so atew asiane a ɛwɔ hɔ sɛ wobenya PTLD no so. Ade a ɛho hia sen biara ne sɛ wubehu eyi na woabisa w’akwahosan kuw no nsɛmmisa biara a ebia wowɔ.

`PTLD, Ntini a Ɛma Nkwammoaa a Ɛma Nnipa Nnua Akyi, Akwaa a Wɔde Si Aman, Ntini a Wɔde Ma, Epstein-Barr Virus, Nkwammoaa a Ɛko Tia Nyarewa, Kokoram