Ðe wodo lãmenugbagbeviwo na wò tso ame aɖe gbɔa? Mina míanya nu tso (Graft vs. Host Disease) sia ŋu!

Ðewohĩ èse lãmenugbagbeviwo dodo na ame ŋu nya kpɔ. Wonye atike vevi aɖe ŋutɔ na dɔléle aɖewo. Ke hã, egbea míele nu ƒom tso kuxi aɖe si ate ŋu ado mo ɖa le amedodo alea megbe ŋu. Woyɔa esia be `(Graft vs. Host Disease)` alo `(GvHD)` kpuie. Mègatsi dzi o, mina míaƒo nu tso esia ŋu bɔbɔe.

Nukae nye `(Graft vs. Host Dɔléle - GvHD)`? Ne míeɖe eme kpuie...

Tsɔe be wodo lãmenugbagbeviwo na wò tso ame bubu, si nye nunala aɖe gbɔ . Míeyɔa esia be allogeneic transplant. Lãmenugbagbevi siawo le abe lãmenugbagbevi siwo metsi o le wò ŋutilã ƒe ʋuwɔƒe, alo ʋumenugbagbevi dzĩwo ene. Esiawoe nye lãmenugbagbevi siwo ava zu ʋumenugbagbevi dzĩwo kple ʋumenugbagbevi ɣi siwo wò ŋutilã hiã emegbe.

Fifia, ɣekaɣie nàhiã lãmenugbagbevi siwo tso nunala abe esia ene gbɔ? Ne kansa abe ʋumenugbagbeviɣidɔ alo ʋumenugbagbeviɣidɔ ene le ŋuwò, alo dɔléle bubu aɖe si me wò ƒumeŋuɖui mewɔa dɔ nyuie abe aplastic anemia ene o la, ɖewohĩ ahiã be woado ame sia ƒomevi.

Enyo, azɔ nukae nye `(GvHD)` sia? Le `(GvHD)` me la, nusi dzɔna enye be lãmenugbagbevi siwo naa lãmenugbagbevi siwo nèxɔ (graft) la kpɔa lãmenugbagbevi siwo le wò ŋutilã me (host) abe nu wɔnuku aɖe, si mènya o ene. Ðeko wòle abe wò ŋutilã nye teƒe yeye na wo ene. Eyata, lãmenugbagbevi siawo siwo naa nu la dzea wò ŋutilã ƒe lãmenugbagbeviwo dzi dzedze gɔme. Esia tae woyɔe be `(Graft vs. Host Disease)`, si gɔmee nye "graft against host." Èse egɔmea?

GvHD ƒomevi vevi kawoe nye?

GvHD ƒomevi vevi eve li. Tsã la, ɖɔktawo nɔa te ɖe ɣeyiɣi si wòxɔna hafi dzesiawo dzea egɔme nu. Gake fifia, woléa ŋku ɖe dɔlélea ƒe dzesiwo kple dodokpɔa me tsonu ŋu be yewoanya ƒomevi si tututu wònye.

1. GvHD sesẽ (aGvHD) .

Zi geɖe la, esia dzɔna le wò lãmenugbagbeviwo dodo vɔ megbe kpuie , zi geɖe le ŋkeke 100 gbãtɔwo me . Gake ɣeaɖewoɣi la, dzesiawo ate ŋu adze egɔme emegbe. Zi geɖe la, GvHD sesẽ gblẽa nu le wò ŋutigbalẽ, nuɖuɖumeŋusẽ (GI tract), alo aklã ŋu.

2. GvHD si nɔa anyi didi (cGvHD) .

GvHD si nɔa anyi didi ate ŋu adzɔ ɣesiaɣi le allogeneic dodo vɔ megbe. Gake zi geɖe la, edzea egɔme le ƒe eve me . GvHD si nɔa anyi didi ate ŋu agblẽ nu le wò ŋutigbalẽ, nu, aklã, lãkusi, GI-mɔ̃, lãmekawo, ƒunukpeƒewo, alo vidzinuwo ŋu.

Vevietɔ: Àte ŋu axɔ GvHD ƒomevi siawo dometɔ ɖeka, evea siaa, alo wo dometɔ aɖeke o. Eto vovo tso ame ɖeka gbɔ yi bubu gbɔ.

Nukae nye `(GvHD)` ƒe dzesiwo? Nya nu tso esiawo ŋu!

GvHD ƒe dzesiwo toa vovo tso ame ɖeka gbɔ yi bubu gbɔ. Ame aɖewo ate ŋu akpɔ dzesi siwo nu mesẽ o , ame aɖewo ƒe dzesiwo ate ŋu asɔ gbɔ , eye ame bubuwo hã ate ŋu akpɔ dzesi sesẽwo.Ate ŋu asẽ ŋutɔ (ate ŋu ade ame ƒe agbe afɔku me gɔ̃ hã).

Dzesiwo le acute `(GvHD)` ŋu

Míegblɔ xoxo be GvHD sesẽe gblẽa nu le ŋutigbalẽ, GI-mɔ̃, kple aklã ŋu wu.

• Ŋutilã (aGvHD): Dzesi si bɔ wue nye ŋutigbalẽ ƒe ʋuʋu alo bibi (abe ɣe ƒe keklẽ ene). Vevesese kple ʋuʋudedi ate ŋu anɔ anyi. Zi geɖe la, ʋuʋudedia dzea egɔme tso kɔ, abɔta, to, asibidɛ, kple afɔkpodzi. Emegbe ate ŋu akaka ɖe ŋutilã ƒe akpa bubuwo.
• Dɔgbo (GI) tract (aGvHD): Dzesi siwo bɔ wue nye ʋuʋudedi, ʋuʋudedi, kple aɖuɖɔtoe (ʋuʋudedi). Dzesi siawo ate ŋu anɔ bɔbɔe alo nu sẽ ale gbegbe be wòahiã be woaxɔ ame ɖe kɔdzi.

GvHD sesẽ ƒe dzesi siwo bɔ dometɔ aɖewoe nye:

• Ŋutilã ƒe ʋuʋudedi kple/alo ʋuʋudedi.
• Dɔmetɔtrɔ.
• Aɖuɖɔtoe kple ʋuʋudedi.
• Dɔgbo ƒe vevesese, lãmetutudɔ.
• Jaundice (ŋutilã kple/alo ŋku ƒe ɣie).

GvHD si nɔa anyi didi ƒe dzesiwo

GvHD si nɔa anyi didi gblẽa nu le wò ŋutigbalẽ, aklã, GI-mɔ̃, kple lãkusi ŋu wu. Ke hã, ate ŋu agblẽ nu le wò ŋutilã ƒe akpa ɖesiaɖe ŋu.

Dzesiawo ate ŋu anye:

• Ŋutilã ƒe ʋuʋudedi kple/alo ʋuʋudedi.
• Ŋutilã ƒe tete kple vuvu.
• Taɖa ƒe vuvu le ta kple ŋutilã ŋu.
• Nu ƒuƒu.
• Nu me ƒe abiwo.
• Aɖuɖɔtoedɔléle.
• Ŋku ƒuƒu, si se le eɖokui me abe keku aɖe si ƒo ɖe eme ene.
• Tɔtrɔ siwo va le nukpɔkpɔ me.
• Dɔmetɔtrɔ.
• Aɖuɖɔtoe kple ʋuʋudedi.
• Ŋutilã kple/alo ŋku ƒe ɣie (jaundice).
• Yagbɔgbɔ sesẽ (gbɔgbɔtsixetsixe).
• Kɔdzi ƒuƒu, si nɔa anyi ɖaa.
• Ɖeɖiteameŋu.
• Lãmetsiwo ƒe gbɔdzɔgbɔdzɔ, lãmekawo ƒe ʋuʋu, alo vevesese.
• Ŋutete manɔanyi be woabɔbɔ ƒunukpeƒewo ahakeke wo ɖe enu nyuie o.
• Nyɔnuwo ate ŋu ase vidzidɔ ƒe kuɖiɖi, ƒoƒo, alo vevesese le gbɔdɔdɔ me.
• Ŋutsuwo ate ŋu ase veve le woƒe vidzinu alo vidzidɔ me, alo woase veve le gbɔdɔdɔ me.

Nukatae `(GvHD)` sia dzɔna? Nuka gbɔe wòtso?

Kpuie ko la, GvHD dzɔna ne lãmenugbagbevi siwo tso nunala si doe na wò gbɔ kpɔ wò ŋutɔ wò ŋutilã me lãmenugbagbeviwo be wonye "dutatɔwo" eye wodze wo dzi dzedze gɔme.

Esiae dzɔna zi geɖe: Wò dɔlélenutsiŋutete ƒe lãmenugbagbeviwo (lãmenugbagbevi siwo le wò ʋu me) kpɔa tawò tso dɔléle me. Wowɔa avu kple dutanuwo abe dɔlékuiwo kple dɔlékuiwo ene. Gake lãmenugbagbevi siawo medzea wò ŋutɔ wò lãmenugbagbeviwo dzi o. Esia le alea elabena protein tɔxɛ aɖe le wò lãmenugbagbeviwo me si woyɔna be ``Human Leukocyte Antigens'', alo ``HLA''. Esia le abe tagbatsu si dzi woŋlɔ ŋkɔ ɖo ene. ``HLA'' siae nye nusi gblɔna na wò dɔlélenutsiŋutete ƒe lãmenugbagbeviwo be, "Hey, mía dometɔ ɖekae nye esia."

Nu vevitɔ enye be, negbe venɔvi siwo ɖi wo nɔewo ko la, amesiame ƒe `(HLA)` to vovo tso wo nɔewo gbɔ.

Ne èdo ʋumenugbagbeviɣidɔ tso ame bubu gbɔ vɔ la, ʋumenugbagbevi yeye siwo le wò ŋutilã me la mexɔa wò `(HLA)` o, ke boŋ ʋumenugbagbevi dzĩ siwo le wò ŋutilã me la ƒe `(HLA)` nɔa esi . Eyata, ne nunala sia ƒe `(HLA)` to vovo kura tso `(HLA)` si le wò ŋutilã me gbɔ la, ʋumenugbagbevi yeye mawo dzea wò ŋutilã ƒe lãmenugbagbeviwo dzi dzedze gɔme. Ɣemaɣie `(GvHD)` dzɔna.

Esia tae ɖɔktawo léa ŋku ɖe amesi tsɔe na ƒe HLA ŋu nyuie be woakpɔe ɖa be ete ɖe tɔwò ŋu alesi yewoate ŋui hafi awɔ lãmenugbagbeviwo ƒe lãmenugbagbeviwo dodo na ame. Ne wokpɔ amesi sɔ kplii nenema la, eɖea afɔku si le GvHD xɔxɔ me dzi kpɔtɔna. Gake ne mèxɔ lãmenugbagbeviwo tso venɔvi si sɔ gbɔ o la, mɔnukpɔkpɔ gakpɔtɔ li be nàtu GvHD, eɖanye aleke kee nète kpɔ be yeawɔ ɖeka o.

Amekae le afɔku me wu be wòaxɔ GvHD?

Afɔku vevitɔ kekeakee nye alesi wò nunala ƒe HLA sɔ kple tɔwò tututu. Afɔku gã aɖe le ŋuwò be GvHD nadze dziwò ne:

• Èxɔ lãmenugbagbeviwo tso ƒometɔ aɖe gbɔ, gake menye HLA si sɔ pɛpɛpɛ o .
• Èxɔ lãmenugbagbeviwo tso ame aɖe si menye wò ƒometɔ o, gake enye `(HLA)` ƒe ƒomedodo .

Afɔku bubuwoe nye:

• Ele be nunala la nanye nyɔnu si fɔ fu kpɔ.
• Ƒe si nunala alo wò ŋutɔ xɔ ƒe dzidziɖedzi.
• Ŋutsu alo nyɔnu ƒe masɔmasɔ le nunala kple wò dome (e.g. lãmenugbagbeviwo xɔxɔ tso ŋutsu nunala gbɔ yi nyɔnu gbɔ, alo tso nyɔnu nunala gbɔ yi ŋutsu gbɔ).
• Ne woɖe ame si tsɔ ʋua na ƒe lãmenugbagbeviwo tso ʋukawo (ʋu) me tsɔ wu be woaɖe wo tso ƒumeŋuɖui (afisi wowɔa ʋumenugbagbeviwo le) me.

Ne `(aGvHD)` si nu sẽ xoxo la, ke èle afɔku me be nàxɔ `(cGvHD)` si nɔa anyi didi.

Aleke wowɔa dea dzesi GvHD?

Wò ɖɔkta ate ŋu anya GvHD ne edo wò kpɔ, wò ŋkuléle ɖe wò dzesiwo ŋu, eye wòlé ŋku ɖe dodokpɔ siwo wowɔ le dodokpɔxɔ me kple lãmenugbagbeviwo ƒe dɔwɔwɔ me tsonu ŋu. Biopsy bia be woaɖe wò lãkusi alo lãmenugbagbeviwo ƒe kpɔɖeŋu sue aɖe atsɔ aɖoe ɖe dodokpɔxɔ me be woadoe kpɔ.

Le GvHD si nɔa anyi didi (cGvHD) me la, dzesi aɖewo ate ŋu asɔ kple dɔléle bubuwo. Eyata ɖɔktaa agbe nu bubu siwo katã gbɔ wòtso hafi akpɔ cGvHD ɖa keŋkeŋ.

Nukawoe nye GvHD ƒe atikewo?

Ne wodo lãmenugbagbeviwo na wò vɔ la, woana dɔlélenutsiŋutete ƒe atikewo wò be wòanye mɔxexeɖedɔléle nu ƒe mɔnu si ana lãmenugbagbevi siwo na wò la ƒe ŋutete be woadze wò ŋutɔ wò lãmekawo dzi dzi akpɔtɔ.

Ne atike siawo medzudzɔ GvHD ƒe dzɔdzɔ o la, wò ɖɔkta aŋlɔ atike na wò le wò dɔlélea ƒe sesẽme kple GvHD ƒomevi si nèle nu.

GvHD si nu sẽ ƒe atikewɔwɔ

Zi geɖe la, ɖɔktawo daa dɔ na amesiwo ŋu GvHD sesẽ le dzidzedzetɔe to atike siwo tea dɔlélenutsiŋutete ɖe to ƒe agbɔsɔsɔ dzi ɖeɖe kpɔtɔ me. Esiawo le atikewo ƒe hatsotso aɖe si woyɔna be corticosteroids me. Woate ŋu ana wo to nu me, to ʋuka me, alo to ame ŋu. Ne steroids mewɔa dɔ o la, wò ɖɔkta ate ŋu aŋlɔ atike aɖe abe Ruxolitinib (Jakafi®) ene na wò. Mɔnukpɔkpɔ ate ŋu asu asiwò hã be nàkpɔ gome le dɔdamɔnu dodokpɔ siwo doa atike yeyewo kpɔna me.

GvHD si nɔa anyi didi ƒe atikewɔwɔ

Zi geɖe la, wozãa dɔlélenutsiŋutete ƒe atike siwo nɔa anyi didi tsɔ daa GvHD si nɔa anyi didi. Ne atike siawo mekpe ɖe ŋuwò o la, wò ɖɔkta ate ŋu aŋlɔ atikewo abe:

• `Ruxolitinib (Jakafi®) ƒe lãmesẽnyawo gbɔ kpɔkpɔ`
• `Belumosudil (RezurockTM)`
• `Ibrutinib (Imbruvica®)`
• Photopheresis (Esia nye atikewɔwɔmɔnu tɔxɛ aɖe) .

Àte ŋu adze na ``dɔdamɔnu dodokpɔwo hã.'' Ðɔkta la agblɔ ema na wò.

Nukawoe nye atikewɔwɔa ƒe kuxiwo/nugbegblẽ le ame ŋu?

Esi dɔlélenutsiŋutete ƒe atike siawo gbɔdzɔa wò dɔlélenutsiŋutete ta la, anɔ eme be fungi, dɔlékui, kple dɔlékuiwo ƒe dɔlélewo adze dziwò . Eyata wò ɖɔkta aŋlɔ atike bubu geɖewo na wò be wòakpɔ tawò tso dɔlékui siawo siwo me afɔku le me.

Ðe woate ŋu axe mɔ ɖe GvHD nua?

Lãmetsiŋusẽtikewɔƒewo le dodokpɔ yeye siwo wotu ɖe DNA dzi siwo de pɛpɛpɛ wu la wɔm ɣesiaɣi hele wo zãm. Esia wɔnɛ be wò atikewɔlawo ƒe ƒuƒoƒoa te ŋu tiaa nunala si ƒe HLA sɔ na wò wu. Zi alesi ƒomedodoa nyoe la, zi nenemae mɔnukpɔkpɔ si li be woaxe mɔ ɖe GvHD nu la nyona ɖe edzii.

Azɔ hã, wò ɖɔkta aŋlɔ dɔlélenutsiŋutete ƒe atikewo na wò be wòaxe mɔ ɖe GvHD nu le wò lãmenugbagbeviwo dodo vɔ megbe.

Ðe woate ŋu ada GvHD keŋkeŋa?

Zi geɖe la, ɖɔktawo te ŋu kpɔa dɔlélea gbɔ dzidzedzetɔe (GvHD). Eyae nye be woate ŋu aɖu dzesiawo dzi eye woakpe ɖe ŋuwò nànɔ agbe si sɔ.

Le ɣeyiɣi ma ke me la, numekulawo le nu srɔ̃m tso mɔ yeye siwo dzi woato axe mɔ ɖe GvHD nu to dɔdamɔnu dodokpɔwo me. Le kpɔɖeŋu me, wole numekuku wɔm tso dɔlélenutsiŋutete ƒe atike vovovowo kple mɔxexeɖedɔléle nu ƒe atike yeyewo ŋu.

Ðe GvHD ate ŋu ade ame ƒe agbe afɔku mea?

Ẽ, GvHD ate ŋu ade ame ƒe agbe afɔku me ɣeaɖewoɣi. GvHD si nɔa anyi didie nye nusi koŋ wua amesiwo wodoa allogeneic stem cell na, ne woɖe woƒe dɔléle vevitɔ ɖa.

Eyata hafi woawɔ atike aɖeke – lãmenugbagbeviwo dodo na ame gɔ̃ hã – ele vevie ŋutɔ be nàdzro afɔkuawo me kple wò ɖɔkta. Ate ŋu aɖe afɔku siwo le eme la me na wò eye wòakpe ɖe ŋuwò nàda atikewɔwɔa ƒe viɖe kple kuxiwo kpɔ.

Ðe viɖe aɖe le `(GvHD)` ŋu ɣeaɖewoɣia?

Megawɔ nuku na wò o, togbɔ be GvHD ate ŋu akpɔ ŋusẽ gbegblẽ ɖe wò agbenɔnɔ dzi hã la, viɖe aɖewo hã le eŋu. Dɔlélenutsiŋutete ma ke si dzea wò lãmenugbagbevi siwo sɔ dzi la dia kansa lãmenugbagbevi ɖesiaɖe si ate ŋu agblẽ ɖe wò ŋutilã me hã hetsrɔ̃nɛ. Woyɔa esia be graft-versus-tumor effect. Wokpɔe be amesiwo ŋu GvHD le la megate ŋu gaxɔa woƒe dɔléle vevitɔ (vevietɔ kansa) o.

Aleke malé be na ɖokuinye? Wɔ ɖe aɖaŋuɖoɖo siawo dzi!

Wò ɖɔkta aɖe alesi wòle be nàlé be na ɖokuiwò le wò lãmenugbagbeviwo dodo vɔ megbe me na wò. Le kpɔɖeŋu me, dzesi siwo ŋu wòle be nàlé ŋku ɖo kple dzesi siwo nàƒo ka na wò atikewɔlawo ƒe ƒuƒoƒoa enumake ne èdze egɔme. Ne GvHD xɔxɔ le afɔku me la, woate ŋu ana belélename ŋuti mɔfiame bubuwo hã wò. Mɔfiame siawo dometɔ aɖewoe nye:

• Ta wò ŋutigbalẽ ta tso ɣe ƒe keklẽ me. Do awudziwui siwo ƒe abɔwo didi kple pantalon legbewo. Zã ɣe ƒe keklẽŋusẽtike si ƒe SPF 50 ya teti.(Ɣe ƒe keklẽ ate ŋu agblẽ nu le GvHD ŋu alo aʋãe.)
• Lé nu me ƒe lãmesẽ nyui me ɖe asi. Esia aɖe afɔku si le aɖuɖɔtoedɔléle xɔxɔ me dzi akpɔtɔ.
• Ƒo asa na nuɖuɖu siwo me nu ʋeʋĩwo le siwo ate ŋu ado dziku na wò dɔgbo eye wòana nu me naxɔ abi.
• Ðe afɔ aɖewo nàtsɔ akpɔ ɖokuiwò ta tso dɔlékuiwo si me. (Wò ɖɔkta agblɔ nya geɖe tso esia ŋu na wò).

Ɣekaɣie wòle be makpɔ ɖɔkta?

Ele vevie be nàna wò ɖɔkta nanya enumake ne tɔtrɔ aɖewo va le ŋuwò le ŋutilã me, vevietɔ dɔléle ƒe dzesiwo kple dzoxɔxɔ (100.4 Fahrenheit / 38 Celsius alo esi wu nenema). Ne èno dɔlélenutsiŋutete ƒe atikewo la, afɔku le eme be nàxɔ dɔlékui siwo ate ŋu ade wò agbe afɔku me.

Le allogeneic stem cell dodo vɔ megbe la, wò ɖɔkta alé ŋku ɖe ŋuwò nyuie be nàkpɔ kuxiwo abe Graft vs. Host Disease (GvHD) ene hã. Ne GvHD si nu sẽ alo esi nɔa anyi didi ƒe dzesiwo dze le ŋuwò la, wò ɖɔkta ate ŋu atrɔ wò atike alo aŋlɔ atike yeye na wò. No atikeawo katã abe alesi wogblɔe ene pɛpɛpɛ. Wɔ ɖe wò ɖɔkta ƒe mɔfiamewo dzi le alesi nàlé be na ɖokuiwò ŋu, vevietɔ le alesi nàkpɔ ɖokuiwò ta tso dɔlékuiwo me ŋu.

Nu vevitɔ kekeake siwo dzi wòle be woaɖo ŋkui kpuie!

Enyo, eyata Graft vs. Host Disease, alo GvHD, nye kuxi si ate ŋu ado mo ɖa le lãmenugbagbeviwo dodo na ame tso ame bubu gbɔ vɔ megbe. Kpuie ko la, ne lãmenugbagbevi siwo naa nuawo dze wò ŋutɔ wò lãmenugbagbeviwo dzie.

Ðo ŋku edzi be atike aɖewo li na GvHD, eye woate ŋu akpɔ nɔnɔmea gbɔ. Nu vevitɔe nye be nàwɔ ɖe wò atikewɔha ƒe mɔfiamewo dzi nyuie eye nàna woanya nu tso dzesi yeye ɖesiaɖe ŋu kaba ale si nàte ŋui.

Ne nya bubu aɖewo gale asiwò ku ɖe esia ŋu la, mègavɔ̃ be yeabia wò ɖɔkta o. Woawoe ate ŋu akpe ɖe ŋuwò nyuie wu.

` GvHD, lãmenugbagbeviwo ƒe dodo, allogeneic dodo, dɔlélenutsiŋutete, HLA, nunala lãmenugbagbeviwo, dzesiwo