Mía dometɔ geɖe vɔ̃na ne míese nya "kansa." Ema sɔ. Gake egbea, esi atikeŋutinunya de ŋgɔ ale gbegbe ta la, míate ŋu anɔ agbe abe alesi wòle ene kple kansa ƒomevi aɖewo. Egbea, míaƒo nu tso ʋumenugbagbeviɣidɔ ƒomevi mawo dometɔ ɖeka ŋu. Enye CML, si tsi tre ɖi na Chronic Myeloid Leukemia. Ðewohĩ èse ŋkɔ sia le ʋudodokpɔ si wowɔna edziedzi megbe. Eyata, mina míaƒo nu tso eŋu tsitotsito vɔvɔ̃ manɔmee.
Enyo, eyata nukae nye CML sia?
Kpuie ko la, CML nye míaƒe ʋu me kansa. Edzea egɔme tso ƒumeŋuɖui si le míaƒe ƒuwo me la me. Ƒumeŋuɖui le abe dɔwɔƒe aɖe si wɔa lãmenugbagbevi ƒomevi siwo míaƒe ŋutilã hiã siwo woyɔna be ʋumenugbagbevi dzĩwo, ʋumenugbagbevi ɣiwo, kple ʋumenugbagbevi dzĩwo ene. Le CML me la, nane gblẽna le myeloid stem cells siwo le ƒumeŋuɖui siawo me ŋu, eye wodzea mama gɔme hedzina ɖe edzi le mɔ si dzi womate ŋu aɖu o nu.
Wogayɔa esia be `ʋumenugbagbeviɣidɔ si nɔa anyi didi` alo `ʋumenugbagbeviɣidɔ si nɔa anyi didi`.
Gake nya vevitɔ kple nyuitɔ kekeake si le afisiae nye be ne wozã egbegbe atikewɔwɔ deŋgɔwo la, amesiwo ŋu CML le ƒe akpa gãtɔ ate ŋu anɔ agbe abe alesi wòle ene . Esia fia be le esi teƒe be wòanye dɔléle si wua ame la, eva zu dɔléle si nɔa anyi didi si woate ŋu atsɔ atikewo aɖu.
Aleke gbegbee CML sia yia ŋgɔ kabakabae?
Nya "si nɔa anyi didi" gɔmee nye "ɣeyiɣi didi." Eye aleae dɔléle sia le. CML nye dɔléle si bɔ ŋutɔ. Ɣeaɖewoɣi la, ate ŋu anɔ anyi ƒe geɖe evɔ dzesi aɖeke manɔ eŋu o. Ame geɖe va kpɔnɛ be exɔe le vo me, ne ʋudodokpɔ si wowɔ le susu bubu aɖe ta ɖee fia be yewoƒe ʋumenugbagbeviɣiwo mesɔ o.
Gake ne womewɔ atike na esia o la, ate ŋu ava zu dɔléle si ate ŋu ade ame ƒe agbe afɔku me le ƒe etɔ̃ va ɖo ene me. Eyata ele vevie ŋutɔ be woakpɔ dɔlélea ahadze edada gɔme kaba.
Dzesi kawoe ate ŋu akpɔ amesi ŋu CML le?
Zi geɖe la, ɖewohĩ dzesi gã aɖeke manɔ eŋu le eƒe gɔmedzedze o. Gake dzesi aɖewo li siwo dzena le ɣeyiɣi aɖe megbe. Zi geɖe la, nusiawo nyea nusiwo míesusuna be wosɔ eye míeŋea aɖaba ƒua wo dzi.
| Dzesi si dzena | Numeɖeɖe bɔbɔe aɖe |
|---|---|
| Ðeɖiteameŋu kple gbɔdzɔgbɔdzɔ ɣesiaɣi | Ðeɖi te ŋuwò ɣesiaɣi, ne èdɔ alɔ̃ nyuie eye mèwɔa dɔ aɖeke o gɔ̃ hã. |
| Yagbɔgbɔ sesẽ (Dyspnea) . | Anyidzedze esime nèle zɔzɔm le didiƒe kpui aɖe alo le atrakpuiwo liam. |
| Asrã si metso o | Dzoxɔxɔ sese le eɖokui me dɔléle bubu aɖeke manɔmee. |
| Zã me fifia | Fifia le zã me ale gbegbe be agbalẽawo tsi, togbɔ be xɔa me fa hã. |
| Lolo dzi ɖeɖe kpɔtɔ le susu aɖeke manɔmee | Lolo dzi ɖeɖe kpɔtɔ kpata nuɖuɖu alo kamedede manɔmee. |
| ƒodoa ƒe miame ƒe akpa si le etame ƒe vuvu alo vevesese | Esia tsoa dɔgbo si le ƒodo ƒe akpa sia ƒe vuvu gbɔ. |
| Sese le eɖokui me be yeɖi ƒo le nuɖuɖu vi aɖe ɖuɖu vɔ megbe gɔ̃ hã | Aɖuɖɔtoe si vuvu ate ŋu azi dɔgboa dzi, si ana nàse le ɖokuiwò me be yeɖi ƒo ne èɖu nu sue aɖe gɔ̃ hã. |
Nukatae CML va dona? Domenyinu mee wònyea?
Nyabiase sia nye nusi le ame geɖe si. Nu vevitɔ kekeake si gɔme wòle be míase le afisiae nye be menye domenyiŋusẽfianu ƒe dɔlélee CML nye o . Esia fia be menye le esi wònɔ wo dzilawo si ta koe ɖeviwo tunɛ ɖo o. Eye menye nane si ƒe dome wonyi o.
CML dzɔna ne tɔtrɔ (trɔtrɔ) aɖe va míaƒe lãmenugbagbeviwo ƒe domenyiŋusẽfianuwo me, si nye lãmenugbagbevi siwo le ƒumeŋuɖui me, le míaƒe agbenɔɣi. Woyɔa esia be `acquired mutation`.
Enyo, azɔ mina míakpɔ alesi esia wɔa dɔe ɖa. Kpuie ko la, ele ale:
1. Tɔtrɔ aɖe dzɔna le míaƒe lãmenugbagbeviwo ƒe domenyiŋusẽfianuwo me, eye domenyiŋusẽfianu yeye aɖe si wotsɔ kpe ɖe eŋu si woyɔna be `BCR-ABL` la dzɔna.
2. This new gene gives new instructions to stem cells to make an unusual form of an enzyme called `tyrosine kinase`.
3. Bu enzyme siawo be wole abe "on" kple "off" ƒe akaɖi ƒe keklẽ ene. Esiawoe kpɔa lãmenugbagbeviwo ƒe mama dzi.
4. Gake `tyrosine kinase` enzyme ma si wowɔ le mɔ si mesɔ o nu la mekpɔa "tsi" ƒe tɔtrɔ o. Enye "on" ɣesiaɣi.
5. Esi "tsi" ƒe tɔtrɔ aɖeke meli o ta la, lãmenugbagbevi siwo le ƒumeŋuɖui me yia edzi xɔa dzesiwo be woama, ama, eye woadzi ɖe edzi le mɔ si dzi womate ŋu aɖu o nu.
6. Esia wɔe be ʋumenugbagbevi ɣi gbogbo aɖewo siwo metsi o (siwo woyɔna hã be `blasts`) dzea wɔwɔ gɔme.
7. Le ɣeyiɣi aɖe megbe la, lãmenugbagbevi siawo siwo mesɔ o la yɔa ƒumeŋuɖui me. Emegbe ƒumeŋuɖui megate ŋu wɔa ʋumenugbagbevi dzĩwo, ʋumenugbagbevi ɣiwo, kple ʋumenugbagbevi dzĩ siwo le lãmesẽ me o. Esia wɔe be dzesi siwo míeyɔ ɖe etame la dzea dzedze gɔme.
Afɔku siwo le esia me kple kuxi siwo ate ŋu ado tso eme
Nusiwo ate ŋu ahe afɔku vɛ
Afɔku ɖeka kolia si wonya be wòana ame naxɔ CML enye keklẽŋusẽ si sɔ gbɔ ŋutɔ ƒe amedzidzedze . Ke hã, esia mebɔ kura o. Kekeli ƒe agbɔsɔsɔ si míedoa goe le agbe si sɔ me (le kpɔɖeŋu me, tso X-ray wɔwɔ me) mehea esia vɛ o.
Kuxi siwo ate ŋu ado mo ɖa
CML ate ŋu ahe kuxi vevi eve vɛ:
- Ʋusɔgbɔdɔ: Ʋumenugbagbevi dzĩ siwo le lãmesẽ me ƒe wɔwɔme dzi ɖena kpɔtɔna, si ɖea oxygen agbɔsɔsɔme si ŋutilã hiã dzi kpɔtɔna, si wɔnɛ be ɖeɖi tea eŋu eye wòzua ɣie.
- Splenomegaly: Ʋumenugbagbevi gbogbo aɖewo siwo mesɔ o ƒoa ƒu ɖe aɖuɖɔtoea me, si wɔnɛ be wòvuvuna. Esia ate ŋu ana dɔgboa nase veve eye wòase le eɖokui me be yeƒe lãme yɔ fũ le nuɖuɖu sue aɖe ɖuɖu vɔ megbe gɔ̃ hã.
Tsɔ kpe ɖe eŋu la, numekuku aɖewo ɖee fia be amesiwo ŋu CML le ate ŋu adzi kansa ƒomevi bubuwo (kansa evelia) xɔxɔ ƒe afɔkua ɖe edzi vie.
Aleke ɖɔktawo wɔa dea dzesi CML?
Wò ɖɔkta ate ŋu asusu esia to ʋudodokpɔ bɔbɔe aɖe me. Gake be woaɖo kpe dɔlélea dzi la, ehiã be woawɔ dodokpɔ tɔxɛ siwo adzro domenyiŋusẽfianu ƒe tɔtrɔwo me.
| Dodokpɔ | Nukae nèkpɔ le esia me? |
|---|---|
| Ʋu Xexlẽme Blibo (CBC) . | Woléa ŋku ɖe eŋu be ʋumenugbagbevi ɣiwo ƒe xexlẽme sɔ gbɔ akpa alo ʋumenugbagbevi dzĩwo ƒe xexlẽme le sue akpa hã. |
| Ƒumeŋuɖui ƒe Aspiration/Biopsy | Woɖea ƒumeŋuɖui sue aɖe hedonɛ kpɔna be domenyiŋusẽfianu ƒe tɔtrɔ si woyɔna be `BCR-ABL` le eme hã. |
| CT Scan (Kɔmpiuta dzi Tomography Scan) . | Kpɔe ɖa be kansa la kaka ɖe ŋutilã ƒe akpa bubuwo (e.g. dɔgbo, aklã) hã. |
| Ultrasound Scan ƒe Dɔwɔnu | Wozãa dodokpɔ sia tsɔ kpɔae ɖa be aɖuɖɔtoea lolo wu alesi wòle dzɔdzɔmee hã. |
Nukawoe nye CML ƒe akpa vovovoawo?
To vovo na kansa bubuwo la, womebu CML be enye "afɔɖeɖe 1, 2, 3, 4 o." Ke boŋ wodae ɖe hatsotso si nye "afãwo" me. Esia nɔa te ɖe ʋumenugbagbevi ɣi siwo metsi o (`blasts`) ƒe xexlẽme si le ʋu kple ƒumeŋuɖui me dzi.
- Akpa si Nɔa Anyi Didi: Esiae nye afɔɖeɖe gbãtɔ. `blasts` lãmenugbagbevi siwo mede 10% o le ʋu kple ƒumeŋuɖui me. Ame siwo ŋu wokpɔ CML le ƒe 80-90% le afɔɖeɖe sia me. Dzesiwo ate ŋu anɔ ame siawo ŋu alo manɔ wo ŋu o.
- Akpa si Wowɔ kabakaba: Le akpa sia me la, `blasts` lãmenugbagbeviwo ƒe xexlẽme dzina ɖe edzi va ɖoa 10% va ɖo 19%. Dzesiawo dzea egɔme nɔa dzedzem nyuie wu.
- Blast Phase alo Blast Crisis: Esiae nye akpa si nu sẽ wu eye wòdea ame ƒe agbe afɔku me. `blasts` lãmenugbagbeviwo ƒe xexlẽme dzina ɖe edzi 20% alo esi wu nenema. Dzesiwo abe ɖeɖiteameŋu si gbɔ eme, dzoxɔxɔ, kple lolo dzi ɖeɖe kpɔtɔ ene va nu sẽna ɖe edzi.
- CML si te ŋu nɔa te ɖe dɔlékuiwo nu: Esiae nye ŋkɔ si wotsɔ na CML si mewɔa nu ɖe atikewɔwɔ ŋu o alo esi gadzɔna le atikewɔwɔ vɔ megbe.
Nukawoe nye atikewɔwɔ na CML?
Afi siae CML ŋuti nya nyuia va le. Egbea la, atike siwo wɔa dɔ ŋutɔ na dɔléle sia li.
Atike vevitɔ si wozãnae nye atikewo ƒe hatsotso aɖe si woyɔna be Tyrosine Kinase Inhibitors (TKIs) . Esiawo nye atike siwo wozãna abe atikekuiwo ene.
Èɖo ŋku enzyme si mebɔ o si ŋu míeƒo nu tsoe va yi si wɔa dɔ abe "on" switch ene dzia? Emae nye nusi atike siawo tɔa ŋkui. Nusi TKIwo wɔna enye be wodzudzɔa enzyme ma si si "off" switch mele o la be wòagawɔ dɔ o. Woxea mɔ nɛ. Emegbe CML lãmenugbagbevi mawo siwo le mamam le mɔ si dzi womate ŋu aɖu o nu la mekpɔa dzesi be woama o, eye le ɣeyiɣi aɖe megbe la, lãmenugbagbevi mawo kuna.
TKI siawo na tɔtrɔ gã aɖe va le CML dɔnɔwo ƒe agbenɔnɔ me. Hafi atike siawo nava la, amesiwo ŋu wokpɔ CML le la dometɔ siwo ade 20% koe tsi agbe ƒe 5 sɔŋ. Gake egbea, le TKIwo gome la, alafa memamã ma dzi ɖe edzi va ɖo 90% kple edzivɔ.
Zi geɖe la, wozãa atike siawo le woƒe agbemeŋkekewo katã me. TKI ƒomevi siwo wozãna zi geɖe dometɔ aɖewoe nye:
- Imatinib ƒe atike
- Dasatinib ƒe atike
- Nilotinib ƒe atike
- Bosutinib ƒe atike
- Ponatinib ƒe atike
Ðe TKI-wo ƒe nugbegblẽ le ame ŋua?
Ẽ, abe atike ɖesiaɖe ene la, eƒe nugbegblẽ le ame ŋu ate ŋu anɔ eme. Gake zi geɖe la, woate ŋu akpɔ wo dzi. Wo dometɔ siwo bɔ wue nye:
- Dɔgbo ƒe vevesese
- Ðeɖiteameŋu
- Dɔmetɔtrɔ
- Lãmetsiwo ƒe ʋuʋu
- Edema ƒe ʋuʋu
- Ɣeaɖewoɣi la, nuwo abe aklã ƒe gbegblẽ kple ʋumenugbagbeviɣidɔ ene ate ŋu adzɔ.
Wò ɖɔkta aƒo nu tso nugbegblẽ siawo ŋu na wò eye wòakpe ɖe ŋuwò nàkpɔ wo gbɔ.
Ðe woate ŋu ada CML keŋkeŋa?
Le ɣeyiɣi sia me la, mɔ ɖeka kolia si dzi woato "ada" CML enye allogeneic stem cell transplant . Esia bia be woatsɔ lãmenugbagbevi siwo tso ame si le lãmesẽ me gbɔ ade dɔnɔa me. Gake esia nye atikewɔwɔ si sesẽ ŋutɔ eye afɔku le eme. Eyata zi geɖe la, dɔnɔ siwo mewɔa nu ɖe TKI ŋu o koe wowɔa esia na.
Aleke wòle be woanɔ agbe kple CML eye aleke nukpɔsusua le?
Ne CML yi ɖe dɔlélea ƒe tsɔtsɔke me kple atikewɔwɔ la, dzesi aɖeke meganɔa ŋuwò o eye womate ŋu ade dzesi dɔlélea ƒe dzesi aɖeke le dodokpɔwo me o. Esia fia be àte ŋu anɔ agbe si sɔ. Gake ahiã be nàyi edzi anɔ atikewo nom be nàɖu dɔlélea dzi. Ahiã hã be nàyi wò ɖɔkta gbɔ edziedzi be woado ʋu kpɔ be nàlé ŋku ɖe alesi wò dɔdamɔnua le dɔ wɔm nyuie ŋu.
Dɔléle si Womezãna Le Atikewɔwɔ Me O (TFR) .
Esiae nye ŋgɔyiyi yeyetɔ si ŋugbe wodo wu le CML dada me. Esia fia be dɔnɔ aɖewo siwo nɔ TKI nom hena ɣeyiɣi aɖe eye wokpɔ woƒe dɔlélea dzi nyuie ŋutɔ la ate ŋu adzudzɔ atikeawo nono le woƒe ɖɔkta ƒe dzikpɔkpɔ te azɔ. Esi wodzudzɔ atikeawo zazã vɔ megbe gɔ̃ hã la, dɔlélea megatrɔ gbɔ o. Gake esia manya wɔ na amesiame o. Ele be nàɖo dzeside aɖewo gbɔ hafi axɔe.
Nu vevitɔe nye be, mègadzudzɔ wò atikewo nono le susu aɖeke ta ne mèƒo nu kple wò ɖɔkta o. Ema ate ŋu anye afɔku gã aɖe.
Nya vevi siwo wòle be nàbia wò ɖɔkta
Ne èva nya be CML le ye ŋu la, esɔ be nyabiase geɖe nanɔ susu me na wò. Mègavɔ̃ o, bia wò ɖɔkta tso nu siawo ŋu.
- CML ƒe akpa kae le asinye?
- Atikewɔwɔmɔnu kawoe le asinye?
- Aleke mase le ɖokuinye me le atikewɔwɔ me? Nukawoe nye eƒe nugbegblẽ le ame ŋu?
- Ðe mate ŋu ayi nye dɔa dzi esime mele atike wɔm?
- Zi nenie wòhiã be mado ʋu kpɔ be dɔdamɔnua kpɔ dzidzedze hã?
- Mɔnukpɔkpɔ kawoe li be nye dɔlélea nagbɔdzɔ?
- Ðe lãmenugbagbeviwo dodo na ame sɔ na nye nɔnɔmea?
- Amekae mate ŋu aƒo nu na tso atikewɔwɔ ƒe gazazãwo dzi kpɔkpɔ ŋu?
Gbedasi si Wotsɔ Yi Aƒeme
- CML nye ʋumenugbagbeviɣidɔ si le tsitsim blewu. Menye domenyiŋusẽfianue wònye o.
- Egbegbe atikewɔmɔnu siwo woɖo taɖodzinu na, siwo woyɔna be TKIs, wɔa dɔ ŋutɔ, si wɔnɛ be ame geɖe siwo ŋu CML le la te ŋu nɔa agbe abe alesi wòle ene, eye wonɔa agbe didi.
- Ne wonya kpɔe be dɔlélea le ŋuwò ko la, mègatsi dzodzodzoe o eye nàwɔ ɖe wò ɖɔkta ƒe mɔfiamewo dzi pɛpɛpɛ.
- Ele vevie be woano atike ɖe game dzi eye woayi atikewɔƒewo be woado wo kpɔ ɖe game dzi.
- Mègadzudzɔ atikewɔwɔ alo atrɔe gbeɖe wò ɖɔkta ƒe mɔɖeɖe manɔmee o.
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