Ðe wòle be míanya PTLD (Post-Transplant Lymphoproliferative Disorders) le ŋutinuwo dodo na ame megbea?

Anɔ eme be wowɔ dɔ gã aɖe na wò alo ame aɖe si nènya, si axɔ ame ɖe agbe, abe ŋutinuwo dodo na ame ene. Alo lãmenugbagbeviwo dodo na ame. Le nu siawo megbe la, kuxi siwo mebɔ o, siwo womele mɔ kpɔm na o, doa mo ɖa. Kuxi mawo dometɔ ɖekae nye PTLD, alo Post-Transplant Lymphoproliferative Disorders. Esi wònye be esia ate ŋu anye nu vevi vie ta la, mina míaƒo nu tso eŋu le mɔ bɔbɔe aɖe si gɔme nàte ŋu ase nu.

Nuka tututue nye PTLD?

Kpuie ko la, PTLD nye kuxi si ate ŋu ade ame ƒe agbe afɔku me si ate ŋu ado mo ɖa le ŋutinuwo dodo na ame alo allogeneic stem cell dodo vɔ megbe. Nusi dzɔna le afisiae nye be ʋumenugbagbevi ɣi ƒomevi aɖe si le míaƒe ŋutilã me, si woyɔna be lymphocytes, ma kabakaba eye wòdzina ɖe edzi le mɔ si dzi womate ŋu aɖu o nu.

Le nyateƒe me la , nɔnɔme sia si woyɔna be PTLD nye ʋumenugbagbeviɣidɔ ƒomevi aɖe . Lãmetsiŋusẽ nye kansa ƒomevi aɖe si dona le míaƒe ʋukawo me. Nɔnɔme sia dzɔna ne ʋumenugbagbevi ɣiwo va zu kansa eye wotsi kabakaba evɔ womeku o.

Zi geɖe la , Epstein-Barr Dɔlékui (EBV) gbɔe PTLD tsona . Esia nye dɔlékui aɖe si le mí katã ƒe ŋutilã me. PTLD ƒomevi vovovowo li, eye alesi wògblẽa nu le ame ŋui ate ŋu ato vovo. Nya nyuiae nye be ɖɔktawo ate ŋu adae. Ke hã, ɣeaɖewoɣi la, nɔnɔmea ate ŋu atrɔ ava.

Nukawoe nye PTLD ƒomevi veviwo?

Ðɔktawo ma PTLD ɖe ƒomevi vevi ene me le alesi ʋumenugbagbeviɣidɔlékuiwo dzena le nusuekpɔmɔ̃ me dzi:

• Nuveviwɔame Gbãtɔ: Ame siawo ƒe dzesiwo sɔ kple esiwo wokpɔ le Epstein-Barr dɔlékui (EBV) ŋu.
• Polymorphic PTLD: Le afisia la, wotsaka ʋumenugbagbeviɣidɔlékuiwo kple ʋumenugbagbevi ɣi ƒomevi bubuwo, abe ʋumenugbagbevi dzĩ siwo sɔ kple ʋumenugbagbevi dzĩwo ene.
• Monomorphic PTLD: Esiae nye PTLD ƒomevi si bɔ wu . Lãmetsiŋusẽ ƒe lãmenugbagbevi siwo le afisia sɔ kple esiwo wokpɔna le ʋumenugbagbeviɣidɔ ƒomevi bubuwo me, abe ``Non-Hodgkin Lymphomas'' ene. Le kpɔɖeŋu me, ``Diffuse Large B-cell Lymphoma'' alo ``Burkitt Lymphoma''.
• Classic Hodgkin Lymphoma - PTLD ƒomevi: Esiae nye PTLD ƒomevi si mebɔ kura o .

Aleke gbegbee woyɔa nɔnɔme sia be PTLD?

Abe alesi míegblɔe va yi ene la, PTLD nye dɔléle si mebɔ kura o . Ema fia be medzɔna ɖe amesiame dzi o. Ne míagblɔe gbadzaa la, ame siwo ade 2 le 100 ɖesiaɖe me siwo wodo lãmenugbagbeviwo na (`(2%)`) axɔ PTLD. Ame siwo wodo ŋutinuwo na la ate ŋu axɔ PTLD vie. Gake ema hã toa vovo le ŋutinu si wodo na ame nu.

Bu eŋu kpɔ ale, togbɔ be ame siwo ade etɔ̃ le 100 ɖesiaɖe me siwo wodo ayiku na (`(3%)`) xɔ nɔnɔme sia hã la, eŋutinunyalawo gblɔ be ame siwo ade ewo le 100 ɖesiaɖe siwo wodo ayiku na (`(10%)`) ate ŋu axɔ nɔnɔme sia. Eyata, naneke meli si ŋu woatsi dzi ɖo o, esia menye nusi dzɔna ɖe ame akpa gãtɔ dzi o.

Nukawoe nye PTLD ƒe dzesi siwo ate ŋu anɔ ame ŋu?

Ðewohĩ dzesi aɖeke madze ame aɖewo ŋu le gɔmedzedzea me o. PTLD ƒe dzesiwo ate ŋu adze ɣesiaɣi, tso ɣleti ʋɛ aɖewo va ɖo ƒe geɖe le ame dodo vɔ megbe. Ne dzesiawo dze ƒã la, woate ŋu anye:

• Sese le eɖokui me be ɖeɖi te ye ŋu ŋutɔ (`Ðɖiteameŋu`) : Agbemanɔamesi ƒe seselelãme ko.
• Asrã le susu aɖeke manɔmee .
• Nuɖuɖu mevivina o .
• Lolo dzi ɖeɖe kpɔtɔ si womele mɔ kpɔm na o .
• Fifia si gbɔ eme le zã me (`Zã me fifia`) .
• Lãmetsiŋusẽ si vuvu : Wosena le wo ɖokui me abe ƒunukpeƒetetedɔ le kɔ kple akɔta ene.

Nukatae PTLD sia dzɔna? Nukawoe gbɔ wòtsona?

Esia nye nusi keke vie be woase egɔme. PTLD dzɔna elabena dɔlékui aɖe si bɔ ŋutɔ wɔa gbɔdzɔgbɔdzɔ aɖe si le míaƒe dɔlélenutsiŋutete me ŋudɔ .

Tsɔe be èle dzadzram ɖo ɖe lãmenugbagbeviwo dodo na ame ŋu. Do ŋgɔ na ema la, woana atike wò be wòawu kansadɔlékui siwo le wò ƒumeŋuɖui me. Woyɔa esia be nɔnɔmewɔwɔ. Esia gbɔdzɔa wò dɔlélenutsiŋutete ƒe ŋutete be wòakpɔ tawò tso dɔléle me. Etɔxɛe la, nɔnɔmewɔwɔ ɖea T lãmenugbagbevi (T-lãmenugbagbeviwo) siwo ŋu EBV le eye wogava zua dɔmawɔmawɔ ake la ƒe dɔwɔwɔ dzi kpɔtɔna.

Emegbe ne wodo lãmenugbagbeviwo alo ŋutinuawo ɖe ame bubu me vɔ la, wonaa dɔlélenutsiŋutete ƒe atike wò ŋutilã be wòagagbe nu yeyea o. Togbɔ be atike siawo kpɔa ŋutinu alo lãmenugbagbevi yeyea ta hã la, wogbɔdzɔa míaƒe ŋutilã ƒe ametakpɔnu hã, si wɔnɛ be dutatɔwo abe dɔlékuiwo ene ate ŋu adze edzi bɔbɔe.

Le PTLD me la, dɔlékui vevitɔe nye Epstein-Barr dɔlékui (EBV) . Wogblɔ be EBV do ƒome kple PTLD si dzɔna le ƒe ɖeka alo eve me tso esime wodo lãmenugbagbevi alo ŋutinu aɖe na ame. Gake womenya nusi tututu gbɔ PTLD si dzɔna le ƒe geɖe le ame dodo vɔ megbe tsona o. Eŋutinunyalawo le numekuku wɔm hã be dɔlékuiwo abe cytomegalovirus (CMV) alo adenovirus (Adenovirus) ate ŋu awɔ akpa aɖe hã.

Le eŋutinunyalawo ƒe nya nu la, míaƒe dukɔmevi siwo ade 90% xɔ EBV le woƒe ɖevime alo ƒewuimenɔɣi ƒe ɣeyiɣi aɖe me. Ðewohĩ dɔlékuia le ŋuwò evɔ dzesi aɖeke manɔ ŋuwò o, eye ɖewohĩ mànyae gɔ̃ hã o. EBV dɔlékuia xɔa míaƒe B lãmenugbagbeviwo eye wònɔa "alɔ̃ dɔm" le ŋutilãa me, si fia be, le ``Latent'' nɔnɔme me, evɔ mehea kuxi aɖeke vɛ o. (Ðewohĩ èxɔ dɔlékuia tso nunala aɖe hã gbɔ.)

Esi wònye be èle dɔlélenutsiŋutete ƒe atike mawo zãm ta la, wò dɔlélenutsiŋutete mate ŋu alé EBV ma si le alɔ̃ dɔm la nu o. Emegbe, B lãmenugbagbevi siwo ŋu EBV le la dzea mama gɔme henɔa dzidzim ɖe edzi kabakaba. Emae nye nusi hea PTLD vɛ.

Amekawoe le afɔku gã me be woaxɔ PTLD?

Afɔku si le wò PTLD xɔxɔ me ate ŋu adzi ɖe edzi le susu siwo gbɔna ta:

• Epstein-Barr dɔlékui (EBV) ƒe amesinɔnɔ le wò ŋutilã me alo le amesi na ŋutinu/lãmenugbagbeviwo (`(Donor)`) ƒe ŋutilã me.
• Esi nèxɔ atike (`Pre-transplant conditioning') si ɖea wò T lãmenugbagbeviwo ƒe dɔwɔwɔ nyuie dzi kpɔtɔna hafi wodoa ame bubu na wò.
• Dɔlélenutsiŋutete ƒe atikewo nono be wò ŋutilã nagagbe ŋutinu alo lãmenugbagbevi yeyea o.
• Domenyiŋusẽfianu aɖewo (`(Domenyiŋusẽfianu)`) ƒe vovototo si naa PTLD xɔxɔ ƒe afɔkua dzina ɖe edzi.

Aleke ɖɔktawo wɔa anya dɔléle sia si woyɔna be PTLD?

Ðɔktawo ado wò ŋutilã kpɔ gbã eye woalé ŋku ɖe wò atikewɔwɔ ŋutinya ŋu nyuie. Tsɔ kpe ɖe eŋu la, zi geɖe la, woawɔ dodokpɔ siwo gbɔna:

• Ʋu Xexlẽme Blibo (`Ʋu Xexlẽme Blibo - CBC`) .
• Metabolic Panel si me nyawo katã le .
• Lactate dehydrogenase (LDH) ƒe agbɔsɔsɔ.
• Aɖuɖɔtoe me dzodzro , si me uric acid ƒe agbɔsɔsɔ hã le.
• Dodokpɔ aɖe si wowɔ be woatsɔ ade dzesi dɔlékuiwutike siwo wowɔna le ŋutilãa me ɖe EBV dɔlékuia ŋu .
• CT scan (`Kɔmpiuta dzi Tomography - CT scan`) .
• MRI-dɔdamɔnu (Magnetic Resonance Imaging - MRI) .
• PET scan (`Positron Emission Tomography - PET scan`) .
• Ƒumeŋuɖui ŋuti numekuku .

Dodokpɔ siawoe nana ɖɔktawo te ŋu nyaa nenye be PTLD le eme alo mele eme o, eye ne ele nenema la, alesi wòle.

Nukawoe nye PTLD ƒe atikewo?

Zi geɖe la ɖɔktawo dzea egɔme kple dɔlélenutsiŋutete ƒe atike siwo wozãna dzi ɖeɖe kpɔtɔ . Ɣeaɖewoɣi la, esia ate ŋu ana tɔtrɔ gã aɖe nava. Tsɔ kpe ɖe eŋu la, atikewɔwɔ bubuwo hã li abe:

• Chemotherapy : Atike si wua kansa lãmenugbagbeviwo.
• Kekeli ƒe atikewɔwɔ : Kansa lãmenugbagbeviwo tsɔtsrɔ̃ to keklẽŋusẽ si me ŋusẽ geɖe le zazã me.
• Dɔlélenutsiŋutete ƒe atikewɔwɔ kple dɔlékuiwutike siwo nye monoclonal antibodies : Esia bia be woazã protein tɔxɛwo (monoclonal antibodies) atsɔ adze kansa lãmenugbagbeviwo dzi.
• Amekoko : Ƒã hafi wowɔa esia. Ne PTLD la le teƒe ɖeka eye woate ŋu aɖee dedie ko hafi wobua amekoko ŋu. Le kpɔɖeŋu me, ne PTLD gblẽ nu le aɖuɖɔtoeawo ŋu la, woate ŋu aɖe aɖuɖɔtoeawo ɖa.

Ðe nane li míate ŋu awɔ be PTLD nagadze oa?

Le nyateƒe me la, naneke meli míate ŋu awɔ atsɔ axe mɔ ɖe PTLD nu tẽ o. Gake ɖɔktawo kple numekulawo le atike aɖewo siwo woate ŋu azã do ŋgɔ na ame dodo na ame kple/alo le wo dodo vɔ megbe la me dzrom be woaɖe PTLD ƒe afɔkua dzi akpɔtɔ. Eyata mɔkpɔkpɔ li be esia gbɔ kpɔnu nyuitɔwo anɔ anyi le etsɔme.

Nukae dzɔna ne èxɔ PTLD? Ðe woate ŋu adaea?

Alesi nàwɔ nui ɖe PTLD ŋu ate ŋu ato vovo tso ame ɖeka gbɔ yi bubu gbɔ. Enɔ te ɖe nu geɖe dzi.

Le kpɔɖeŋu me, ɣeaɖewoɣi PTLD nyona ɖe edzi ne ɖeko ɖɔktawo ɖe dɔlélenutsiŋutete ƒe atikewo dzi kpɔtɔ gɔ̃ hã.

Numekuku siwo wowɔ nyitsɔ laa ɖee fia be amesiwo xɔ ʋumenugbagbeviɣidɔ le ŋutinuwo dodo na wo megbe eye wotsɔ dɔlélenutsiŋutete kple atikewo da dɔ na wo dometɔ 60% va ɖo 70% ƒe dzesiwo dzi ɖe kpɔtɔ alo bu (eƒe ɖeɖeɖa) .

Ðe woate ŋu ada PTLDa? Ẽ, woate ŋu ada PTLD kple `Dɔlélenutsiŋutete ƒe atikewɔwɔ` ɖeɖeko alo woatsɔe akpe ɖe `Atikewɔmɔnu` ŋu. Numekukuwo ɖee fia be amesiwo xɔa atike sia dometɔ 50% va ɖo 60% hayana keŋkeŋ . Eyata, esia nye nusi ŋu mɔkpɔkpɔ le.

Nya vevi kawoe wòle be mabia nye ɖɔkta?

Ne PTLD le ŋuwò la, anyo be nàbia wò ɖɔkta nya siawo abe esiawo ene:

• Nukatae esia dzɔ ɖe dzinye?
• Aleke wodaa PTLDe?
• Ne meɖe nye dɔlélenutsiŋutete ƒe atikewo dzi kpɔtɔ la, mɔnukpɔkpɔ kae li be nye ŋutilã agbe ŋutinu/lãmenugbagbevi yeyeawo?
• Ne nye atikewɔwɔa kpɔ dzidzedze la, mɔnukpɔkpɔ kawoe li be nɔnɔme sia nagatrɔ ava?

Tsɔ kpe ɖe biabia siawo ŋu la, mègavɔ̃ be yeabia nya sia nya si le susu me na wò la ɖɔktaa o.

Ɣekaɣie wòle be makpɔ ɖɔkta?

Ne PTLD le ŋuwò la, wò ɖɔkta alé ŋku ɖe wò lãmesẽ bliboa ŋu nyuie . Woadi dzesi siwo fia be wò nɔnɔmea le sesẽm ɖe edzi. Ne wole PTLD dam na wò la, wò ɖɔkta aɖe tɔtrɔ siwo me tom nèle alo ne wò dzesiwo le sesẽm ɖe edzi la me na wò. Ele vevie be nàgblɔe na wò ɖɔkta enumake ne esia dzɔ.

Mlɔeba la, nu siwo dzi wòle be woaɖo ŋkui

Lãmenugbagbeviwo dodo na ame kple lãmenugbagbeviwo dodo na ame ate ŋu axɔ amewo ɖe agbe alo ana amewo nadidi ɖe edzi ɣeaɖewoɣi . Gake esi wònye be esiawo nye atikewɔwɔ ƒe mɔnu veviwo ta la, woate ŋu ahe afɔkuwo vɛ. PTLD nye kuxi mawo dometɔ ɖeka si mebɔ o, gake ate ŋu anye nu sesẽ.

Ne ame si di be woado ŋutinu alo lãmenugbagbeviwo na wò la, wò lãmesẽnyawo gbɔ kpɔha aƒo nu tso afɔku si le ŋuwò be nàxɔ PTLD , kpakple afɔku bubu geɖe ŋu na wò. Ðɔktawo kple numekulawo le mɔ siwo dzi woato aɖe PTLD ƒe afɔkua dzi akpɔtɔ dim. Nu vevitɔe nye be nànya esia eye nàbia wò lãmesẽdɔwɔlawo ƒe ƒuƒoƒoa nya ɖesiaɖe si anɔ asiwò.

`PTLD, Lãmetsiŋusẽ ƒe Dɔléle Siwo Dona Le Ame Dodo Megbe, Ŋutilãwo Dodo Na Ame, Lãmetsidɔ, Epstein-Barr Dɔlékui, Dɔlélenutsiŋutete, Kansa