Ua loaʻa anei iā ʻoe kahi hoʻoili cell kumu mai kekahi? E makaʻala kākou i kēia (Graft vs. Host Disease)!

Ua lohe paha ʻoe i nā hoʻoili ʻana o nā cell stem. He lāʻau lapaʻau koʻikoʻi loa ia no kekahi mau maʻi. Eia nō naʻe, i kēia lā e kamaʻilio mākou e pili ana i kahi pilikia e hiki ke hana ma hope o ia ʻano hoʻoili ʻana. Ua kapa ʻia kēia ʻo `(Graft vs. Host Disease)` a i ʻole `(GvHD)` no ka pōkole. Mai hopohopo, e kamaʻilio maʻalahi kākou e pili ana i kēia.

He aha ka `(Graft vs. Host Disease - GvHD)`? Ua wehewehe maʻalahi ʻia...

E noʻonoʻo ua loaʻa iā ʻoe kahi hoʻoili cell kumu mai kekahi kanaka ʻē aʻe, he mea hāʻawi . Kāhea mākou i kēia he hoʻoili allogeneic. Ua like kēia mau cell kumu me nā cell ʻōpiopio i loko o ka hale hana hana koko o kou kino, a i ʻole nā ​​cell kumu hematopoietic. ʻO kēia nā cell e lilo ma hope i nā cell koko ʻulaʻula a me nā cell koko keʻokeʻo e pono ai kou kino.

I kēia manawa, i ka manawa hea ʻoe e pono ai i nā cell kumu mai kahi mea hāʻawi e like me kēia? Inā loaʻa iā ʻoe kahi maʻi kanesa e like me ka leukemia a i ʻole lymphoma, a i ʻole kekahi maʻi ʻē aʻe kahi i hana pono ʻole ai kou iwi iwi e like me ka anemia aplastic, pono paha ʻoe i kēia ʻano hoʻoili.

ʻAe, he aha kēia `(GvHD)`? Ma `(GvHD)`, ʻo ka mea e hana ʻia ana, ʻike nā cell donor āu i loaʻa ai (graft) i nā cell i loko o kou kino (host) me he mea ʻē, ʻaʻole maopopo. Me he mea lā he wahi hou kou kino no lākou. No laila, hoʻomaka kēia mau cell donor e hoʻouka i nā cell o kou kino. ʻO ia ke kumu i kapa ʻia ai ʻo `(Graft vs. Host Disease)`, ʻo ia hoʻi "graft against host." Maopopo iā ʻoe?

He aha nā ʻano nui o GvHD?

ʻElua ʻano nui o GvHD. I ka wā ma mua, ua hoʻokaʻawale nā ​​kauka iā ia ma muli o ka manawa i hoʻomaka ai nā hōʻailona. Akā i kēia manawa, nānā lākou i nā hōʻailona a me nā hopena hoʻāʻo e hoʻoholo ai i ke ʻano pololei.

1. GvHD ʻoi (aGvHD)

ʻO ka maʻamau, hana ʻia kēia ma hope koke iho o kāu hoʻoili ʻana i nā cell stem, pinepine i loko o nā lā 100 mua . Eia nō naʻe, i kekahi manawa hiki ke hoʻomaka nā hōʻailona ma hope. ʻO ka GvHD acute ka mea pinepine e hoʻopilikia i kou ʻili, ka ʻōnaehana digestive (GI tract), a i ʻole ke akepaʻa.

2. GvHD Mau Loa (cGvHD)

Hiki ke loaʻa ka GvHD mau i kēlā me kēia manawa ma hope o kahi hoʻoili allogeneic. Eia nō naʻe, hoʻomaka pinepine ia i loko o ʻelua mau makahiki . Hiki i ka GvHD mau ke hoʻopilikia i kou ʻili, waha, akepaʻa, māmā, ala GI, nā ʻiʻo, nā hono, a i ʻole nā ​​​​genital.

Mea nui: Hiki iā ʻoe ke loaʻa i hoʻokahi, ʻelua, a i ʻole ʻaʻole kekahi o kēia mau ʻano GvHD. He ʻokoʻa ia mai kēlā kanaka a kēia kanaka.

He aha nā hōʻailona o ka `(GvHD)`? E makaʻala i kēia mau mea!

ʻOkoʻa nā hōʻailona o GvHD mai kēlā kanaka a kēia kanaka. Loaʻa paha i kekahi poʻe nā hōʻailona iki , loaʻa paha i kekahi nā hōʻailona waena , a ʻo kekahi poʻe he nui nā hōʻailona koʻikoʻi.Hiki ke koʻikoʻi loa (a hiki ke hoʻoweliweli i ke ola).

Nā hōʻailona o ka `(GvHD)` koke

Ua ʻōlelo mua mākou ʻo ka GvHD koʻikoʻi ka hopena pinepine i ka ʻili, ke ala GI, a me ke akepaʻa.

• ʻIli (aGvHD): ʻO ka hōʻailona maʻamau ka ʻili ʻulaʻula a i ʻole ka ʻulaʻula (e like me ka wela o ka lā). Hiki ke loaʻa ka ʻeha a me ka maneʻo. Hoʻomaka ka ʻili ma ka ʻāʻī, nā poʻohiwi, nā pepeiao, nā poho lima, a me nā kapuwaʻi o nā wāwae. A laila hiki ke laha i nā ʻāpana ʻē aʻe o ke kino.
• ʻŌnaehana Gastrointestinal (GI) (aGvHD): ʻO nā hōʻailona maʻamau ka nausea, ka luaʻi ʻana, a me ka diarrhea (pehu ʻana). Hiki i kēia mau hōʻailona ke akahai a koʻikoʻi paha e pono ai ke mālama ʻia i ka haukapila.

ʻO nā hōʻailona maʻamau o ka GvHD koʻikoʻi:

• ʻO ka ʻili a me/a i ʻole ka maneʻo.
• Ka maʻi pākī.
• Ka luaʻi a me ka luaʻi.
• ʻEha ka ʻōpū, ʻōʻō.
• Jaundice (melemele o ka ʻili a me/a i ʻole nā ​​​​maka).

Nā hōʻailona o ka GvHD mau loa

ʻO ka GvHD mau loa ka hopena pinepine i kou ʻili, ke akepaʻa, ke ala GI, a me nā māmā. Eia nō naʻe, hiki iā ia ke hoʻopilikia i kekahi ʻāpana o kou kino.

Hiki i nā hōʻailona ke komo pū me:

• ʻO ka ʻili a me/a i ʻole ka maneʻo.
• Ka ʻūmiʻi ʻana a me ka pehu ʻana o ka ʻili.
• Ka hāʻule ʻana o ka lauoho ma ke poʻo a me ke kino.
• Waha maloʻo.
• Nā ʻeha waha.
• Maʻi ʻāʻī.
• Nā maka maloʻo, me he mea lā ua paʻa kahi hua one i loko.
• Nā loli i ka ʻike.
• Ka maʻi pākī.
• Ka luaʻi a me ka luaʻi.
• Melemele o ka ʻili a me/a i ʻole nā ​​​​maka (jaundice).
• Ka paʻakikī o ka hanu ʻana (dyspnea).
• ʻŪhū maloʻo a mau loa.
• Luhi.
• Ka nāwaliwali o nā ʻiʻo, ka ʻoʻopa, a i ʻole ka ʻeha.
• ʻAʻole hiki ke kulou a hoʻolōʻihi pono i nā hono.
• Hiki i nā wāhine ke loaʻa ka maloʻo o ka ʻōpū, ka ʻeha, a i ʻole ka ʻeha i ka wā o ka moekolohe.
• Hiki i nā kāne ke ʻike i ka maneʻo o ka penis a i ʻole nā ​​testicles, a i ʻole ka ʻeha i ka wā o ka moekolohe.

No ke aha i hana ʻia ai kēia `(GvHD)`? He aha ke kumu?

I ka ʻōlelo maʻalahi, hana ʻia ʻo GvHD i ka wā e ʻike ai nā pūnaewele kumu mai ka mea hāʻawi āu i loaʻa ai i ke kāpili ʻana i kāu mau pūnaewele kino ponoʻī he "haole" a hoʻomaka e hoʻouka iā lākou.

ʻO kēia ka mea maʻamau e hana ʻia: Mālama kāu mau pūnaewele ʻōnaehana pale (nā pūnaewele i loko o kou koko) iā ʻoe mai nā maʻi. Ke kaua nei lākou i nā mea ʻē, e like me nā virus a me nā bacteria. Eia naʻe, ʻaʻole hoʻouka kēia mau pūnaewele i kāu mau pūnaewele ponoʻī. ʻO kēia no ka mea he protein kūikawā ko kāu mau pūnaewele i kapa ʻia ʻo "Human Leukocyte Antigens", a i ʻole "HLA". Ua like kēia me kahi lepili me kahi inoa ma luna. ʻO kēia "HLA" ka mea e haʻi aku i kāu mau pūnaewele pale, "E, ʻo kēia kekahi o kā mākou."

ʻO ka mea nui loa, koe wale nō nā māhoe like, he ʻokoʻa ko kēlā me kēia `(HLA)` kekahi i kekahi.

Ma hope o kou loaʻa ʻana o kahi hoʻoili cell kumu mai kekahi kanaka ʻē aʻe, ʻaʻole i loaʻa i nā hunaola koko hou i loko o kou kino kāu `(HLA)`, akā ʻo ka `(HLA)` o ka mea hāʻawi . No laila, inā ʻokoʻa loa ka `(HLA)` o kēia mea hāʻawi mai ka `(HLA)` i loko o kou kino, hoʻomaka kēlā mau hunaola koko hou e hoʻouka i nā hunaola o kou kino. ʻO ia ka manawa e hana ʻia ai ka `(GvHD)`.

ʻO ia ke kumu e nānā pono ai nā kauka i ka HLA o ka mea hāʻawi e hōʻoia i kona kokoke loa iā ʻoe ma mua o ka hana ʻana i kahi hoʻoili cell stem. ʻO ka loaʻa ʻana o kahi kūlike e like me kēlā e hōʻemi i ka pilikia o ka hoʻomohala ʻana i ka GvHD. Eia nō naʻe, inā ʻaʻole ʻoe e loaʻa i nā cell mai kahi māhoe like, aia nō ka manawa kūpono e loaʻa iā ʻoe ka GvHD, ʻaʻohe mea i ka nui o nā kūlike āu e hoʻāʻo ai.

ʻO wai ka mea i pilikia nui i ka hoʻomohala ʻana i ka GvHD?

ʻO ke kumu pilikia koʻikoʻi loa, ʻo ia ke ʻano o ka like ʻana o ka HLA o kāu mea hāʻawi me kāu. ʻOi aku kou pilikia o ka loaʻa ʻana o GvHD inā:

• Ua loaʻa iā ʻoe nā pūnaewele kumu mai kahi hoahānau, akā ʻaʻole i loaʻa kahi kūlike HLA kikoʻī .
• Ua loaʻa iā ʻoe nā pūnaewele kumu mai kahi mea ʻaʻole ʻo kou hoahānau, akā he hoa kūlike '(HLA)' .

ʻO nā kumu pilikia ʻē aʻe:

• Pono ka mea hāʻawi he wahine i hāpai mua.
• Ke hoʻonui nei i ka makahiki o ka mea hāʻawi a i ʻole ʻoe iho.
• Ka kūlike ʻole o ke kāne a me ke kāne ma waena o ka mea hāʻawi a me ʻoe (e like me ka loaʻa ʻana o nā pūnaewele mai kahi mea hāʻawi kāne i kahi wahine, a i ʻole mai kahi mea hāʻawi wahine i kahi kāne).
• Inā lawe ʻia nā hunaola kumu o ka mea hāʻawi mai nā kīʻaha koko (koko) ma kahi o ka iwi iwi (kahi e hana ʻia ai nā hunaola koko).

Inā ua loaʻa mua iā ʻoe ka `(aGvHD)` koʻikoʻi, ua ʻoi aku kou pilikia o ka loaʻa ʻana o ka `(cGvHD)` mau loa.

Pehea e ʻike ʻia ai ʻo GvHD?

Hiki i kāu kauka ke ʻike i ka GvHD ma ka nānā ʻana iā ʻoe, ka nānā ʻana i kāu mau hōʻailona, ​​a me ka nānā ʻana i nā hoʻokolohua lab a me nā hopena biopsy. ʻO ka biopsy e pili ana i ka lawe ʻana i kahi hāpana liʻiliʻi o kou ʻiʻo a i ʻole nā ​​​​​​kelepona a hoʻouna iā ia i kahi lab no ka hoʻāʻo ʻana.

I loko o ka GvHD mau loa (cGvHD), hiki ke like kekahi o nā hōʻailona me nā maʻi ʻē aʻe. No laila, e kāpae ke kauka i nā kumu ʻē aʻe a pau ma mua o ka hana ʻana i kahi hōʻoia paʻa o cGvHD.

He aha nā lāʻau lapaʻau no GvHD?

Ma hope o kou loaʻa ʻana o kahi hoʻoili cell stem, e hāʻawi ʻia ʻoe i nā lāʻau immunosuppressive ma ke ʻano he prophylactic e hōʻemi i ka hiki o nā cell donor ke hoʻouka i kāu mau ʻiʻo ponoʻī.

Inā ʻaʻole kēia mau lāʻau lapaʻau e hoʻōki i ka ulu ʻana o GvHD, e kuhikuhi kāu kauka i ka lāʻau lapaʻau e pili ana i ke koʻikoʻi o kou kūlana a me ke ʻano o GvHD.

Ka mālama ʻana i ka GvHD koʻikoʻi

Hoʻomaʻamaʻa pinepine nā kauka i nā poʻe me ka GvHD koʻikoʻi ma ka hoʻonui ʻana i ka nui o nā lāʻau lapaʻau e kāohi ana i ka ʻōnaehana pale. No kēia mau mea kahi papa o nā lāʻau lapaʻau i kapa ʻia ʻo corticosteroids. Hiki ke hāʻawi ʻia ma ka waha, intravenously, a i ʻole topically. Inā ʻaʻole hana nā steroids, hiki i kāu kauka ke kuhikuhi i kahi lāʻau lapaʻau e like me Ruxolitinib (Jakafi®). ​​​​Hiki iā ʻoe ke loaʻa ka manawa kūpono e komo i nā hoʻokolohua lapaʻau e hoʻāʻo ai i nā lāʻau lapaʻau hou.

Ka mālama ʻana i ka GvHD mau loa

Hoʻomaʻamaʻa pinepine ʻia ka GvHD mau loa me nā lāʻau lapaʻau immunosuppressive lōʻihi. Inā ʻaʻole kōkua kēia mau lāʻau, hiki i kāu kauka ke kuhikuhi i nā lāʻau lapaʻau e like me:

• ʻO Ruxolitinib (Jakafi®)
• ʻO Belumosudil (Rezurock™)
• ʻIbrutinib (Imbruvica®)
• Photopheresis (He ʻano lapaʻau kūikawā kēia)

Hiki paha iā ʻoe ke kūpono no nā "hoʻokolohua lapaʻau." E haʻi aku ke kauka iā ʻoe e pili ana i kēlā.

He aha nā pilikia/nā hopena ʻaoʻao o ka lāʻau lapaʻau?

Ma muli o ka hoʻonāwaliwali ʻana o kēia mau lāʻau lapaʻau immunosuppressive i kāu ʻōnaehana pale, ʻoi aku ka nui o kou loaʻa ʻana i nā maʻi fungal, bacteria, a me nā viral . No laila, e kuhikuhi kāu kauka i kekahi mau lāʻau lapaʻau ʻē aʻe e pale aku iā ʻoe mai kēia mau maʻi weliweli.

Hiki ke pale ʻia ka GvHD?

Ke hoʻomohala mau nei nā keʻena hoʻokolohua ʻano kiko a hoʻohana i nā hoʻokolohua DNA hou a ʻoi aku ka pololei. Hiki i kēia i kāu hui lapaʻau ke koho i ka mea hāʻawi me ka HLA kūlike loa nou. ʻO ka maikaʻi o ka kūlike, ʻoi aku ka maikaʻi o ka manawa kūpono e pale aku ai iā GvHD.

Eia kekahi, e kuhikuhi kāu kauka i nā immunosuppressants e pale aku iā GvHD ma hope o kāu hoʻoili cell stem.

Hiki ke ho'ōla loa ʻia ʻo GvHD?

I ka hapanui o nā hihia, hiki i nā kauka ke hoʻokele pono i ke kūlana (GvHD). ʻO ia hoʻi, hiki iā lākou ke kaohi i nā hōʻailona a kōkua iā ʻoe e ola i kahi ola maʻamau.

I kēia manawa, ke aʻo nei nā kānaka noiʻi i nā ala hou e pale aku ai i ka GvHD ma o nā hoʻokolohua lapaʻau. No ka laʻana, ke noiʻi nei lākou i nā lāʻau lapaʻau immunosuppressive like ʻole a me nā lāʻau lapaʻau prophylaxis hou.

Hiki i ka GvHD ke hoʻoweliweli i ke ola?

ʻAe, hiki i ka GvHD ke hoʻoweliweli i ke ola i kekahi manawa. ʻO ka GvHD mau ke kumu nui o ka make ma waena o ka poʻe i loaʻa i kahi hoʻoili cell stem allogeneic, koe wale nō ko lākou maʻi mua.

No laila, ma mua o ka hana ʻana i kekahi lāʻau lapaʻau - ʻoiai he hoʻoili cell kumu - he mea nui loa ia e kūkākūkā i nā pilikia me kāu kauka. Hiki iā ia ke wehewehe i nā pilikia iā ʻoe a kōkua iā ʻoe e kaupaona i nā pono a me nā pōʻino o ka lāʻau lapaʻau.

Aia kekahi pono i kekahi manawa i ka `(GvHD)`?

Mai kahaha, ʻoiai hiki i ka GvHD ke loaʻa ka hopena maikaʻi ʻole i kou ʻano ola, loaʻa nō hoʻi kekahi mau pono. ʻO ka pane pale like e hoʻouka i kāu mau cell maʻamau e ʻimi pū a luku i nā cell kanesa i waiho ʻia i loko o kou kino. Ua kapa ʻia kēia ʻo ka hopena graft-versus-tumor. Ua ʻike ʻia ka poʻe i loaʻa iā GvHD he emi iki ka hiki ke hoʻi hou mai kā lākou maʻi mua (ʻoi aku ka maʻi kanesa).

Pehea wau e mālama ai iaʻu iho? E hahai i kēia mau ʻōlelo aʻoaʻo!

E wehewehe kāu kauka iā ʻoe pehea e mālama ai iā ʻoe iho ma hope o kāu hoʻoili ʻana i nā cell stem. Eia kekahi laʻana, he aha nā hōʻailona e makaʻala ai a he aha nā hōʻailona e kāhea koke aku ai i kāu hui lapaʻau inā loaʻa iā ʻoe. Inā pilikia ʻoe i ka loaʻa ʻana o GvHD, hiki iā lākou ke hāʻawi iā ʻoe i nā ʻōlelo aʻoaʻo mālama hou aʻe. ʻO kēia mau ʻōlelo aʻoaʻo:

• E pale i kou ʻili mai ka lā. E ʻaʻahu i nā pālule lima lōʻihi a me nā lole lōʻihi. E hoʻohana i kahi pale lā me ka liʻiliʻi o SPF 50. (Hiki i ka lā ke hoʻonui a hoʻoulu paha i ka GvHD.)
• E mālama i ke olakino waha maikaʻi. E hōʻemi kēia i ka pilikia o ka loaʻa ʻana o nā maʻi ʻāʻī.
• E pale i nā meaʻai ʻala e hiki ai ke hoʻonāukiuki i kou ʻōpū a hoʻoulu i nā ʻeha waha.
• E hana i nā hana e pale aku iā ʻoe iho mai nā germs. (E haʻi aku kāu kauka iā ʻoe i nā mea hou aʻe e pili ana i kēia.)

Āhea wau e ʻike ai i ke kauka?

He mea nui e hoʻomaopopo koke i kāu kauka inā loaʻa iā ʻoe kekahi mau loli kino, ʻoiai nā hōʻailona o ka maʻi a me ke kuni (100.4 Fahrenheit / 38 Celsius a ʻoi aku paha). Ke lawe ʻoe i nā immunosuppressants, aia ʻoe i ka nui o ka pilikia o ka loaʻa ʻana o nā maʻi e hiki ke hoʻoweliweli i ke ola.

Ma hope o kahi hoʻoili ʻana o nā cell stem allogeneic, e nānā pono kāu kauka iā ʻoe no nā pilikia e like me ka Graft vs. Host Disease (GvHD). Inā loaʻa iā ʻoe nā hōʻailona o ka GvHD acute a i ʻole ka maʻi mau, hiki i kāu kauka ke hoʻololi i kāu lāʻau lapaʻau a kuhikuhi paha i kahi lāʻau lapaʻau hou. E lawe i nā lāʻau lapaʻau āpau e like me ke kauoha. E hahai i nā ʻōlelo a kāu kauka e pili ana i ke ʻano o ka mālama ʻana iā ʻoe iho, ʻoiai e pili ana i ke ʻano o ka pale ʻana iā ʻoe iho mai nā maʻi.

ʻO nā mea nui loa e hoʻomanaʻo i ka pōkole!

ʻAe, no laila, ʻo ka Graft vs. Host Disease, a i ʻole GvHD, he pilikia ia e hiki ke kū ma hope o ka loaʻa ʻana o kahi hoʻoili cell stem mai kekahi kanaka ʻē aʻe. I ka ʻōlelo maʻalahi, ʻo ia ka wā e hoʻouka ai nā cell donor i kāu mau cell ponoʻī.

E hoʻomanaʻo, aia nā lāʻau lapaʻau no GvHD, a hiki ke mālama ʻia ke kūlana. ʻO ka mea nui loa, ʻo ia ke hahai pono i nā ʻōlelo a kāu hui lapaʻau a e hoʻomaopopo iā lākou e pili ana i nā hōʻailona hou i ka hikiwawe loa.

Inā he mau nīnau hou aku kāu e pili ana i kēia, mai makaʻu e nīnau i kāu kauka. ʻO lākou ka poʻe hiki ke kōkua maikaʻi loa iā ʻoe.

ʻO GvHD, hoʻoili pūnaewele kumu, hoʻoili allogeneic, ʻōnaehana pale, HLA, nā pūnaewele mea hāʻawi, nā hōʻailona